• Joseph Pergolizzi, Karsten Ahlbeck, Dominic Aldington, Eli Alon, Beverly Collett, Flaminia Coluzzi, Frank Huygen, Wolfgang Jaksch, Magdalena Kocot-Kępska, Ana Cristina Mangas, Cesar Margarit, Philippe Mavrocordatos, Bart Morlion, Gerhard Müller-Schwefe, Andrew Nicolaou, Concepción Pérez Hernández, Patrick Sichere, and Giustino Varrassi.
• Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. jpjmd@msn.com
• Curr Med Res Opin. 2012 Feb 1;28(2):249-56.

BackgroundDespite limited empirical support, chronic pain has traditionally been defined mainly on the basis of its duration, which takes no account of the causative mechanisms or its clinical significance.ScopeFor this commentary on current pain management practice, the CHANGE PAIN Advisory Board considered the evidence for adopting a prognostic definition of chronic pain. The rationale underlying this approach is to take psychological and behavioural factors into account, as well as the multidimensional nature of pain. Measures of pain intensity, interference with everyday activities, role disability, depression, duration and number of pain sites are used to calculate a risk score, which indicates the likelihood of a patient having pain in the future. The consistency of a prognostic definition with the concept of integrated patient care was also considered.FindingsWhen this method was compared with the number of pain days experienced over the previous 6 months--in patients with back pain, headache or orofacial pain--it was a better predictor of clinically significant pain 6 months later for all three pain conditions. Further evidence supporting this approach is that several factors other than the duration of pain have been shown to be important prognostic indicators, including unemployment, functional disability, anxiety and self-rated health. The use of a multifactorial risk score may also suggest specific measures to improve outcomes, such as addressing emotional distress. These measures should be undertaken as part of an integrated pain management strategy; chronic pain is a biopsychosocial phenomenon and all aspects of the patient's pain must be dealt with appropriately and simultaneously for treatment to be effective.ConclusionThe implementation of a prognostic definition and wider adoption of integrated care could bring significant advantages. However, these measures require improved training in pain management and structural revision of specialist facilities, for which political support is essential.

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