Implications of recent advances in the understanding of pain pathophysiology for the assessment of pain in patients

As we approach the new millennium, it is clear that we are on the brink of a major change in clinical pain management. We are poised to move from a tr eatment paradigm that has been almost entirely empirical to one that will b e derived from an understanding of the actual mechanisms involved in the pa thogenesis of pain. When this is achieved, pain treatment will at last be r ationally based. The implications of this are immense and will necessitate major changes in the way we classify pain, which until now has been based o n disease, duration and anatomy, to a mechanism-based classification. In ad dition, the assessment, diagnosis and treatment of pain will change. The ai m in the future will be to identify in individual patients what mechanisms are responsible for their pain and to target treatment specifically at thos e mechanisms. We present for discussion, a new approach for classifying pai n, based on an analysis of mechanisms, and show how this could be used to a ssess pain clinically. Such kinds of pain assessment, which need to be desi gned to reveal as much as possible about mechanisms, are necessary for more sophisticated epidemiology and clinical research as well as for providing the outcome measures necessary for the evaluation of the efficacy of new tr eatments targeted at particular pain mechanisms. (C) 1999 International Ass ociation for the Study of Pain. Published by Elsevier Science B.V.