title: How to investigate: Chronic pain.
abstract: Chronic pain is defined as an unpleasant sensory and emotional experience persisting longer than the normal process of healing, usually longer than 3 months. About a fifth of the world's population is believed to suffer from chronic pain. In Europe, chronic pain accounts for nearly 500 m lost working days, and it costs the European economy >€34 billion (£28 billion) every year. Establishing a reliable diagnosis is the primary challenge in evaluating a patient with chronic pain. Common diagnoses not to miss include seronegative spondyloarthritides, endocrine abnormalities including severe vitamin D deficiency and polymyalgia rheumatica. Once important or treatable diagnoses have been ruled out, the history can be used as a tool to establish a therapeutic plan for shared decision-making using the biopsychosocial model. Onward referral to pain clinics can be helpful for more involved patient management, but often good outcomes are achieved with the support of primary care.
authors.affiliation: University of Cambridge Clinical School, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK. Electronic address: mh623@cam.ac.uk.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hague
authors.affiliation: Box 204, Rheumatology Research Unit, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK. Electronic address: Nicholas.shenker@addenbrookes.nhs.uk.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Shenker
mesh_terms: D059350:Chronic Pain / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D005060:Europe / Q000453:epidemiology; D006801:Humans; D011111:Polymyalgia Rheumatica / Q000175:diagnosis; D011320:Primary Health Care / Q000379:methods*
keywords: Back pain; Chronic pain; Diagnosis; Fibromyalgia; Investigations