The Disease-Based Treatment of Pain

  • Andrew So
  • Karina Gritsenko


Today pain is one of the most commonly reported symptoms by individuals seeking medical treatment. Once thought of as merely sensation, pain has evolved into a complex experience with biological and psychosocial components. Consequently, pain management now represents a multidisciplinary field, which utilizes various medications, techniques, and therapies to address pain’s complexity. In order to fully understand the current treatment approaches, it is important that clinicians understand the modern definition of pain as a disease through knowledge of its history, proposed mechanisms, and varying types. This chapter will provide an introduction to the field of pain management by exploring historical definitions of pain and summarizing the evolutionary theories that have led to today’s view of pain as a biological disease. Equipped with a better understanding of pain’s origin as a disease, this chapter will then highlight the different types of pain and the current treatment modalities used to tackle the multifaceted factors of the pain system.


History of pain Gate-control theory Biopsychosocial model Nociceptive pain Neuropathic pain Multimodal treatment of pain Pharmacological treatment of pain Neuromodulation Cognitive-based therapy 

Recommended Reading

  1. 1.
    Anwar K. Pathophysiology of pain. Dis Mon. 2016;16(9):324–9.CrossRefGoogle Scholar
  2. 2.
    Ashburn M, Staats P. Management of chronic pain. Lancet. 1999;353(9167):1865–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Baron R. Mechanisms of disease: neuropathic pain—a clinical perspective. Nat Clin Pract Neurol. 2006;2(2):95–106.PubMedCrossRefGoogle Scholar
  4. 4.
    Bashir U, Colvin LA. The place of pharmacological treatment in chronic pain. Anaesth Intensive Care Med. 2013;14(12):528–32.CrossRefGoogle Scholar
  5. 5.
    Beissner F, Brandau A, Henke C, et al. Quick discrimination of A delta and C fiber mediated pain based on three verbal descriptors. Ikeda K, ed. PLoS One. 2010;5(9):e12944.PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    Binshtok AM. Mechanisms of nociceptive transduction and transmission: a machinery for pain sensation and tools for selective analgesia. Int Rev Neurobiol. 2011;97:143–77.PubMedCrossRefGoogle Scholar
  7. 7.
    Bittar RG, Teddy PJ. Peripheral neuromodulation for pain. J Clin Neurosci. 2009;16(10):1259–61.PubMedCrossRefGoogle Scholar
  8. 8.
    Braz J, Solorzano C, Wang X, Basbaum AI. Transmitting pain and itch messages: a contemporary view of the spinal cord circuits that generate gate control. Neuron. 2014;82(3):522–36.PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Buyten JP. Radiofrequency or neuromodulation treatment of chronic pain, when is it useful? Eur J Pain Suppl. 2008;2(S1):57–66.CrossRefGoogle Scholar
  10. 10.
    Campbell LC, Clauw DJ, Keefe FJ. Persistent pain and depression: a biopsychosocial perspective. Biol Psychiatry. 2003;54(3):399–409.PubMedCrossRefGoogle Scholar
  11. 11.
    Chapman CR. New directions in the understanding and management of pain. Soc Sci Med. 1984;19(12):1261–77.PubMedCrossRefGoogle Scholar
  12. 12.
    Cheatle MD. Biopsychosocial approach to assessing and managing patients with chronic pain. Med Clin N Am. 2016;100(1):43–53.PubMedCrossRefGoogle Scholar
  13. 13.
    Chen J. History of pain theories. Neurosci Bull. 2011;27:343.PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Chen M, Hoshino H, Saito S, Yang Y, Obata H. Spinal dopaminergic involvement in the antihyperalgesic effect of antidepressants in a rat model of neuropathic pain. Neurosci Lett. 2017;649:116–23.PubMedCrossRefGoogle Scholar
  15. 15.
    Cohen S, Raja S. Goldman’s Cecil medicine. 24th ed. Philadelphia: Elsevier; 2012. Chapter 29, Pain. p. 133–40.CrossRefGoogle Scholar
  16. 16.
    Colloca L, Ludman T, Bouhassira D, Baron R, Dickenson A, et al. Neuropathic pain. Nat Rev Dis Primers. 2017;3:17002.PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Craig AD. Pain mechanisms: labeled lines versus convergence in central processing. Annu Rev Neurosci. 2003;26(1):1–30.PubMedCrossRefGoogle Scholar
  18. 18.
    Dale R, Stacey B. Multimodal treatment of chronic pain. Med Clin N Am. 2016;100(1):55–64.PubMedCrossRefGoogle Scholar
  19. 19.
    Dedeli O, Kaptan G. Spirituality and religion in pain and pain management. Health Psychol Res. 2013;1(3):e29.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Deer TR. An overview of interventional spinal techniques. Semin Pain Med. 2004;2(3):154–66.CrossRefGoogle Scholar
  21. 21.
    Dietrich J. Psychology and chronic pain. Anaesth Intensive Care Med. 2011 Feb;12(2):42–3.CrossRefGoogle Scholar
  22. 22.
    D'Mello R, Dickenson AH. Spinal cord mechanisms of pain. Br J Anaesth. 2008;101(1):8–16.PubMedCrossRefGoogle Scholar
  23. 23.
    Doleys DM. Chronic pain as a hypothetical construct: a practical and philosophical consideration. Front Psychol. 2017;8:664.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain – United States, 2016. MMWR Recomm Rep. 2016;65(RR-1):1–49.PubMedCrossRefGoogle Scholar
  25. 25.
    Duan B, Cheng L, Ma Q. Spinal circuits transmitting mechanical pain and itch. Neurosci Bull. 2018;34(1):186–93.PubMedCrossRefGoogle Scholar
  26. 26.
    Dubin AE, Patapoutian A. Nociceptors: the sensors of the pain pathway. J Clin Invest. 2010;120(11):3760–72.PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Dworkin RH, O’Connor AB, Audette J, et al. Recommendations for the pharmacological management of neuropathic pain: an overview and literature update. Mayo Clin Proc. 2010;85(3 Suppl):S3–S14.PubMedPubMedCentralCrossRefGoogle Scholar
  28. 28.
    Finnerup NB, Haroutounian S, Kamerman P, Baron R, Bennett DL, Bouhassira D, et al. Neuropathic pain. Pain. 2016;157(8):1599–606.PubMedPubMedCentralCrossRefGoogle Scholar
  29. 29.
    Grichnik KP, Ferrante FM. The difference between acute and chronic pain. Mt Sinai J Med. 1991;58(3):217–20.PubMedGoogle Scholar
  30. 30.
    Hadidi S, Baranidharan G. Implantable technology for pain management. Anaesth Intensive Care Med. 2016;17(11):536–42.CrossRefGoogle Scholar
  31. 31.
    Hamann MCJ, Tsai EC, Tator CH, Shoichet MS. Novel intrathecal delivery system for treatment of spinal cord injury. Exp Neurol. 2003;182(2):300–9.CrossRefGoogle Scholar
  32. 32.
    Handwerker H. Itch hypotheses. Itch Front Neurosci. 2014:1–8.Google Scholar
  33. 33.
    High KNW. Pain pathways: peripheral, spinal, ascending, and descending pathways. In: Rajs practical management of pain. Elsevier Inc. 2008. p. 119–34.
  34. 34.
    Hillinger MG, Wolever RQ, Mckernan LC, Elam R. Integrative medicine for the treatment of persistent pain. Prim Care. 2017;44(2):247–64.PubMedCrossRefGoogle Scholar
  35. 35.
    Hoffert M. The gate control theory re-revisited. J Pain Symptom Manag. 1986;1(1):39–41.CrossRefGoogle Scholar
  36. 36.
    Honey CM, Tronnier VM, Honey CR. Deep brain stimulation versus motor cortex stimulation for neuropathic pain: a minireview of the literature and proposal for future research. Comput Struct Biotechnol J. 2016;14:234–7.PubMedPubMedCentralCrossRefGoogle Scholar
  37. 37.
    Kansal A. Visceral pain. Anaesth Intensive Care Med. 2016;17(11):543–7.CrossRefGoogle Scholar
  38. 38.
    Keele KD. Anatomies of pain. Oxford: Pl. XIII. Blackwell Scientific Publications; 1957.Google Scholar
  39. 39.
    Kremer MCA, Salvat E, Muller A, Yalcin I, Barrot M. Antidepressants and gabapentinoids in neuropathic pain: mechanistic insights. Neuroscience. 2016;338:183–206.PubMedCrossRefGoogle Scholar
  40. 40.
    Kroenke K, Krebs EE, Bair MJ. Pharmacotherapy of chronic pain: a synthesis of recommendations from systematic reviews. Gen Hosp Psychiatry. 2009;31(3):206–19.PubMedCrossRefGoogle Scholar
  41. 41.
    Lima D. Endogenous pain modulatory system in the light of the gate control theory. Pain Forum. 1996;5(1):31–9.CrossRefGoogle Scholar
  42. 42.
    Lynch ME, Watson CPN. The pharmacotherapy of chronic pain: a review. Pain Res Manag. 2006;11(1):11–38.PubMedPubMedCentralCrossRefGoogle Scholar
  43. 43.
    Maixner W, Fillingim RB, Williams DA, Smith SB, Slade GD. Overlapping chronic pain conditions: implications for diagnosis and classification. J Pain. 2016;17(9):T93–107.PubMedPubMedCentralCrossRefGoogle Scholar
  44. 44.
    Manworren RC. Multimodal pain management and the future of a personalized medicine approach to pain. AORN J. 2015;101(3):307–18.CrossRefGoogle Scholar
  45. 45.
    Marchand S. The phenomenon of pain. Seattle: IASP Press; 2012.Google Scholar
  46. 46.
    Mcdonald J, Lambert DG. Opioid mechanisms and opioid drugs. Anaesth Intensive Care Med. 2016;17(9):464–8.CrossRefGoogle Scholar
  47. 47.
    Melzack R. From the gate to the neuromatrix. Pain. 1999;82:S121–6.CrossRefGoogle Scholar
  48. 48.
    Melzack R, Wall PD. Pain mechanisms: a new theory. Pain Forum. 1996;5(1):3–11.CrossRefGoogle Scholar
  49. 49.
    Mendell LM. Constructing and deconstructing the gate theory of pain. Pain. 2014;155(2):210–6.PubMedCrossRefGoogle Scholar
  50. 50.
    Mendis V, Mottaleb R, Fung M. Radiofrequency techniques in pain management. Anaesth Intensive Care Med. 2016;17(11):564–7.CrossRefGoogle Scholar
  51. 51.
    Moayedi M, Davis KD. Theories of pain: from specificity to gate control. J Neurophysiol. 2012;109(1):5–12.PubMedCrossRefGoogle Scholar
  52. 52.
    Nasmerow L, Kutner E, Wakefiled E, Rzepski B, Sahl R. Pain amplification syndrome: a biopsychosocial approach. Semin Pediatr Neurol. 2016;23(3):224–30.CrossRefGoogle Scholar
  53. 53.
    Nijs J, Wilgen CPV, Oosterwijck JV, Ittersum MV, Meeus M. How to explain central sensitization to patients with ‘unexplained’ chronic musculoskeletal pain: practice guidelines. Man Ther. 2011;16(5):413–8.PubMedCrossRefGoogle Scholar
  54. 54.
    Ochs S-A. History of nerve functions: from animal spirits to molecular mechanisms. Cambridge: Cambridge University Press; 2004.CrossRefGoogle Scholar
  55. 55.
    Ossipov MH, Dussor GO, Porreca F. Central modulation of pain. J Clin Invest. 2010;120(11):3779–87.PubMedPubMedCentralCrossRefGoogle Scholar
  56. 56.
    Pearce JMS. Von Frey’s pain spots. J Neurol Neurosurg Psychiatry. 2006;77(12):1317.PubMedPubMedCentralCrossRefGoogle Scholar
  57. 57.
    Penney JN. The biopsychosocial model of pain and contemporary osteopathic practice. Int J Osteopathic Med. 2010;13(2):42–7.CrossRefGoogle Scholar
  58. 58.
    Pergolizzi J, Ahlbeck K, Aldington D, Alon E, Coluzzi F, Dahan A, et al. The development of chronic pain: physiological CHANGE necessitates a multidisciplinary approach to treatment. Curr Med Res Opin. 2013;29(9):1127–35.PubMedPubMedCentralCrossRefGoogle Scholar
  59. 59.
    Perl ER. Pain mechanisms: a commentary on concepts and issues. Prog Neurobiol. 2011;94(1):20–38.PubMedPubMedCentralCrossRefGoogle Scholar
  60. 60.
    Pleuvry B. Non-opioid analgesics. Anaesth Intensive Care Med. 2005;6(1):25–9.CrossRefGoogle Scholar
  61. 61.
    Rey R. The history of pain. Cambridge, MA: Harvard Univ. Press; 1998.Google Scholar
  62. 62.
    Roe M, Sehgal A. Pharmacology in the management of chronic pain. Anaesth Intensive Care Med. 2016;17(11):548–51.CrossRefGoogle Scholar
  63. 63.
    Sanchis MN, Lluch E, Nijs J, Struyf F, Kangasperko M. The role of central sensitization in shoulder pain: a systematic literature review. Semin Arthritis Rheum. 2015;44(6):710–6.PubMedCrossRefGoogle Scholar
  64. 64.
    Serpell MG, Makin A, Harvey A. Acute pain physiology and pharmacological targets: the present and future. Acute Pain. 1998;1(3):31–47.CrossRefGoogle Scholar
  65. 65.
    Seth B, Gray LD. Genesis of chronic pain. Anaesth Intensive Care Med. 2016;17(9):431–5.CrossRefGoogle Scholar
  66. 66.
    Sousa MVPD, Ferraresi C, Magalhães ACD, Yoshimura EM, Hamblin MR. Building, testing and validating a set of home-made von Frey filaments: a precise, accurate and cost effective alternative for nociception assessment. J Neurosci Methods. 2014;232:1–5.PubMedPubMedCentralCrossRefGoogle Scholar
  67. 67.
    Stanos S, Tyburski M, Harden NR. Braddom’s physical medicine and rehabilitation. 5th ed. Philadelphia: Elsevier; 2015. Chapter 37, Chronic Pain. p. 809–17.CrossRefGoogle Scholar
  68. 68.
    Steeds C. The anatomy and physiology of pain. Surgery – Oxford International Edition. 2009;27(12):507–11.Google Scholar
  69. 69.
    Stein C. Opioids, sensory systems and chronic pain. Eur J Pharmacol. 2013;716(1–3):179–87.PubMedCrossRefGoogle Scholar
  70. 70.
    Tashani O, Johnson M. Transcutaneous Electrical Nerve Stimulation (TENS) a possible aid for pain relief in developing countries? Libyan J Med. 2009;4(2):62–5.PubMedPubMedCentralCrossRefGoogle Scholar
  71. 71.
    Taylor LEV, Stotts NA, Humphreys J, Treadwell MJ, Miaskowski C. A biopsychosocial-spiritual model of chronic pain in adults with sickle cell disease. Pain Manag Nurs. 2013;14(4):287–301.PubMedCrossRefGoogle Scholar
  72. 72.
    Tompkins DA, Hobelmann JG, Compton P. Providing chronic pain management in the “Fifth Vital Sign” Era: historical and treatment perspectives on a modern-day medical dilemma. Drug Alcohol Depend. 2017;173:S11–21.PubMedPubMedCentralCrossRefGoogle Scholar
  73. 73.
    Turk DC, Wilson HD, Cahana A. Treatment of chronic non-cancer pain. Lancet. 2011;377(9784):2226–35.PubMedCrossRefGoogle Scholar
  74. 74.
    Wolff BB. Gate control theory and the brain. Pain Forum. 1996;5(2):147–9.CrossRefGoogle Scholar
  75. 75.
    Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011;152(3 Suppl):S2–15.PubMedPubMedCentralCrossRefGoogle Scholar
  76. 76.
    Wrigley P, Siddall P. Wall & Melzack’s textbook of pain. 6th ed. Philadelphia: Elsevier/Saunders; c2013. Chapter 68, Pain following Spinal Cord Injury. p. 978–89.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Andrew So
    • 1
  • Karina Gritsenko
    • 2
  1. 1.Albert Einstein College of Medicine/Montefiore Medical CenterNew York CityUSA
  2. 2.Albert Einstein College of Medicine/Montefiore Medical Center, Montefiore Multidisciplinary Pain ProgramThe BronxUSA

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