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Reviewing the Concept of Subgroups in Subacute and Chronic Pain and the Potential of Customizing Treatments 

Reviewing the Concept of Subgroups in Subacute and Chronic Pain and the Potential of Customizing Treatments
Chapter:
Reviewing the Concept of Subgroups in Subacute and Chronic Pain and the Potential of Customizing Treatments
Author(s):

Adina C. Rusu

, Katja Boersma

, and Dennis C. Turk

DOI:
10.1093/med/9780199558902.003.0143
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date: 21 April 2021

Even when successful, pain rehabilitation does not cure pain but emphasizes self-control and self-management of symptoms. Examination of the results of long-term opioid therapy reveals significant residual pain; similarly, the majority of people who have surgery or have spinal cord stimulators or drug delivery systems implanted continue to report substantial pain (Turk and Okifuji 1998). Because these pain sufferers are not cured, they require regular care and follow-up. We have tended to view chronic pain more as an acute condition that will resolve following treatment, but this is patently not the case. If we view chronic pain as a lifelong disease, then, as with other chronic diseases such as diabetes, we should expect treatment to be ongoing, requiring regular check-up and continuing care. From this perspective, treatment is not over after a few sessions or a 3–4 weeks rehabilitation programme. Instead, we should expect and plan for the need to include booster sessions (Lanes et al. 1995; Bendix et al. 1998). We need to give attention to the development and evaluation of treatments of pain as a chronic disease that is not cured but requires maintenance-enhancement strategies.

In conclusion, we noted the importance of considering a range of factors that contribute to individual differences, and posed a diathesis–stress–environment heuristic model. We focused on psychosocial factors to illustrate the importance of understanding meaningful groups of patients. Similar analyses focusing on genetics, pathophysiology, and environmental variables are also relevant and a need to be considered when developing a treatment plan. At this point, whether treatment tailoring will produce greater effects than providing completely idiographic or generic treatments can only be viewed as a reasonable hypothesis. The fact that a significant proportion of patients with chronic pain are not successfully treated by current general approaches and the identification of various subgroups of patients makes investigation of treatment matching of particular importance.

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