New concepts meeting the complexity of pain

Current treatment of chronic pain is largely based on the severity of pain – but does this still meet the increasing awareness that most chronic pain conditions are multifactorial in nature, e.g. nociceptive and neuropathic components present?

 

In order to allow a more targeted approach to the choice of pharmacological treatment, ideally, clinicians would identify the specific causal mechanisms underlying each patient's symptoms.

 

However, identifying these mechanisms in practice is difficult, as one mechanism can produce different symptoms and one symptom can be produced by different mechanisms¹.

 

Where the pathophysiology of a medical condition is multifactorial in nature, the optimal therapeutic strategy is to use drugs addressing different mechanisms. Since most commonly available analgesic drugs predominantly affect only a single pain modulation system (opiodergic / monoaminergic system), combination therapy is frequently required but often limited due to the increased risk of side effects².

 

In consequence, low patient compliance or even treatment discontinuations may occur (Vicious Circle) hampering the therapy success².

 

References
¹ Woolf JC, Mannion R. Neuropathic pain: aetiology, symptoms, mechanisms, and management. Lancet, 1999, 353:1959-1964.
² Varrassi et al. Pharmacological treatment of chronic pain – the need for CHANGE. Cur Med Res Opin. 2010, Vol 26(5): 1231-1245.