Fast Facts: Chronic and Cancer Pain, 4th edition

Book Preface

On average, at least 1 in 5 people has chronic pain, with 30% being severely disabled by it. All clinicians, regardless of specialty, will see patients with pain that has persisted for more than 6 months, and this book is aimed at the wide range of busy health professionals who may be well aware they have received little education and training to help them manage such patients. The extraordinary situation where such a book is necessary has come about as a result of major ongoing deficiencies in pain education and training, the result of which is highlighted by the recent epidemic of overdoses amongst patients prescribed opioid analgesics.

There is growing awareness of the devastating effect that chronic pain has on individuals and their families, on society as a whole and on the economy in terms of lost output and productivity. The Global Burden of Disease Study 2013 revealed that low back pain was a leading cause of ‘years lived with disability’ in both 1990 and 2013. It is no wonder that many national governments now recognize chronic pain as a chronic ‘condition’, or more appropriately as a chronic disease. In fact, governments around the world are accepting the importance of developing specialized strategies for the prevention, treatment and management of chronic pain as a fundamental human right, and passing laws and regulations that encourage, and even mandate, improved systems of care for pain (see Key references, page 6). Medical science has progressed from marginalizing chronic pain as merely a symptom of disease to developing a better understanding of its causes, effects and pathophysiological mechanisms, leading to new treatments aimed at a wide range of novel targets. New and old treatments are being integrated into comprehensive multimodal management plans focused on the control of pain, with the ultimate aim of improving function and quality of life.

This book describes a variety of chronic pain syndromes, and set out the principles of assessment and treatment for each, with an eye toward successful early interventions that prevent pain chronification. It does not aim to be comprehensive. Rather, it seeks to distill a great deal of pain-related evidence and, because every individual’s experience of pain is unique, we have adopted the current practice in clinical decisionmaking of ‘evidence-guided’ rather than ‘evidence-based’ medicine. Assessment and treatment of chronic pain is most effectively carried out in a biopsychosocial framework, drawing on the knowledge and skills of a wide range of health professionals who need to work in an interdisciplinary manner. With health services around the world responding to calls to improve the management of painful long-term conditions, develop preventive and cost-effective solutions, respond to patient choice and voice, and create healthier workplaces, this is a timely resource that provides a concise introduction to the complex and extensive field of chronic pain for all health professionals wanting – and needing – to know more.