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Chronic Pain Treatment should focus on improving function and quality of life.
In the commentary, Ballantyne and Sullivan discuss the growing influence of the basic pain scale (patients' self-reported rating of their pain on a scale of 0-10). For many patients with chronic pain, "especially those who have developed opioid dependence, maintaining low pain scores requires taking continuous or escalating doses of opioids at the expense of worsening function and quality of life." Instead, according to Ballantyne and Sullivan, treatment should focus on helping patients improve their ability to function at work and at home, shifting the focus from pain to moving on with their lives. This shift will require embracing multimodal therapies that encompass behavioral, physical, and integrated medical approaches.
Ballantyne and Sullivan clarify that use of the pain scale for measuring acute or post-surgery pain, as well as for end-of-life pain, is distinct from its use for chronic pain. "When pain is chronic, its intensity isn't a simple measure of something that can be easily fixed," they write. Instead, multiple measures of the complex causes and consequences of pain, including associated depression and anxiety, are needed for effective treatment. "For this purpose, nothing is more revealing than a conversation between a patient and a clinician, which allows the patient to be heard and the clinician to appreciate the patient's experiences and offer empathy, encouragement, mentorship, and hope."