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3. Cohen et al. 2021

Introduction

  • 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

Chronic pain as a disease model

  • 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 and consequences of chronic pain

  • 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

Classification of pain and its importance

  • 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

Mixed pain and pain classification as a continuum

  • 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

Pain management

Best practices

  • 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

Exercise and psychotherapy

  • Exercise: excellent self-management strategy

  • CBT

3. Cohen et al. 2021

Introduction

  • 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

Chronic pain as a disease model

  • 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 and consequences of chronic pain

  • 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

Classification of pain and its importance

  • 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

Mixed pain and pain classification as a continuum

  • 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

Pain management

Best practices

  • 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

Exercise and psychotherapy

  • Exercise: excellent self-management strategy

  • CBT