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

Despite continuous improvements in available pain treatments, many patients with chronic pain still remain insufficiently relieved. Although such ther apeutic failures are often ascribed to pharmacological or psychological fac tors, difficulties in elucidating pain-generating mechanisms may be the mai n cause of insufficient pain management. These difficulties arise from seve ral origins, including the unsuitability of the usual classification of pai n, the exclusive use of etiology or symptom criteria as the main dimension of pain to guide the choice of therapeutic agents, the inadequate interpret ation of sensory deficit, the lack of identification of the injured tissues , the absence of objective pain assessment by psychophysical methods. In th is paper, we review briefly some fundamental knowledge to determine pain tr eatment based on the identification of the physiopathological mechanisms of pain. We advocate that once pain generating mechanisms are known, it becom es possible to establish the appropriate treatment of pain. Copyright (C) 2 001 S. Karger AG, Basel.