621
Views
17
CrossRef citations to date
0
Altmetric
Pain: Commentary

The chronic pain conundrum: should we CHANGE from relying on past history to assessing prognostic factors?

, , , , , , , , , , , , , , , , & show all
Pages 249-256 | Accepted 15 Dec 2011, Published online: 19 Jan 2012
 

Abstract

Background:

Despite limited empirical support, chronic pain has traditionally been defined mainly on the basis of its duration, which takes no account of the causative mechanisms or its clinical significance.

Scope:

For this commentary on current pain management practice, the CHANGE PAIN Advisory Board considered the evidence for adopting a prognostic definition of chronic pain. The rationale underlying this approach is to take psychological and behavioural factors into account, as well as the multidimensional nature of pain. Measures of pain intensity, interference with everyday activities, role disability, depression, duration and number of pain sites are used to calculate a risk score, which indicates the likelihood of a patient having pain in the future. The consistency of a prognostic definition with the concept of integrated patient care was also considered.

Findings:

When this method was compared with the number of pain days experienced over the previous 6 months – in patients with back pain, headache or orofacial pain – it was a better predictor of clinically significant pain 6 months later for all three pain conditions. Further evidence supporting this approach is that several factors other than the duration of pain have been shown to be important prognostic indicators, including unemployment, functional disability, anxiety and self-rated health. The use of a multifactorial risk score may also suggest specific measures to improve outcomes, such as addressing emotional distress. These measures should be undertaken as part of an integrated pain management strategy; chronic pain is a biopsychosocial phenomenon and all aspects of the patient’s pain must be dealt with appropriately and simultaneously for treatment to be effective.

Conclusion:

The implementation of a prognostic definition and wider adoption of integrated care could bring significant advantages. However, these measures require improved training in pain management and structural revision of specialist facilities, for which political support is essential.

Transparency

Declaration of funding

This article was based on a meeting held in Zurich, Switzerland, on the 31st October and 1st November 2010, which was supported by Grünenthal GmbH, Aachen, Germany, who also sponsored the preparation of this manuscript.

Declaration of other financial relationships

The following authors received honoraria to attend the meeting in Zurich: J.P., K.A., D.A., E.A., B.C., F.C., F.H., W.J., M. K-K., A.C.M., C.M., P.M., B.M., G.M-S., A.N., C.P.H., P.S., G.V.

G.V. and G.M-S. have been chairmen of Grünenthal’s international CHANGE PAIN Advisory Board since June 2009, and receive honoraria in this context.

Acknowledgements

The authors thank Derrick Garwood Ltd, Cambridge, UK, for editorial support, which was sponsored by Grünenthal GmbH, Aachen, Germany.

Reprints and Corporate Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

To request a reprint or corporate permissions for this article, please click on the relevant link below:

Academic Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

Obtain permissions instantly via Rightslink by clicking on the button below:

If you are unable to obtain permissions via Rightslink, please complete and submit this Permissions form. For more information, please visit our Permissions help page.