PHARMACOECONOMICS OF CHRONIC NONMALIGNANT PAIN

Pain is one of the most common reasons for patients to seek medical ca re. In most settings, the model of acute pain treatment, with its emph asis on pharmacological therapy, is used for acute and chronic pain al ike. Persistent chronic pain, however, often leads to complex social a nd psychological maladaptations, as well as substantial direct and ind irect costs. Thus, the proper treatment of chronic pain usually involv es pharmacological, behavioural and psychological interventions, Pain is a subjective sensation, but persistent chronic pain often results i n long term neurophysiological and psychological changes that might be more appropriately considered disease manifestations. Unfortunately, the subjectivity of pain has meant that the assessment of the epidemio logy, pharmacotherapy and economic costs of chronic pain has been diff icult. As a result, many of the techniques for chronic pain management are unfamiliar to practising physicians. Even those healthcare profes sionals who are familiar with the special techniques for the managemen t of chronic pain may be unable to identify the subpopulations for whi ch they might be most effective. The clinician must evaluate patients for the appropriateness of a number of alternative drug delivery metho ds, novel analgesic agents, neuromodulatory techniques and multidiscip linary behavioural and psychological treatment programmes. The most ef fective treatment will often involve a combination of these techniques , as determined by the unique features of the patient's pain condition as well as individual patient characteristics. The costs and outcomes of various treatment strategies vary considerably and there is a need for comparative studies. Increasing emphasis on diagnosis and treatme nt in the primary care setting will place more importance on knowing t he relative efficacies and appropriate use of a widening array of choi ces for chronic pain treatment. The management of chronic pain is rema rkably complex and resource-intensive, and there is clearly a need for more intensive pharmacoeconomic studies, especially those comparing t he many alternative strategies for management.