n CME : Your SA Journal of CPD - Conceptual and practical issues in the management of chronic pain : main topic

Volume 21, Issue 3
  • ISSN : 0256-2170



Chronic pain represents a massive too often unacknowledged burden to individuals, the health services and the economy. It is most usefully conceptualised as a multi-dimensional, multifactorial, essentially subjective phenomenon. Acute pain is a virtually universal phenomenon. The prevention of chronic pain is therefore a priority of management. This requires an awareness of a number of pitfalls, including mind-body dualist assumptions that may form a significant iatrogenic component to the disabilities associated with chronic pain. The basic principles of management are acknowledging the reality or the validity of the problem, identifying pathophysiological and psychosocial perpetuating factors, targeting treatment to the particular needs of the individual, and continuing practical support and evaluation. Improving the quality of life, avoiding the inappropriate use of medication, and restoring a sense of self-efficacy are more appropriate goals than the elimination of pain. Effective management involves a paradigm shift from the notion of cure to rehabilitation, and from addressing chronic pain as a symptom with an underlying cause to understanding the phenomenon as a problem in itself.

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