Chronic pain

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By K K Jain MD

Neurologic pain management is now recognized as a subspecialty of neurology. In this clinical article, Dr. K K Jain, a neurology consultant in Basel, Switzerland, focuses on the evaluation of chronic pain as a symptom, including discussion of mechanism, differential diagnosis, diagnostic workup, and general management. Studies on molecular basis of pain have provided receptors as targets for analgesic drugs. The ideal management of a chronic pain patient is by a multidisciplinary approach, including disciplines such as internal medicine, neurology, anesthesia, nursing, psychology, pharmacy, rehabilitation medicine, physical therapy, etc. Gene therapy may be used in the near future as a method of delivery of therapeutic proteins with analgesic effect to the site of action and, thus, avoiding some of the undesirable effects of drugs. Viral vectors, expressing proenkephalin can transduce neurons of the dorsal root ganglion, leading to release of enkephalin from nerve terminals in dorsal horn and produce analgesic effect.

Key points

  • An understanding of basic mechanisms of pain is essential for developing management strategies.
  • Acute pain can rapidly evolve into chronic pain.
  • A large number of pharmacological as well as nonpharmacological approaches have been used for the management of chronic noncancer pain.