Pharmacoeconomics of chronic nonmalignant pain

Pain is one of the most common reasons for patients to seek medical care. In most settings, the model of acute pain treatment, with its emphasis on pharmacological therapy, is used for acute and chronic pain alike. Persistent chronic pain, however, often leads to complex social and psychological maladaptations, as well as substantial direct and indirect costs. Thus, the proper treatment of chronic pain usually involves pharmacological, behavioural and psychological interventions. Pain is a subjective sensation, but persistent chronic pain often results in long term neurophysiological and psychological changes that might be more appropriately considered disease manifestations. Unfortunately, the subjectivity of pain has meant that the assessment of the epidemiology, pharmacotherapy and economic costs of chronic pain has been difficult. As a result, many of the techniques for chronic pain management are unfamiliar to practising physicians. Even those healthcare professionals who are familiar with the special techniques for the management of chronic pain may be unable to identify the subpopulations for which they might be most effective. The clinician must evaluate patients for the appropriateness of a number of alternative drug delivery methods, novel analgesic agents, neuromodulatory techniques and multidisciplinary behavioural and psychological treatment programmes. The most effective treatment will often involve a combination of these techniques, as determined by the unique features of the patient's pain condition as well as individual patient characteristics. The costs and outcomes of various treatment strategies vary considerably and there is a need for comparative studies. Increasing emphasis on diagnosis and treatment in the primary care setting will place more importance on knowing the relative efficacies and appropriate use of a widening array of choices for chronic pain treatment. The management of chronic pain is remarkably complex and resource-intensive, and there is clearly a need for more intensive pharmacoeconomic studies, especially those comparing the many alternative strategies for management.