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4 not sufficiently recognized. Only a small number of chronic pain patients are referred to pain specialists, so the onus of diagnosis and treatment will often fall on the general practitioner. Communication between patients and physicians is of vital importance so that the clinician can fully understand the patient’s situation. Many of the pain classification systems in use are outdated, although newer versions such as pain DETECT have been designed to identify neuropathic pain components, which is especially important in low back pain (Freynhagen, 2006)1. Dr med Gerhard H.H. Müller-Schwefe EFFECTIVE PHYSICIAN-PATIENT COMMUNICATION IS CRUCIAL TO ENSURE TREATMENT SUCCESS Current management of severe chronic pain is often inadequate. Physician-related reasons why therapy fails include difficult or in- adequate diagnosis, incomplete understanding of the underlying mechanism that generates pain, inappropriate selection of treat- ment options, inadequate out- come measures, and a failure to understand co-morbid conditions which influence pain response. Individual treatment goals Most importantly, in many cases individual patient treatment goals are However, in clinical practice this questionnaire is still not broadly used. A typical severe chronic pain patient may have a long medical history of many years of pain suffering, during which time they may have seen numerous clinicians. Many will have a history of ineffective therapies. Co- morbidities and other medication will also have to be taken into account by the physician as well as any psychosocial problems. Degree and type of pain Pain is individual and subjective and many patients have a problem de- scribing their condition to the physi- cian. Although they may be able to indicate the location, frequency and type of pain they are experiencing, they find it difficult to express the in- tensity of pain. Estimates of inten- sity using standardized pain measurement tools are still fairly subjective and variable and there are indications that such tools are in- frequently used. In clinical reality, patients are rarely asked to describe their pain intensity using e.g. numer- ical rating scales or questionnaires. Pain-related impairment Assessment of pain-related impair- ment made by the patient and the physician may differ, with the physi- cian failing to appreciate the extent, or the effect, that pain is having on the patients’ normal physical and mental functioning and quality of life. When comparing the assess- ment of the degree of pain-related impairment, the physicians' view often does not match the one of their patients.