Introduction: What is Pain?

All patients with persistent pain should undergo an assessment designed to clarify 1) pain characteristics and its history; 2) the prior evaluation performed to understand the nature of the pain and its results; 3) prior pain therapies and their outcomes; 4) impact of the pain on multiple functional domains; and 5) relevant comorbidities. Combined with information from the assessment and existing laboratory and radiographic data, this assessment should clarify an understanding of the pain in terms of etiology (e.g., structural disease in the body, such as arthropathy, or disease process, such as diabetes), pathophysiology (e.g., somatic nocicieptive, visceral nociceptive, neuropathic), and syndrome (e.g., pain due to osteoarthritis, pain due to degenerative spine disease, painful diabetic polyneuropathy). This initial evaluation also should allow the clinician to clarify whether further evaluation is needed to assess the etiology of the pain or a relevant comorbidity.

This analysis provides the foundation for an individualized therapeutic strategy for patients with persistent pain. This strategy may include primary therapy for the etiology, if possible and appropriate. It often incorporates a multimodality approach to the pain and its consequences, and it may include specific treatments for relevant comorbidities. Specialist referral for additional evaluation and treatment may be necessary to achieve treatment objectives. Consultation/referral may also be required in the management of persistent pain in patients with a history of substance abuse or with a comorbid psychiatric disorder (see Module 4: Assessing and Treating Pain in Patients with a Substance Abuse History).

This CME program discusses persistent pain conditions likely to be encountered in primary care.