Treatment of intractable pain

The mechanism of acute pain is believed to be mainly a neurophysiological event involving the transmission along A delta and fibers to the neuraxis and then via discrete paths to higher cortical levels. This incoming signal can undergo modification at a levels, either by other incoming signals, or by descending inhibition. In its refractory form chronic pain probably represents a complex balance of a nociceptive stimulus and its interaction with the co-existing psychological state, and behavioral factors. To successfully treat chronic pain it is necessary to direct therapy at the tissue damage (if any), the psychological state of the patient, and the environment in which the pain complaint is made, This often needs a multidisciplinary therapeutic environment to effect change.