Chronic pain affects hundreds of millions of people worldwide and alters their physical and emotional functioning, decreases their quality of life, and impairs their ability to work.
According to a 1998 WHO survey of nearly 26 000 primary-care patients in five continents, 22% of those surveyed reported that sometime over the past year they had suffered persistent pain. Indeed, patients with chronic pain can become so desperate for relief that they go from doctor to doctor seeking help.
In fact, the rise in the use of non-traditional health-care providers partly reflects the large number of patients with chronic pain, especially from headache, neck and back disorders, and arthritis, who feel they must go outside of mainstream medicine to find help, despite the fact that there is little evidence that such interventions are effective.
In general, pain falls into three main categories: acute, chronic, and cancer-related pain . Acute pain, such as that experienced after trauma or surgery, is a normal response to tissue damage and typically resolves as the injured tissue heals or soon after.
Chronic pain syndromes are frequently due to changes in the peripheral or central nervous system, in response to tissue injury . Several changes in the peripheral nervous system occur that persist even after healing has occurred. Similarly, changes in nociceptive processing within the central nervous system can lead to persistent pain. If these changes are the source of persistent pain, surgical intervention at the site of original tissue injury is unlikely to provide relief.
Whatever the cause, the effect of chronic pain on the patient tends to be more pervasive than that of acute pain: it often profoundly affects the patient's mood, personality, and social relationships. People with chronic pain typically experience concomitant depression, sleep disturbance, fatigue, and decreased overall physical and mental functioning. As a result, pain is only one of many issues that must be addressed in the management of patients with chronic pain.
Single modalities of treatment are rarely sufficient to treat chronic pain. Indeed, pain therapy that addresses only one component of the pain experience is destined to fail. Interventions that, for example, only target nociception, with nerve blocks or implantable devices, without addressing the patient's depression and social stresses are unlikely to lead to long-term benefit.
In most patients, chronic pain cannot be eradicated or cured. Thus, the goal of therapy is to control pain ( disease control -in the case of RA- #1 ) and to rehabilitate the patient so that they can function as well as possible.
Evidence increasingly lends support to the use of an interdisciplinary approach to patients with chronic pain. The patient receives comprehensive rehabilitation that includes multiple therapies provided in a coordinated manner. Care must be designed so that all the dimensions of the patient's condition are treated. Indeed, because of the plastic nature of the nervous system, it is frequently necessary to both rehabilitate the patient with chronic pain and remove the cause of pain,( control the disease in RA ) if one exists.
Multidisciplinary pain management involves health-care providers from several disciplines, each of whom specialises in different features of the pain experience. The shortcoming of this approach is that access to such a range of health-care providers is usually limited and the patient's care is rarely coordinated.