Effective Pain Assessments Achieved by Targeting Multiple Pain Mechanisms

Newswise — ANAHEIM, March 6, 2018 – Greater understanding of complex, underlying pain mechanisms, which are different in most pain patients, holds promise to improve the quality and precision of clinical pain assessments and help foster successful treatment outcomes.

Roger B. Fillingim, Ph.D. professor at the University of Florida College of Dentistry, today addressed a plenary session at the American Pain Society Scientific Summit, www.americanpainsociety.org, focused on pain mechanisms, which he defined as processes or events that causally contribute to the pain experience.

“Unfortunately, pain management today still relies mainly on trial and error.  We know when treatments fail but often don’t understand why because multiple pain mechanisms are involved and typically require multiple treatments,” said Fillingim.  “Existing treatments for chronic pain, therefore, produce meaningful benefits for only a minority of patients, and we have limited ability to predict which patients will benefit from specific treatments.”

Fillingim explained that mechanism-based approaches to pain assessment offer excellent potential to enhance treatment outcomes by better matching patients to appropriate treatments.  He emphasized the importance applying the biopsychosocial model for identifying the mechanisms that lead to individual differences in pain.

“The biopsychosocial model provides an ideal framework for conceptualizing person variations  in the pain experience,” Fillingim said.  “It posits that pain is influenced by complex and dynamic interactions among multiple biological, psychological and social factors, which vary considerably from patient to patient.  Thus, pain is sculpted by a mosaic of factors that are unique to each individual at a given point in time, and this entire mosaic must be considered if we are to provide optimal pain treatment.”

Fillingim further explained that although these distinct factors can independently influence pain, the more important and complex influences emerge from the interactions among factors, which shape the individual differences contributing to pain in each person. The influence of psychological stress, for example, could be mediated through specific biological processes, such as heightened sympathetic nervous system outflow or increased inflammation. 

“The complexity of the biopsychosocial mosaic that influences pain demands an equally sophisticated approach to pain assessment and treatment,” Fillingim stressed.  “So pain treatment should target the multiple biopsychosocial drivers of a patient’s pain, and the goal is to deploy personalized pain management comprised of multiple treatment modalities designed for each patient.”

For example, pain research has determined that brain imaging identifies structural and functional abnormalities in several pain conditions.  Although the mechanisms driving these pain related changes in brain structure and function remain largely unknown, this evidence suggests that brain imaging might be useful for mechanism-based pain assessment, and some approaches can  provide specific information regarding possible neurochemical alternations responsible for chronic pain.

Also, for treatment of low back pain, the most common pain condition for which people seek treatment, the biopsychosocial model directs clinicians to consider myriad causes or mechanisms contributing to the pain experience – somatic, neuropathic, central nervous system, and psychological.  “Multiple components of pain – intensity, perceptual qualities, bodily distribution and temporal features -- can be assessed using mechanism-based approaches,” said Fillingim. 

“This approach coupled with evaluations of psychological and social functioning gives clinicians a more complete pain assessment from which multi model treatment options can be used to target multiple pain mechanisms,” Fillingim added.

About the American Pain Society

Based in Chicago, the American Pain Society (APS) is a multidisciplinary community that brings together a diverse group of scientists, clinicians and other professionals to increase the knowledge of pain and transform public policy and clinical practice to reduce pain-related suffering.  APS is the professional home for investigators involved in all aspects of pain research including basic, translational, clinical and health services research to obtain the support and inspiration they need to flourish professionally.  APS strongly advocates expansion of high quality pain research to help advance science to achieve effective and responsible pain relief.  For more information on APS, visit www.americanpainsociety.org.  ###