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Introduction to the Symposium on Pain Medicine

      This issue of Mayo Clinic Proceedings includes the beginnings of an ambitious series of articles spanning the broad field of pain medicine. A nationally and internationally recognized group of leading pain experts has been assembled to author a series of articles specifically tailored for a general medical readership. This perspective is important because most patients with medical and surgical conditions associated with pain receive care in a general medical setting.
      • Clark J.D.
      Chronic pain prevalence and analgesic prescribing in a general medical population.
      • Reid M.C.
      • Engles-Horton L.L.
      • Weber M.B.
      • Kerns R.D.
      • Rogers E.L.
      • O'Connor P.G.
      Use of opioid medications for chronic noncancer pain syndromes in primary care.
      Since 1998, pain medicine has been a recognized medical subspecialty certified by the American Board of Medical Specialties. According to the Accreditation Council for Graduate Medical Education, pain medicine is a “discipline of medicine [specializing] in the [care] of patients suffering from acute or chronic pain, or pain in patients requiring palliative care.”

      Accreditation Council for Graduate Medical Education. ACGME Program Requirements for Graduate Medical Education in Pain Medicine (Anesthesiology, Neurology, Physical Medicine and Rehabilitation, or Psychiatry). ACGME approved focused revision with categorization: September 29, 2013; effective July 1, 2014. http://acgme.org/acgmeweb/Portals/0/PFAssets/ProgramRequirements/530_pain_medicine_07012014_1-YR.pdf. Accessed October 15, 2014.

      ,p1 Physicians successfully completing residences in anesthesiology, physical medicine and rehabilitation, neurology, or psychiatry are eligible for board certification after completion of a 1-year accredited fellowship training program. However, many physicians in other specialties, such as family medicine, internal medicine, surgery, and emergency medicine, elect to do pain medicine fellowships under the auspices of one of the aforementioned specialties. Currently, there are 96 accredited civilian and 4 accredited armed forces fellowship training programs in the United States, and approximately 265 physicians successfully complete training annually.
      Pain is a ubiquitous component of human existence, and it is encountered in medical practice on a daily basis. This is reflected in the Global Burden of Disease 2010 study, in which low-back pain was reported to be the leading cause of years lived with disability, with neck pain ranked number 4.
      US Burden of Disease Collaborators
      The state of US health, 1990-2010: burden of diseases, injuries, and risk factors.
      Despite decades of work, the taxonomy of pain remains underdeveloped
      • Jamison R.N.
      • Rudy T.E.
      • Penzien D.B.
      • Mosley Jr., T.H.
      Cognitive-behavioral classifications of chronic pain: replication and extension of empirically derived patient profiles.
      • Knudsen A.K.
      • Brunelli C.
      • Klepstad P.
      • et al.
      Which domains should be included in a cancer pain classification system? analyses of longitudinal data.
      • Turk D.C.
      The potential of treatment matching for subgroups of patients with chronic pain: lumping versus splitting.
      • Turk D.C.
      • Rudy T.E.
      IASP taxonomy of chronic pain syndromes: preliminary assessment of reliability.
      ; however, many experts choose to categorize pain syndromes as musculoskeletal, inflammatory, or neuropathic. Neuropathic pain also encompasses central pain states that result from lesions or disease processes of the central nervous system.
      • Lambert M.
      ICSI releases guideline on chronic pain assessment and management.
      The articles in the Symposium are generally organized around these broad categories for 2 important reasons. First, these categories allow many commonly occurring pain syndromes to be grouped together. For example, patients with musculoskeletal low-back or neck pain can be grouped together and distinguished from patients with neuropathic pain stemming from diabetic peripheral neuropathy. Second, the principal pathophysiologic mechanisms that contribute to pain vary among the specified groups, although there is significant overlap. This is clinically important because awareness of the underlying pathogenesis could drive diagnostic decisions and selection of the most appropriate treatments. However, it is important to recognize that many commonly occurring pain syndromes have characteristics of more than 1 category; most notable is radicular spine pain, whereby patients frequently exhibit signs and symptoms of both musculoskeletal and neuropathic pain.
      The inaugural article of the Symposium on Pain Medicine published in this issue of Mayo Clinic Proceedings highlights the epidemiologic features and broad economic impact of pain.
      • Henscke N.
      • Kamper S.J.
      • Maher C.G.
      The epidemiology and economic consequences of pain.
      This article is intended to set the stage for subsequent articles on commonly occurring pain syndromes, including chronic low-back and neck pain, neuropathic pain, fibromyalgia and functional pain states, central pain states, cancer-related pain, and headache. In addition to the articles focused on specific pain syndromes, the Symposium on Pain Medicine also includes articles pertaining to potentially controversial or underrecognized treatment modalities, including prescription opioid analgesics, behavioral interventions, and complementary and alternative therapies. Finally, the series includes an article that focuses on the pioneering research that has elucidated the mechanisms responsible for the transition of acute to chronic pain and another article that highlights recent advances in pain genetics.
      This current endeavor extends the long and rich tradition of Mayo Clinic Proceedings in developing and promoting high-quality educational materials for primary care specialists.
      • Matteson E.L.
      • Terzic A.
      Introduction to the symposium on regenerative medicine.
      • Gerber T.C.
      • Asirvatham S.J.
      • Lavie C.J.
      • Oh J.K.
      Introduction to symposium on cardiovascular diseases.
      • Evans J.M.
      • Fleming K.O.
      Symposium on geriatrics: introduction.
      • Simonet W.T.
      • Sim F.H.
      Symposium on sports medicine, part I: current concepts in the treatment of ligamentous instability of the knee.
      • Goldstein N.P.
      • Owen Jr., C.A.
      Introduction: symposium on copper metabolism and Wilson's disease.
      • Steinhilber R.M.
      • Kuluvar V.D.
      • Anderson D.J.
      • Heilman R.O.
      • Hansen P.L.
      Symposium on the problem of the chronic alcoholic.
      At the completion of the Symposium on Pain Medicine series, we will explore collating the articles into a single volume to function as a resource for use in a general medical setting. However, most important, through the Mayo Clinic Proceedings Symposium on Pain Medicine, it is anticipated that clinicians will expand their knowledge of pain medicine, which could lead to improvements in the care of patients with pain.

      Supplemental Online Material

      References

        • Clark J.D.
        Chronic pain prevalence and analgesic prescribing in a general medical population.
        J Pain Symptom Manage. 2002; 23: 131-137
        • Reid M.C.
        • Engles-Horton L.L.
        • Weber M.B.
        • Kerns R.D.
        • Rogers E.L.
        • O'Connor P.G.
        Use of opioid medications for chronic noncancer pain syndromes in primary care.
        J Gen Intern Med. 2002; 17: 173-179
      1. Accreditation Council for Graduate Medical Education. ACGME Program Requirements for Graduate Medical Education in Pain Medicine (Anesthesiology, Neurology, Physical Medicine and Rehabilitation, or Psychiatry). ACGME approved focused revision with categorization: September 29, 2013; effective July 1, 2014. http://acgme.org/acgmeweb/Portals/0/PFAssets/ProgramRequirements/530_pain_medicine_07012014_1-YR.pdf. Accessed October 15, 2014.

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        The state of US health, 1990-2010: burden of diseases, injuries, and risk factors.
        JAMA. 2013; 310: 591-608
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        • Mosley Jr., T.H.
        Cognitive-behavioral classifications of chronic pain: replication and extension of empirically derived patient profiles.
        Pain. 1994; 57: 277-292
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        • Brunelli C.
        • Klepstad P.
        • et al.
        Which domains should be included in a cancer pain classification system? analyses of longitudinal data.
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        The potential of treatment matching for subgroups of patients with chronic pain: lumping versus splitting.
        Clin J Pain. 2005; 21: 44-55
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        IASP taxonomy of chronic pain syndromes: preliminary assessment of reliability.
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        The epidemiology and economic consequences of pain.
        Mayo Clin Proc. 2015; 90: 139-147
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        • Terzic A.
        Introduction to the symposium on regenerative medicine.
        Mayo Clin Proc. 2013; 88: 645-646
        • Gerber T.C.
        • Asirvatham S.J.
        • Lavie C.J.
        • Oh J.K.
        Introduction to symposium on cardiovascular diseases.
        Mayo Clin Proc. 2008; 83: 1168-1169
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        Symposium on geriatrics: introduction.
        Mayo Clin Proc. 1995; 70: 683-684
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        Symposium on sports medicine, part I: current concepts in the treatment of ligamentous instability of the knee.
        Mayo Clin Proc. 1984; 59: 67-76
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        Introduction: symposium on copper metabolism and Wilson's disease.
        Mayo Clin Proc. 1974; 49: 363-367
        • Steinhilber R.M.
        • Kuluvar V.D.
        • Anderson D.J.
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        Symposium on the problem of the chronic alcoholic.
        Mayo Clin Proc. 1967; 42: 705-723

      Linked Article

      • The Epidemiology and Economic Consequences of Pain
        Mayo Clinic ProceedingsVol. 90Issue 1
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          Pain is considered a major clinical, social, and economic problem in communities around the world. In this review, we describe the incidence, prevalence, and economic burden of pain conditions in children, adolescents, and adults based on an electronic search of the MEDLINE and EMBASE databases for articles published from January 1, 2000, through August 1, 2014, using the keywords pain, epidemiology, burden, prevalence, and incidence. The impact of pain on individuals and potential risk factors are also discussed.
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