The Complexity of Chronic Pain

Dear Colleagues,

Chronic pain is a devastating type of pain, and its management is challenging for clinicians. It has recently been highlighted as one of the most prominent causes of disability worldwide, and it significantly affects both the individual and society. For example, in a very recent study from Chile, it was found that 0.417% of the national GDP is spent on the management of chronic musculoskeletal pain, and this condition can cause nearly 140.000 years lost due to disability.

Chronic pain is defined as any pain lasting more than three months and can affect about 20% of the whole population. About 10% of people suffer from chronic widespread pain. Chronic pain is also associated with poor quality of life and reduced daily activity, and it is also an enormous burden on the healthcare system. Neuropsychiatric complications include mood disorders, persistent fatigue, cognitive dysfunction, headaches, irritable bowel syndrome, and insomnia.

Cognitive, psychosocial, and emotional factors have a critically important influence on pain perception due to the connectivity of brain regions controlling pain perception, attention or expectation, and emotional states. Imaging studies have confirmed the presence of altered activity in afferent and descending pain pathways, as well as the atrophy of different pain perception regions of the brain, which can result in psychiatric symptoms. The current neurophysiological understanding of pain-related fear is that it is a psychopathological problem in which people who catastrophize about the meaning of pain become trapped in a vicious cycle of avoidance behavior, pain experience, and disability, as recognized in the fear-avoidance model. It has been hypothesized that individuals with chronic pain can change their motor behavior, which is fundamentally an adaptation mechanism aimed at minimizing the real or perceived risk of further pain.

Although advances have been made in treatments for chronic pain, it remains inadequately controlled for many people. Conventional analgesic drugs (NSAIDS) are minimally effective and overused in the management of chronic pain, leading to serious adverse effects and complications such as heart attacks, kidney failure, and gastrointestinal bleeding. Opioids, if properly selected, can be efficacious but are also associated with addiction.

However, the introduction of the neurophysiological model of pain during the past decade stimulated the development of more therapeutically effective and cost-effective interdisciplinary chronic pain management programs, including pharmacological programs.

We invite authors to submit original research and review articles presenting their latest research and developments in this growing field. We further encourage authors to provide research papers exploring the impact and implementation of their clinical findings and outcomes on and in everyday clinical practice.

Potential topics include but are not limited to the following:

• The neurophysiology of chronic pain;
• The neuropsychiatric consequences of chronic pain;
• Multidisciplinary pain management;
• Chronic pain;
• Neuropathic pain in chronic pain syndromes;
• Chronic pain in multiple sclerosis;
• Choric pain in neurodegenerative disorders;
• Neuropsychiatry in lower back pain and failed back syndrome;
• Pain in neurodegenerative disorders;
• Pain in multiple sclerosis;
• The neuropsychiatry of orofacial pain;
• Poststroke pain and depression: a focus on neurophysiology.

You may choose our Joint Special Issue in IJERPH.

Dr. Gergely Fehér
Dr. Délia Szok
Guest Editors

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