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Abstract
Chronic non-cancer pain is a common, often undiagnosed condition in primary care across the world, with prevalence rates between 20% and 40%. To effectively address this problem, the primary care practitioner needs to have an organised, comprehensive approach to diagnosing and managing these patients within a biopsychosocial framework, in collaboration with members of the interdisciplinary team. The aim of this article is to provide the primary care practitioner with up to date information on the management of chronic pain. A case study is introduced to raise awareness of some of the complexities of dealing with the problem. A series of key questions are raised that address the various levels of complexity. Current evidence is used to guide the reader through these questions, covering a wide area of pain research as it pertains to primary care. The article concludes with five practice points that link the literature to clinical practice.
Highlights
This article proposes that the clinician needs to answer a series of key pain-related questions to be able to comprehensively care for this patient: What is the pain diagnosis? Is there an underlying clinical diagnosis? What is the impact of the pain? What factors will affect the outcomes? What is the best treatment option for this patient?The summary in Box 1 describes a typical patient presenting to primary care, offering some interesting learning opportunities.The pain diagnosisChronic non-cancer pain (CNCP) is a common condition in primary care anywhere in the world, with an estimated prevalence that ranges from 20% to 40%, with a 2013 Pretoria-based study suggesting a 41% prevalence in a South African context.[1]
When making a pain diagnosis, it is useful for the clinician to decipher if the mechanism of pain is related to underlying tissue damage, a neurological mechanism, a central component or is a mixture of the preceding three
Tools that assess the emotional, social and functional impact of chronic pain are more useful in the primary care context
Summary
This article proposes that the clinician needs to answer a series of key pain-related questions to be able to comprehensively care for this patient:. In the case of Mrs A presented here, a mixed picture of underlying tissue damage emerges (likely spinal degenerative disease), with associated neuropathy and a strong emotional component This ‘pain diagnosis’ is important as it helps the clinician to make decisions about subsequent pharmacological and non-pharmacological interventions. Pain scales focus on pain severity and are useful clinically, but tend to limit the assessment to the physical experience of pain.[4] Tools that assess the emotional, social and functional impact of chronic pain are more useful in the primary care context One such scale is the Wisconsin Brief Pain Inventory (BPI), used widely since its development in 1983, and crossculturally validated in various contexts.[5] This tool consists of nine questions (Figure 1) that can be answered by the patient even before the consultation. Please rate your pain by circling the one number that tells how much pain you have
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Schedule a callMore From: South African family practice : official journal of the South African Academy of Family Practice/Primary Care
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