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A land half won: pain and the modern world

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Pain medicine needs to be clear about what can and cannot be achieved

Much has been done by the International Association for the Study of Pain, its members and its national chapters over the past two decades to improve the recognition and treatment of chronic pain. The World Health Organization has similarly mounted a sustained international campaign for cancer pain relief, and palliative care has improved and grown almost everywhere. However, despite real progress, especially in awareness, big challenges remain.

Research has revealed some of the multiple mechanisms at play in causing pain, and multimodal therapeutics tend to reflect this complex neurobiology.1 There is strong emphasis on neuroplasticity, particularly central sensitisation, with the growing realisation that central changes generate pain long after peripheral nociceptive stimuli have waned or disappeared altogether (hence the name change from “chronic” to “persistent” pain). A holistic approach to care — the so-called biopsychosocial model — has been widely and enthusiastically adopted for all forms of pain management.2

Modern pain specialists tend to be polarised into centralists and peripheralists: those who concentrate their efforts on the brain and…