Page 24 - CASA Bulletin of Anesthiology 2021, Vol 8, No. 6 (1)

CASA Bulletin of Anesthesiology

Challenges in Current Chronic Pain Management

Lucy Chen, M.D.

Department of Anesthesia, Critical Care and Pain Medicine
Massachusetts General Hospital
Associate Professor
Harvard Medical School

On July 16, 2020 the International Association for the Study of
Pain (IASP) published a revised definition of pain: Pain is an
unpleasant sensory and emotional experience associated with, or
resembling that associated with, actual or potential tissue damage.
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Chronic pain, a term that often refers to pain conditions that last
more than three months, is one of the most common reasons for
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patients to seek medical treatment.

Incidence and Prevalence

In the US, pain affects 100 million Americans. About 25.3
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million adults have daily chronic pain and 23.4 million adults
experience a substantial level of pain. The economic cost due to pain has been estimated at
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about $560–635 billion/year. The incidence of chronic low back pain, neck pain, and arthritic
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pain may be as high as 29%, 15.7%, and 28%, respectively, in American adult populations. The
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World Health Organization’s 2010 Global Burden of Disease Study estimation indicates that low
back pain is among the top ten clinical conditions affecting all age groups, particular in
populations of 35 to 55 years old. The lifetime prevalence of low back pain is estimated at 60-
70% in several countries.
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Clinical Challenges

Although advances have been made in pharmacological and interventional (e.g., nerve block)
treatments for chronic pain, chronic pain remains inadequately controlled for many people.
Moreover, side effects and complications of chronic pain treatments, such as addiction to opioid
analgesics, kidney failure, or gastrointestinal bleeding due to long term use of NSAIDs, make it
difficult to manage chronic pain conditions.

A. Medical Management and Opioid Crisis

Opioid therapy plays a significant role in current pain management. Opioid medications
provide adequate pain control in most acute and some chronic pain conditions. However, a short
or long-term opioid exposure could potentially lead to opioid addiction, misuse and abuse, or
opioid diversion.
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