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Basic guide to chronic pain assessment: from neurophysiology to bedside.

Gabriele Finco1, Maurizio Evangelista2, Salvatore Sardo3

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Understanding chronic pain mechanisms like central sensitization and neuropathic features is key for effective treatment. Early detection and targeted therapies can prevent the worsening of refractory pain syndromes.

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Area of Science:

  • Pain Medicine
  • Neuroscience
  • Musculoskeletal Disorders

Background:

  • Chronic musculoskeletal pain is prevalent but challenging due to limited evidence-based guidance.
  • Current understanding often lacks a mechanism-oriented approach for diagnosis and management.
  • Refractory chronic pain poses a significant clinical challenge.

Purpose of the Study:

  • To review the pathophysiological mechanisms of chronic pain.
  • To provide a mechanism-oriented approach for diagnosis and management.
  • To empower clinicians with knowledge for better patient stratification and treatment selection.

Main Methods:

  • Literature review summarizing pathophysiological mechanisms of chronic pain.
  • Focus on central sensitization and neuropathic features.
  • Discussion of neurobiological underpinnings of refractory pain.

Main Results:

  • Central sensitization involves spinal cord remodeling, recruiting non-pain afferents into pain pathways.
  • Neuropathic features include sensory deficits (negative signs) and abnormal sensations like electric shock pain (positive symptoms).
  • These mechanisms contribute to the neurobiology of refractory chronic pain.

Conclusions:

  • A basic understanding of pain mechanisms can guide medication choice and identify high-risk patients.
  • Early detection and specific treatment of central sensitization and neuropathic features are crucial.
  • Intervention is needed to prevent the reinforcement of pronociceptive remodeling in the nervous system.