Chronic Non-Cancer Pain: New Definitions, New Paradigms and Old Myths

Chronic pain is a highly prevalent phenomenon that involves biological, psychological, and social aspects with negative effects on function, mood, and quality of life. The International Association for the Study of Pain (IASP) advocates updating the current definition of chronic pain to better recognize the diversity and complexity that is difficult to capture in a brief definition. Treatment of chronic pain is still a challenge, indeed two-thirds of patients report an unsatisfactory level of pain control with currents approaches. This article discusses the features characterizing chronic pain towards new definitions and treatment paradigms while challenging existing myths and considers the obstacles to achieving a satisfactory level of pain control. It highlights the literature’s criticisms of a unimodal approach to chronic pain and supports a multimodal (pharmacological and non-pharmacological) and holistic strategy that comprises the intensity of pain, but also its pathophysiology, comorbidities, such as anxiety and depression, social context, and psychological aspects. Finally, concerns relating to the management of chronic non-cancer pain and the use of opioids are addressed. The good and the bad of opioids are discussed for a more responsible opioid-prescribing strategy in chronic pain based upon a strong clinical and educational component and continuous monitoring of these patients both in primary care as well as in specialized settings. Translating from a multidisciplinary approach to an interdisciplinary team approach will lead to an improved response to the needs of patients, providing a holistic strategy that accounts for the different pathogenese of pain syndromes, their phenotypes, the nervous system involvement, and remodeling, and the biopsychosocial components of chronic pain.