Management of chronic pain

Pain is an unpleasant, subjective experience which escapes objective measurements. It is the normal response to the disruption of healthy tissues, but its persistence beyond the period of healing should alert the practitioner to other unrecognized causes. On the other hand, learned pain is a condition resulting mainly from socio-emotional factors in the absence of progressive, invasive and, most of the time, demonstrable pathology. The key to success in the management of a painful condition is an accurate diagnosis followed by appropriate intervention and treatment. A complete history and a detailed physical examination, complemented by ancillary laboratory tests and consultations, when necessary, offer the best approach to initial management. This article discusses the pathophysiology of pain, the diagnostic approach and therapeutic interventions for evaluation and management of pain patients. The role of multiple factors as reinforcers of pain behavior deserves careful attention, and a comprehensive, multi-disciplinary approach may be indicated in selected cases.