Practical approach to a patient with chronic pain of uncertain etiology in primary care

Abstract

Shaquir Salduker1, Eugene Allers2, Sudha Bechan3, R Eric Hodgson4, Fanie Meyer5, Helgard Meyer6,7, Johan Smuts8, Eileen Vuong9, David Webb10 1Durban Pain Clinic, St Augustine Hospital, Durban, South Africa; 2Glynview Multiprofessional Practice, Gauteng, South Africa; 3Department of Anaesthesiology, Head Clinical Unit, Inkosi Albert Luthuli Central Hospital, Nelson R Mandela School of Medicine, Durban, South Africa; 4Inkosi Albert Luthuli Central Hospital, Nelson R Mandela School of Medicine, Durban, South Africa; 5Optima Psychiatric Hospital, Bloemfontein, South Africa; 6Department of Family Medicine, University of Pretoria, Pretoria, South Africa; 7Wilgers MR & Medical Centre, Pretoria, South Africa; 8Faculty of Medicine, University of Pretoria, Pretoria, South Africa; 9South African Research Chairs Initiative (SARChI), PTSD Program, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa; 10Houghton House Group, Gauteng, South AfricaCorrespondence: Shaquir SaldukerDurban Pain Clinic, St Augustines Hospital, Chelmsford 1, Durban, South AfricaEmail [email protected]: Chronic pain of uncertain etiology often presents a challenge to both patients and their health care providers. It is a complex condition influenced by structural and physiological changes in the peripheral and central nervous systems, and it directly influences, and is modulated by, psychological well-being and personality style, mood, sleep, activity level and social circumstances. Consequently, in order to effectively treat the pain, all of these need to be evaluated and addressed. An effective management strategy takes a multidisciplinary biopsychosocial approach, with review of all current medications and identification and careful withdrawal of those that may actually be contributing to ongoing pain. The management approach is primarily nonpharmacological, with carefully considered addition of medication, beginning with pain-modulating treatments, if necessary. In this article, we present a primary care approach to the assessment and management of a patient with chronic pain where the cause cannot be identified.Keywords: etiology, biopsychosocial, central sensitization, chronic, pain

Keywords

• aetiology
• biopsychosocial
• central sensitisation
• chronic
• pain