Background

Our understanding of pain is constantly evolving and we need to be open to changing our views on treating people with pain. Having both sensory and emotional components, persistent pain is a complex area. Persistent, or chronic, pain is defined as pain from non-malignant causes lasting for at least 3 months. It is not necessarily a sign of existing tissue damage but can be a problem with the central and peripheral nervous system when pain signaling mechanisms become self-perpetuating.

A comprehensive history of the pain should be taken. This may help clarify the likely origin of the pain which in turn can guide management. Neuropathic pain is often described as burning, sharp or shooting pain. Some people describe a feeling of pins and needles. The National Institute of Health and Care Excellence has recommended the use of amitriptyline, gabapentin, pregabalin or duloxetine for neuropathic pain and capsaicin cream for focal pain. Drug doses should be titrated according to individual response and if no improvement is seen, the medication should be discontinued. If the trigger for the neuropathic pain is uncertain, investigations such as full blood count, renal function, liver function test, thyroid function test, HbA1c, C-reactive protein, vitamin B12, folate as well as a urine sample should be undertaken. There is emerging evidence that low levels of vitamin d and/or iron can contribute to chronic pain. Consideration should be given to testing levels, particularly if there is “all over” pain.

A biopsychosocial model should be used in assessment and management of chronic pain. Biomedical factors do not always explain the severity of symptoms or disability and psychosocial factors have a major impact on disability and outcome. A multi-disciplinary team approach is often warranted to manage chronic pain and help cope with daily functioning.

Chronic pain

Epidemiology

It is estimated that 14 million people live with chronic pain in the United Kingdom and over 600,000 are affected within Wales1. Chronic pain can affect people physically, mentally and socially impacting their quality of life2. It is difficult to manage and if unalleviated, is a major socio-economic burden for the health service3.


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