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

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