Updates & Features

Reframing chronic pain as a disease, not a symptom: rationale and implications for plan management

Clauw DJ, et al. Postgrad Med. 2019;131(3):185–198

The widespread prevalence of chronic pain in different forms, together with mounting evidence, has led to researchers classing chronic pain as a separate disease area. Clauw et al. eludes to three chronic pain categories identified: neuropathic, centralised/sensitisation and nociceptive, with some degree of overlap. These in turn are affected by a number of interacting psychosocial factors, grouped into positive resilience/protective (e.g. active coping) and negative/risk vulnerability (e.g. mood or sleep disturbances) types, to produce each patients’ distinctive pain experience

In this clinical review, Clauw et al. suggests that the focus should be on the patient as a whole and not just the pain. This means considering things such as other illnesses, social environment, quality of life, behaviour and emotions. The authors believe that this will enable a more beneficial treatment plan, specific for each individual patient that prescription medicines alone cannot provide. This means including self-management techniques, such as exercise, behaviour therapy and education. Encouragingly, these have been shown to be effective both alone and in combination with prescription medicines.