How to investigate: Chronic pain

Area of Science:

• Pain Medicine
• Rheumatology
• General Practice

Background:

• Chronic pain, defined as pain lasting over 3 months, affects approximately 20% of the global population.
• It incurs significant economic costs, with Europe losing nearly 500 million working days annually.
• Accurate diagnosis is a major hurdle in managing chronic pain patients.

Purpose of the Study:

• To highlight key diagnostic challenges in chronic pain.
• To outline essential diagnoses to consider and rule out.
• To emphasize the role of history-taking and the biopsychosocial model in treatment planning.

Main Methods:

• Review of common chronic pain diagnostic challenges.
• Identification of critical differential diagnoses, including seronegative spondyloarthritides, endocrine abnormalities (e.g., vitamin D deficiency), and polymyalgia rheumatica.
• Application of the biopsychosocial model for therapeutic planning and shared decision-making.

Main Results:

• Diagnostic difficulties are prevalent in chronic pain assessment.
• Seronegative spondyloarthritides, severe vitamin D deficiency, and polymyalgia rheumatica are crucial diagnoses to exclude.
• Patient history is a vital tool for developing treatment plans within a biopsychosocial framework.

Conclusions:

• Reliable diagnosis is paramount for effective chronic pain management.
• Excluding specific treatable conditions is a key initial step.
• Primary care, supported by pain clinics when necessary, can achieve good outcomes using a biopsychosocial approach.