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News&Review No.3

September 2010 l ISSUE NO 3 9 NEWS & REVIEWS Professor Joseph Pergolizzi FROM SYMPTOM CONTROL TO MECHANISM- BASED TREATMENT OF CHRONIC PAIN Chronic pain is multifactorial in na- ture where both nociceptive and neuropathic pain often occur simul- taneously and is seldom controlled by one drug1. While assessing chronic pain patients the possibility of the diverse mechanisms under- lying the pain need to be considered rather than classifying patients on the basis of common diseases like osteoarthritis or low back pain. Iden- tifying these mechanisms is in many cases difficult due to the in- consistent symptoms but important for an accurate diagnosis to ensure effective drug treatment2. The rationale for mechanism-orien- tated treatment is based on a num- ber of elements3: Pain can be caused by multiple, different mechanisms; pain is processed by multiple ex- citatory and inhibitory systems; drug efficacy may vary according to the underlying system; analgesia may be achieved by drugs that either block excitatory COMMENTARY Professor Joseph Pergolizzi, John Hopkins University School of Medicine, Florida, USA Considering the multifactorial aetiology of chronic pain we can only start to treat patients efficiently if we improve the knowledge about the physio- logical differences between nociceptive and neuro- pathic pain and then base our treatment decisions on this understanding. I was very pleased that a large group of experienced international pain specialists attended the CHANGE PAIN Expert Summit. These special- ists will now be able to start disseminating the outcomes of the meeting which I am convinced will ultimately help to improve the management of chronic pain. with different mechanisms of action is the most popular method of phar- macological pain treatment. This approach, although effective in inter- rupting the pain signals, can also in- crease the dangers of side effects4. Thus, strong acting drugs that ad- dress both underlying mechanisms, combined with a promising tolera- bility profile would represent a sig- nificant advancement in the pharmacological management of chronic pain. References 1. Besson M et al. New approaches to the pharma- cotherapy of neuropathic pain. Expert Rev Clin. Pharmacol, 2008, 1(5):683-693. 2. Woolf CJ, Max MB. Mechanism-based pain diagnosis: Issues for analgesic drug develop- ment. Anesthesiology, 2001, 95(1): 241-249. 3. Rafffa RB et al.The determination and application of fixed-dose analgesic combinations for treating multimodal pain. J Pain, 2010, 11(8): 701-709. 4. Varrassi G et al. Pharmacological treatment of chronic pain – the need for CHANGE. Curr Med Res Opin, 2010, 26(5):1231-1245. systems or activate inhibitory systems; individual patients may have multiple mechanisms that need to be addressed by different pharmacological agents. The use of different drugs (either loose or fixed combination doses)