Improved chronic pain treatment should stem from improved pain assessment

To echo the voice of so many suffering with chronic pain, yes, “pain sucks!” If we do not work as researchers, clinicians, and policymakers to see chronic pain as more than a biological nociceptive experience, we will simply perpetuate where we are now: often strained clinical relationships and largely discouraging efficacy in treating chronic pain.

“Pain sucks!”

That is the answer I often get when asking patients to describe their experiences with chronic pain. And whether you are a healthcare provider or not, I am sure most of us have some connection or experience with pain. It is universal. It is human. But when pain persists and develops a chronic course, it can be crushing.

The devastating effects of chronic pain range from family stress and job loss, to staggering healthcare costs. The Institute of Medicine estimates chronic pain costs the nation $635 billion annually. I was shocked when I first saw that number. I knew the effects of chronic pain were pervasive and disabling, but didn’t realize they were that bad.

With that in mind, I have struggled with how we as individuals and healthcare providers can reverse this trend and provide better care to those suffering with chronic pain. Despite the amazing research and resources dedicated to this dilemma over decades, treatments still lack the efficacy we hope for.

These realities led me to question how we fundamentally assess chronic pain. This was the thinking behind the review article I published in Translational Behavioral Medicine’s December issue (Chronic pain assessment from bench to bedside: lessons along the translation continuum).

Pain isn’t simply nociceptive communication in your nervous system. Pain, particularly chronic pain, is a complex biopsychosocial mixture of nociception, behavior, learning, emotions, and social interaction. If this is the case, why do we typically assess only nociception in an effort to understand a patient’s experience?

More than 40 years ago, Melzack and Torgerson, founders in the field, summed it up well, suggesting: “To describe pain solely in terms of intensity…is like specifying the visual world in terms of light flux only, without regard to pattern, color, texture, and the many other dimensions of the visual experience.”

So, if we want to change how we treat chronic pain, let’s assess the full dimension of its experience.

To do this, one must start at the foundations of our basic science regarding chronic pain. Researchers utilize models that employ the observation of animals in response to a stimulus as their main assessment measure. In clinical practice, however, chronic pain assessment involves obtaining a zero to 10 pain rating scale and, if you are lucky, some indication of functional limitations.

To me, this points to a disconnect between how researchers and clinicians measure the chronic pain experience. There are also gaps in measurement definitions, assessment strategies, and implementation of appropriate protocols. If we want to improve treatment, let’s use research models that more closely approximate how we can assess the human pain experience in real clinical practice.

What is the solution? Fortunately, the literature suggests an answer!

In my review, I explore research pointing to the usefulness of observational techniques, practical measurement tools, technology assisted measures, and promising biomarker sampling as a means to bridge some of our current disconnects.

I do not suggest that these methods or changes will be the sole solution or that all these methods are even currently viable for all healthcare settings. What I hope to do is raise awareness of the need to change our assessment practices all along the continuum in evidence-based ways to improve chronic pain care.

To echo the voice of so many suffering with chronic pain, yes, “pain sucks!” If we do not work as researchers, clinicians, and policymakers to see chronic pain as more than a biological nociceptive experience, we will simply perpetuate where we are now: often strained clinical relationships and largely discouraging efficacy in treating chronic pain.

I am not the first to suggest it, but wouldn’t it be nice if I was the last? Now is the time to move more broadly—across the whole translational continuum, from bench to bedside—to view the assessment of chronic pain as a biopsychosocial phenomenon. This shift has the ability to impact our basic science, our clinical practice, and policy initiatives to help our patients have more functional and fulfilling lives.

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