• John D Loeser and Jane C Ballantyne.
• Departments of Neurological Surgery and Anesthesiology and Pain Medicine.
• Clin J Pain. 2024 Aug 1; 40 (8): 459462459-462.

ObjectivesThe management of pain patients has not evolved as rapidly as envisioned when IASP was founded almost 50 years ago. We sought to identify factors that could contribute to this situation, with a focus on concepts of pain and the education of pain physicians.MethodsRelevant literature describing new strategies for diagnosing and managing patients with high-impact chronic pain was reviewed.ResultsIt appears that the acute-chronic dichotomy has outlived its usefulness and pains should be identified as of peripheral origin or due to central processing errors. Pains of peripheral origin and those of central processing errors require different diagnostic and therapeutic strategies.DiscussionPeripheral treatments and opioids are not effective for central pains. When the cause of the pain lies in the central nervous system, a more centrally focused approach is needed to minimize wasteful pursuit of peripheral causes. The education and training of pain physicians should reflect the skills needed to address these 2 very different clinical problems.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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