[Clinical approach in patients with chronic pain]

In the case of a patient having persistent pain for 3 to 6 months, the physician needs to structure the various data obtained over that time. We propose an approach which analyzes pain according to various independent axes, in particular somatic and psychosocial. Correct diagnosis of the pathophysiological mechanism of pain (excess nociception, neurogenous, maintenance by the sympathetic nervous system, or muscular) is required in order to direct appropriate symptomatic treatment. In parallel with this somatic approach to the aetiology of chronic pain, certain individual variables must be taken into account such as anxiety level, depression, personality, and reinforcement factors (secondary benefits) that can amplify pain or maintain the chronicity of pain in such patients.