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Functional disorders and chronic pain

Richard Sawyer
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DOI: https://doi.org/10.7861/clinmed.Let.21.2.4
Clin Med March 2021
Richard Sawyer
Consultant in anaesthesia and pain management and honorary senior clinical lecturer, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Editor – I read the article by Eccles and Davies with great interest.1 I think they have highlighted well the overlapping issues of chronic pain and fatigue symptoms and the diagnostic overlap between patients with fibromyalgia and myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS).

I was, however, disappointed to note that there are a number of deficiencies within the article. While they are correct to note that there are multiple referral pathways for patients with chronic pain, pain clinics within anaesthetic departments across the UK provide significant input into pain management and are often one of the ‘last resorts’ in the patient treatment pathway.2,3

While Eccles and Davies note the presence of cognitive dysfunction in patients with chronic pain conditions, they seem to not acknowledge that chronic pain is a biopsychosocial condition and must be approached as such, as identified within the International Association for the Study of Pain revised definition of pain and the proposed International Statistical Classification of Diseases and Related Health Problems 11th revision (ICD-11) classification criteria.4,5 It is well recognised that psychological contributions to chronic pain and functional conditions are significant.6,7

While I applaud the descriptions used by Eccles and Davies to describe various approaches to chronic pain patient management as embraced by different doctors (particularly that used by Dr B), it seems to me that they then proceed further along the biomedical route by exploring hypermobility syndromes, small fibre neuropathy, mast cell activation disorders and inflammatory reactivity. This approach, in my experience, further entrenches ‘illness behaviour’ and distress among patients with functional chronic pain conditions and fails to approach pain management through a biopsychosocial approach. This then becomes a ‘barrier to progress’.8

The impact of psychological illness on chronic pain symptom presentation is well recognised and a holistic approach to managing these patients through illness de-escalation and promoting improved self efficacy is, in my opinion, more appropriate.

  • © Royal College of Physicians 2021. All rights reserved.

References

  1. ↵
    1. Eccles JA
    , Davies KA. The challenges of chronic pain and fatigue. Clin Med 2021;21:19–27.
    OpenUrlAbstract/FREE Full Text
  2. ↵
    1. Bridges S
    . Health Survey for England 2011. Health and Social Care Information Centre, 2012;1:291–323.
    OpenUrl
  3. ↵
    1. Dr Foster Intelligence, British Pain Society, Healthcare Quality Improvement Partnership
    . National Pain Audit Final Report 2010-2012. HQIP, 2012. www.hqip.org.uk/wp-content/uploads/2018/02/EBfI8i.pdf
  4. ↵
    1. Treede RD
    , Rief W, Barke A, et al. Chronic pain as a symptom or a disease: the IASP classification of chronic pain for the International Classification of Diseases (ICD-11). Pain 2019;160:19–27.
    OpenUrlCrossRefPubMed
  5. ↵
    1. Raja SN
    , Carr DB, Cohen M, et al. The revised international Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain 2020;161:1976–82.
    OpenUrl
  6. ↵
    1. Wiech K
    , Tracey I. The influence of negative emotions on pain: behavioral effects and neural mechanisms. Neuroimage 2009;47:987–94.
    OpenUrlCrossRefPubMed
  7. ↵
    1. Henningsen P
    , Zipfel S, Herzog W. Management of functional somatic symptoms. Lancet 2007;369:946–55.
    OpenUrlCrossRefPubMed
  8. ↵
    1. Main CJ
    , Spanswick CC. Pain management: an interdisciplinary approach. Churchill Livingstone, 2000.
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Functional disorders and chronic pain
Richard Sawyer
Clinical Medicine Mar 2021, 21 (2) e242-e243; DOI: 10.7861/clinmed.Let.21.2.4

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Functional disorders and chronic pain
Richard Sawyer
Clinical Medicine Mar 2021, 21 (2) e242-e243; DOI: 10.7861/clinmed.Let.21.2.4
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