Intended for healthcare professionals

Clinical Review Recent developments

Management of pain

BMJ 2003; 326 doi: (Published 22 March 2003) Cite this as: BMJ 2003;326:635
  1. Anita Holdcroft, reader (,
  2. Ian Power, professorb
  1. a Magill Department of Anaesthesia, Imperial College London, Chelsea and Westminster Hospital, London SW10 9JP
  2. b Anaesthesia, Critical Care, and Pain Medicine, University of Edinburgh, Royal Infirmary, Edinburgh EH16 4SA
  1. Correspondence to: A Holdcroft
  • Accepted 26 February 2003

The management of pain differs if pain is self limiting or persistent; for example, if pain is prolonged then treatment will be managed by a multidisciplinary team in a pain clinic. Pain is not just from physical disorders but also from combinations of physiological, pathological, emotional, psychological, cognitive, environmental, and social factors (fig 1). The keys to successful pain control are the mechanisms that initiate and maintain pain. Major advances in neurobiology, from molecular studies to imaging the cortex of the brain, show the complex integration of nerve cell activity and have generated a fundamental change in attitude and expectation about the control of pain.1 Now, the public and health professionals expect to control pain by using preventive and active strategies, including drugs and physical and psychosocial interventions.

Fig 1

Biopsychosocial factors that interact and modulate the experience of pain


The topics we have chosen result from discussions with all grades of staff involved in the management of acute and chronic pain and range from new drug development based on scientific evidence that may impact on future pain management to a holistic approach to patient care. Our searches focused on the key words “pain,” “systematic review,” “management,” and “neuropathic.” We searched Medline, the Cochrane Library, and Health Technology Assessments, and we scrutinised the BMJ and the National Institutes of Health websites as well as professionally based websites for pain, such as that of the International Association for the Study of Pain and scientific websites such as that of the National Academy of Sciences. We identified systematic reviews from the past three years from these sources and leading scientific papers.

Recent developments

A major change in pain management is a move from empirical therapies to a mechanism based approach

New drug developments are targeting specific receptor subtypes

Pain assessment includes qualitative sensory affective and …

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