![]() ![]() Comprehensive instruments are needed to accomplish this. ![]() Rational choice of therapy is greatly facilitated by the correct diagnosis of the type and mechanism of pain, and identification of the points where painful impulses are generated or modified, the so-called “pain generators”. Ĭhronic pain can have a variety of mechanisms, and can include nociceptive, neuropathic, and or nociplastic (primary) pain. Most patients with chronic pain are managed in general practice. Moderate-to-severe acute pain is a risk factor for developing chronic pain. This classification distinguishes between chronic primary pain and six chronic secondary pain conditions (Box 1). In the 11th revision of the ICD, a task force of the IASP has established a new classification of chronic pain that is applicable in in primary care and specialized settings. Until recently, chronic pain conditions were not represented systematically in the International Classification of Diseases (ICD) maintained by the WHO. Note that this inclusive definition establishes a pain duration but does not indicate a cause, thereby covering pain of uncertain origin. The IASP defines chronic pain as “pain that lasts or recurs for longer than 3 months. Acute pain has a sudden onset, short duration, and is clearly associated with a cause. Recently, the International Association for the Study of Pain (IASP) has updated its definition of pain as “ An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”. Pain education can improve the confidence and knowledge of GPs and outcomes for their patients with chronic pain. In a survey of prescribing practices and training needs for pain management among 636 Canadian GPs, development of skills for patient evaluation and differential diagnoses of chronic pain received the highest priority. This public health problem is considered a priority by the World Health Organization (WHO), European health institutions, and the Italian Ministry of Health. The clinical problem of "chronic pain" has reached alarming proportions in terms of disability, consumption of health and social resources, and impact on primary and specialist care services. Once the site of origin of the pain (the “pain generator”) is identified, or a primary pain syndrome is suspected, the accompanying article provides information and rationale to support treatment decisions based on patient characteristics. The algorithm identifies cases that may require referral to a pain specialist. A set of diagnostic tools and a pain algorithm are presented to guide the clinician toward the correct diagnosis. ![]() Successful pain management is facilitated by identification of the pain type. This document provides an overview of pain types and their underlying mechanisms. More recently, a third descriptor, nociplastic (primary) pain, was added to classify patients with chronic pain conditions such as fibromyalgia, nonspecific back pain, or mixed pain that persists or other conditions in which altered central pain modulation results in central sensitization and chronic pain in the absence of actual or threatened damage to tissues, including in the somatosensory nervous system. It has traditionally been considered to include nociceptive pain that that persists longer than the normal healing time, neuropathic pain lasting more than 3 months, or a combination of these. Chronic pain management can be challenging due to its complexity. Primary care physicians are often called on to manage this condition. It has reached alarming proportions in terms of disability, consumption of health and social resources, and impact on primary and specialist care services. Chronic pain is considered a public health priority by the World Health Organization and European health institutions.
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