Page 26 - CASA Bulletin of Anesthiology 2021, Vol 8, No. 6 (1)

CASA Bulletin of Anesthesiology

C. Pain Management in Special Populations

Unique issues related to pediatric populations, adolescents, the patients with intellectual or
developmental disability, the elderly, and pregnant women must be understood and addressed.
These populations may have difficulty in communication about their pain which leads to
inaccurate pain assessment, increased vulnerability for chronic pain, decreased effectiveness and
increased risk of side effects from treatment, and decreased quality of life.
A proper guidance with evidence-based principles of managing these special patient
populations must be provided so that multiple modalities of treatment as described above could
be utilized to provide proper care for their chronic pain conditions.

D. Access to the Pain Specialty

Uneven access and quality of chronic pain management, including fragmented, inconsistent,
and incomplete care, exist in America. In addition, more pain specialists are needed in the
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field. According to the data from Association of American Medical Colleges on Physician
Specialty Data Report in 2020 that reports the number of people per active physician, there are
only 5,871 active pain physicians accounting for 56,453 people per active pain physician in
2019. It is necessary to train more pain physicians to provide proper care for the increased
chronic pain population.

Challenges in Translational Pain Research

The current gap between basic science research and the development of new analgesics
presents a serious challenge for the future of pain medicine. This is particularly difficult in the
search for better treatment for comorbid chronic pain conditions because (1) animal ‘pain’
models do not simulate multidimensional clinical pain conditions; (2) animal behavioral testing
does not assess subjective pain experience; (3) preclinical data provide little assurance regarding
the direction of new analgesic development; and (4) clinical trials routinely use over-sanitized
study populations and fail to capture the multidisciplinary consequences of comorbid chronic
pain. Therefore, a paradigm shift in translational pain research is necessary to transform the
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current focus on molecular switches of nociception to studying pain as a system-based integral
response that includes psychosocial comorbidities. Translational pain research needs to involve a
number of important areas including: 1) bridging the gap between pain research and clinical pain
management; 2) developing objective pain-assessment tools; 3) analyzing current theories of
pain mechanisms and their relevance to clinical pain; 4) exploring new tools for both preclinical
and clinical pain research; and 5) coordinating research efforts among basic scientists, clinical
investigators, and pain-medicine practitioners.
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In summary, chronic pain management is facing many challenges as discussed
above. Enhancing translational pain research may help bridge the gap between basic
science/clinical research and advancement of clinical treatment modalities to improve the
effectiveness of chronic pain management.

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