Intensity of chronic pain - The wrong metric?

Ballantyne JC et al : Intensity of chronic pain - The wrong metric? N Engl J Med 2015;373:2098-2099

  • Achieving a balance between the benefits and potential harms of opioids has become a matter of national importance.
  • it produced what has been termed an epidemic of prescription-opioid abuse, overdoses, and deaths — and no demonstrable reduction in the burden of chronic pain.
  • The National Pain Strategy emphasizes the importance of self-management and interdisciplinary treatments and recognizes that drug treatment alone has limited utility when it comes to managing chronic pain.
  • But is a reduction in pain intensity the right goal for the treatment of chronic pain?
  • Pain-intensity ratings aren't necessarily a reflection of tissue damage or sensation intensity in patients with chronic pain.
  • Thus, over time, pain intensity becomes linked less with nociception and more with emotional and psychosocial factors.
  • Many of the interdisciplinary and multimodal treatments recommended in the National Pain Strategy use coping and acceptance strategies that primarily reduce the suffering associated with pain and only secondarily reduce pain intensity.
  • Many of these initiatives recognize that chronic pain differs from short-lived pain in its causes, psychopathology, and social meaning. -Borrowing treatment principles from acute and end-of-life pain care, particularly a focus on pain-intensity scores, has had unfortunate and harmful consequences.
  • We propose that pain is not the best measure of the success of chronic-pain treatment
  • For this purpose, nothing is more revealing or therapeutic than a conversation between a patient and a clinician, which allows the patient to be heard and the clinician to appreciate the patient's experiences and offer empathy, encouragement, mentorship, and hope.