Clinical Drug Investigation

, Volume 32, Supplement 1, pp 21–33

The Appropriate Treatment of Chronic Pain


    • Rheumatology UnitL. Sacco University Hospital
  • Renato Vellucci
    • Palliative Care and Pain Therapy UnitUniversity Hospital of Careggi
  • Stefano Maria Zuccaro
    • Department of GeriatricsOspedale Israelitico
  • Paolo Cherubino
    • Department of Orthopaedics and TraumatologyUniversity of Insubria, Ospedale di Circolo-Fondazione Macchi
  • Roberto Labianca
    • Oncology UnitOspedali Riuniti di Bergamo
  • Diego Fornasari
    • Department of Pharmacology, School of MedicineUniversità degli Studi di Milano and CNR-Institute of Neuroscience
Review Article

DOI: 10.2165/11630050-000000000-00000

Cite this article as:
Sarzi-Puttini, P., Vellucci, R., Zuccaro, S.M. et al. Clin Drug Investig (2012) 32: 21. doi:10.2165/11630050-000000000-00000


Chronic pain is a common healthcare problem worldwide that ranks as a predominant reason for consulting a physician, yet effective management of chronic pain remains suboptimal, often resulting in unnecessary suffering and decreased quality of life, lost productivity and excessive healthcare costs. To overcome the challenges associated with the management of chronic pain, increased awareness and both patient and physician education are required. Improving physician knowledge of pain assessment and management guided by recommendations for a comprehensive, multifactorial, personalised treatment approach involving pharmacological and non-pharmacological approaches is key to achieving effective pain relief. Guidelines for the management of non-cancer and cancer pain recommend thorough patient assessment before individualized therapy based on the type and intensity of pain. The availability of mechanism-specific analgesics has facilitated improvements in the treatment of chronic non-cancer pain, which may be of neuropathic, muscle, inflammatory, mechanical/compressive or mixed origin. Stepwise escalation of analgesic therapy (paracetamol, non-steroidal anti-inflammatory drugs, mild to strong opioids) according to the World Health Organization’s three-step pain ladder remains the standard approach for the selection of treatment for chronic cancer pain, although there is now a greater awareness of the requirements for effective administration of opioids including dose titration, use of short versus long-acting opioids, opioid rotation, management of adverse effects, and ongoing monitoring. Selection of an effective, appropriate, personalized analgesic regimen for patients with chronic pain is achievable and is expected to enhance compliance, overall functioning and quality of life.

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© Adis Data Information BV 2012