Chronic pain: an update on burden, best practices, and new advances
This paper is the first in a Series of three papers and covers chronic pain as a disease and biopsychosocial model and discusses consequences of chronic pain, classification of pain and its importance, pain management, and future avenues for research.
Source:
The Lancet
SPS commentary:
The other articles focus on nociplastic pain and neuromodulation, two areas that have witnessed substantial advances in the past several years but have not been adequately addressed in the general medicine literature.
According to an editorial, this Lancet Series debunks a common misconception of chronic pain as an indicator of ongoing injury, requiring suspension of activity. Instead, chronic pain is often a product of abnormal neural signalling, with biopsychosocial dimensions requiring a multimodal treatment approach. It highlights that chronic pain is complex and treatment can be fraught, as concerns about UK guidelines show, with many clinicians and patients lacking an understanding of treatment options; they might rely on medication alone, and use of costly neuromodulation techniques is also rising, despite a limited evidence base. It notes that over-reliance on drugs or devices may be spurred on by aggressive industry marketing, lack of access to multidisciplinary services, such as physiotherapy or psychology, and perverse financial incentives for shorter consultations, drug prescribing, and invasive interventions. It adds that the opioid crisis has prompted clinical and regulatory attempts to curb all opioid prescribing, leaving patients feeling angry, abandoned, and further stigmatised. It suggests that the right balance needs to be struck; for some people (cancer pain), opioids might be essential; for others, opioid deprescribing might be appropriate, but either path should be embedded in a multimodal treatment plan, with appropriate safeguards and support, and treatment for dependence if needed.