Towards a pain treatment based on the identification of the pain generating mechanisms

The selection of a pain treatment should be based on the identification of the mechanisms of its origin. Nowadays, many patients with chronic pain con tinue to suffer severe pain. Failure to obtain a satisfactory response is o ften ascribed to individual peculiarities in drug metabolism, tolerance, re sistance to common analgesics or to psychological factors. However, difficu lties in elucidating pain-generating mechanisms may be the main source of i nsufficient pain management These difficulties can be explained by several factors including: the unsuitability of the usual classification of pain, t he use of etiology and symptom criteria as the main dimension of pain to gu ide the choice of therapeutic agent, the inadequate interpretation of senso ry deficit, the lack of identification of the injured tissues and the lack of use of psychophysical methods to assess pain. This article reviews some fundamental knowledge to determine pain treatment based on the identificati on of the physiopathological mechanisms of pain.