title: The development of chronic pain: physiological CHANGE necessitates a multidisciplinary approach to treatment.
abstract: Chronic pain is currently under-diagnosed and under-treated, partly because doctors' training in pain management is often inadequate. This situation looks certain to become worse with the rapidly increasing elderly population unless there is a wider adoption of best pain management practice. This paper reviews current knowledge of the development of chronic pain and the multidisciplinary team approach to pain therapy. The individual topics covered include nociceptive and neuropathic pain, peripheral sensitization, central sensitization, the definition and diagnosis of chronic pain, the biopsychosocial model of pain and the multidisciplinary approach to pain management. This last section includes an example of the implementation of a multidisciplinary approach in Belgium and describes the various benefits it offers; for example, the early multidimensional diagnosis of chronic pain and rapid initiation of evidence-based therapy based on an individual treatment plan. The patient also receives continuity of care, while pain relief is accompanied by improvements in physical functioning, quality of life and emotional stress. Other benefits include decreases in catastrophizing, self-reported patient disability, and depression. Improved training in pain management is clearly needed, starting with the undergraduate medical curriculum, and this review is intended to encourage further study by those who manage patients with chronic pain.
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. jpjmd@msn.com
authors.forename: Joseph
authors.initials: J
authors.lastname: Pergolizzi
authors.forename: Karsten
authors.initials: K
authors.lastname: Ahlbeck
authors.forename: Dominic
authors.initials: D
authors.lastname: Aldington
authors.forename: Eli
authors.initials: E
authors.lastname: Alon
authors.forename: Flaminia
authors.initials: F
authors.lastname: Coluzzi
authors.forename: Albert
authors.initials: A
authors.lastname: Dahan
authors.forename: Frank
authors.initials: F
authors.lastname: Huygen
authors.forename: Magdalena
authors.initials: M
authors.lastname: Kocot-Kępska
authors.forename: Ana Cristina
authors.initials: AC
authors.lastname: Mangas
authors.forename: Philippe
authors.initials: P
authors.lastname: Mavrocordatos
authors.forename: Bart
authors.initials: B
authors.lastname: Morlion
authors.forename: Gerhard
authors.initials: G
authors.lastname: Müller-Schwefe
authors.forename: Andrew
authors.initials: A
authors.lastname: Nicolaou
authors.forename: Concepción
authors.initials: C
authors.lastname: Pérez Hernández
authors.forename: Patrick
authors.initials: P
authors.lastname: Sichère
authors.forename: Michael
authors.initials: M
authors.lastname: Schäfer
authors.forename: Giustino
authors.initials: G
authors.lastname: Varrassi
mesh_terms: D001530:Belgium; D059350:Chronic Pain / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D059408:Pain Management / Q000379:methods*; D010353:Patient Education as Topic / Q000379:methods