3. Cohen et al. 2021

Chronic pain: unpleasant sensory and emotional experience associated with actual or potential tissue damage * It is the main reason why people seek medical care * Higher prevalence rates for women, people from low socioeconomic background, military veterans, and people residing in rural areas * Racial + ethnic minorities: due to enhanced physiological pain sensitivity, cultural differences, and reduced access to care
The economic costs of chronic pain are substantial

Acute pain: in response to tissue trauma, has a survival value and plays a role in healing
Pain becomes pathological when it persists beyond the expected healing period (3 months)
Chronic pain = disease * Alterations in the PNS and CNS + quality of life decrements
Factors promoting resiliency can promote healing and reduce pain chronification

Biopsychosocial model: pain and disability are multi-dimensional. They are dynamic interactions among biological, psychological, and social factors that reciprocally influence each other
Chronic pain effects * Interferes with someone’s ability to work and can lead to financial ramifications, including homelessness * Affects relationships and self-esteem * Reduces life expectancy * Deleterious pathophysiological and anatomical changes * Suppression of cell-mediated immunity and humoral immunity * Alterations in gene expression * Decreases in grey brain matter
Pain might affect the survival rate of patients with cancer

Pain is always subjective * A patient’s report of pain should be accepted at face value in absence of evidence to the contrary
3 main categories of chronic pain: * Nociceptive * Results from activity in neural pathways * Most common * Neuropathic * Caused by damage or disease affecting the somatosensory nervous system * It is maladaptive * Associated with greater decrements in quality of life * Nociplastic * Arises from the abnormal processing of pain signals without any clear evidence of tissue damage of discrete pathology involving the somatosensory system * Augmented sensory processing + diminished inhibitory pathways

Many pain conditions have a mixed pain phenotype
Types of pain occupy different points on a continuum
There is no reason cancer and non-cancer patients should be treated differently * In patients who have recovered from cancer and have chronic pain, treatments should be similar to other patients, tailored to unique consideration

Mechanism-based pain treatment = optimal but difficult
Treatment is typically symptom-based or disease-based
Goals of therapy: tailored towards an improved quality of life
Interdisciplinary treatment: uses a personalized approach and a shared-decision model
Multimodal approach: includes self-care, a healthy lifestyle, and ergonomic modifications

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