Intended for healthcare professionals


Challenges of managing chronic pain

BMJ 2017; 356 doi: (Published 17 February 2017) Cite this as: BMJ 2017;356:j741
  1. Jianren Mao, Richard J Kitz professor of anesthaesia research
  1. Division of Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
  1. jmao{at}

Start by ensuring realistic expectations

Chronic pain is an individualised experience with multifactorial aetiology.1 It can cause unexpectedly prolonged suffering when, for example, an initial injury evolves into a complex disease state. A transient ankle sprain may turn into a complex regional pain syndrome lasting for months to years; or a week long episode of shingles may cause post-herpetic neuralgia with disabling pain for months or years. Moreover, chronic pain can be an accompanying symptom of largely irreversible underlying disease, such as degenerative arthritis (osteoarthritis), spinal stenosis, or compression fracture resulting from osteoporosis in older people. Chronic pain can also be a primary complaint of clinical conditions such as fibromyalgia and trigeminal neuralgia, for which neither the aetiology nor mechanism is currently well understood.

Chronic pain is therefore not simply a chronological extension of acute pain and requires different diagnostic approaches and management strategies. For example, …

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