Key Points
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Chronic pain usually involve with overprotective nervous system and is associated with significant emotional distress and functional disability.
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If the patient has not responded to conventional treatments within 6-8 weeks, a referral for comprehensive multidisciplinary pain assessment should be considered.
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Biopsychosocial model could be used to delineate the risk factors for persistent pain.
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Early intervention is the key to mitigate the risk of transition from acute to chronic pain.
Pain is an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage. Pain is a manifestation of our body’s protective systems to keep us safe, preventing from tissue damage. Chronic pain (defined as pain that lasts or recurs for longer than 3 months) will usually involve the pain system becoming overprotective, and is associated with significant emotional distress and/or significant functional disability.
When should I refer to Pain service?
Just like other chronic illness model of care, a coordinated and integrated health care services should encompass a multidisciplinary continuing care for people living with pain, through early identification and intervention to impede the progression of disease severity and chronicity. After ruling out the RED flags, if the patient has not responded to the conventional treatments within 6-8 weeks, a complex pain assessment should be considered.
Who is at risk?
WHO has adopted the new edition of International Classification of Diseases (ICD-11) in May 2019. Most chronic pain diagnoses share the similar biopsychosocial vulnerability, which is listed below.
Biology: genetic predisposition with/out personal or family history, severe pain more than a month, repetitive tissue trauma, prolonged high opioid use
Psychology: low self efficacy, catastrophising, mood disturbance, anxiety, stress, poor coping skills, perceived injustice, psychological vulnerability
Social: childhood maltreatment, third party compensation, history of physical, sexual and/or substance abuse, isolation, over-solicitous family
How do Pain Physicians help?
Early intervention is recommended for people at risk of developing persistent pain. A comprehensive biopsychosocial assessment will be conducted by the accredited Pain Physician to tailor a series of personalised multidisciplinary pain management. This might include optimisation of pharmacotherapy, integration of physical and psychological interventions, pain procedures to facilitate the rehabilitation and/or referral to other medical specialists if needs be.
Our Promise
As a pain physician, Dr Chow Chow will provide prompt response to all referral with affordable competitive consultation fees. Telehealth options are available for people unable to attend during office hours on request.
Reference
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Raja SN, Carr DB, Cohen M, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020;161(9):1976-1982.
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Nicholas M, Vlaeyen JWS, Rief W, et al. The IASP classification of chronic pain for ICD-11: chronic primary pain. Pain. 2019;160(1):28-37.
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Painaustralia (2011). National pain strategy: pain management for all Australians. Sydney: Painaustralia.
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Schug SA, Bruce J. Risk stratification for the development of chronic postsurgical pain. Pain Rep. 2017;2(6):e627. Published 2017 Oct 31.
Photo credited to diana.grytsku
