Question 1

What is chronic pain?

Accepted Answer

Chronic pain is pain that persists or recurs for more than three months. Unlike acute pain — which is a protective signal warning of tissue damage — chronic pain often persists after healing or arises from nervous system sensitisation without clear ongoing tissue damage. The 2019 ICD-11 formally recognised chronic pain as a disease in its own right, distinguishing chronic primary pain (with no better explanation) from chronic secondary pain (from cancer, post-surgical causes, neuropathic conditions, headache and musculoskeletal disease).

Question 2

How many people have chronic pain?

Accepted Answer

Chronic pain affects approximately 20-30% of adults globally — an estimated 1.5 billion or more people. It is the leading reason for seeking medical care in many countries and the most prevalent condition driving disability globally. Prevalence increases with age, is higher in women than men, and is elevated in people with depression, anxiety, sleep disorders and social disadvantage.

Question 3

What is the biopsychosocial model of pain?

Accepted Answer

The biopsychosocial model — now the dominant scientific framework for understanding chronic pain — recognises that pain experience is shaped by biological factors (tissue damage, neurological sensitisation, inflammation), psychological factors (mood, catastrophising, fear, beliefs about pain) and social factors (work environment, relationship support, healthcare access, social isolation). This model explains why pain cannot be reduced to a simple injury-response relationship and why purely biomedical treatments are often insufficient.

Question 4

What is central sensitisation?

Accepted Answer

Central sensitisation occurs when the central nervous system becomes persistently hyperexcitable — amplifying pain signals and generating pain from inputs that would not normally be painful. Mechanisms include: increased excitatory neurotransmission (glutamate, NMDA); reduced inhibitory neurotransmission (GABA, opioid); and glial activation in the spinal cord and brain. Central sensitisation explains: allodynia (pain from touch or pressure); hyperalgesia (amplified pain from painful stimuli); widespread pain beyond the original injury site; and pain persistence after healing.

Question 5

What is neuropathic pain?

Accepted Answer

Neuropathic pain arises from damage or disease affecting the somatosensory system — causing sensations described as burning, shooting, electric shock-like or stabbing. Common causes: diabetic peripheral neuropathy; postherpetic neuralgia (from shingles); radiculopathy (from disc compression); trigeminal neuralgia; and neuropathy from cancer treatment (chemotherapy-induced). Standard analgesics are largely ineffective; specific treatments: gabapentin/pregabalin, SNRIs (duloxetine, venlafaxine), tricyclic antidepressants, topical lidocaine/capsaicin.

Question 6

What is the best treatment for chronic pain?

Accepted Answer

Chronic pain requires multimodal management: exercise and physical therapy (the most evidence-based and cost-effective interventions for most chronic pain conditions); psychological therapies (CBT, acceptance and commitment therapy, mindfulness-based approaches — addressing catastrophising, fear-avoidance and psychosocial factors); pharmacological (NSAIDs, SNRIs, gabapentinoids for neuropathic pain, tricyclics — opioids for carefully selected patients only); and complementary therapies (acupuncture for some conditions). Multidisciplinary pain programmes achieve the best outcomes for complex chronic pain.

Question 7

What is fibromyalgia?

Accepted Answer

Fibromyalgia is a chronic widespread pain condition driven by central sensitisation — characterised by widespread musculoskeletal pain, profound fatigue, unrefreshing sleep, cognitive impairment ("fibro fog") and often co-morbid depression and anxiety. It affects approximately 2-4% of adults — predominantly women. Diagnosis is clinical (based on widespread pain index and symptom severity scores — ACR 2016 criteria). Management: aerobic exercise (best evidence); CBT; amitriptyline/duloxetine/pregabalin.

Question 8

What is the global opioid access crisis?

Accepted Answer

The opioid access gap is one of the starkest global health inequities: 83% of the world's medical opioids are consumed by 10% of the population (high-income countries), while billions of people — including cancer patients, post-surgical patients and palliative care patients in LMICs — lack access to adequate opioid pain relief. Regulatory over-restriction, pharmacist/physician fear of legal consequences, lack of opioid prescriber training and supply chain failures all contribute. WHO calls for regulatory reform to balance preventing misuse with ensuring therapeutic access.

Question 9

How are opioids used appropriately for chronic pain?

Accepted Answer

Opioids are appropriate for: cancer pain (WHO Pain Ladder); moderate-severe pain in palliative care; and carefully selected chronic non-cancer pain conditions after non-opioid treatments have been optimised. Prescribing principles: lowest effective dose; regular reassessment; monitoring for misuse and side effects; risk stratification; avoidance in chronic non-cancer pain in most patients. The opioid crisis in North America (driven by OxyContin overprescribing) has led to much stricter prescribing environments — but also inadvertent under-treatment of legitimate pain patients.

Question 10

What is chronic primary pain?

Accepted Answer

ICD-11 introduced "chronic primary pain" as a new diagnostic category — encompassing conditions where chronic pain is itself the disease, not a symptom of another condition: chronic widespread pain (including fibromyalgia); chronic primary headache (migraine, tension-type); chronic primary visceral pain (irritable bowel syndrome); complex regional pain syndrome (CRPS); and primary low back pain. This recognition drives research into these conditions and supports insurance/healthcare access for pain treatment as a legitimate indication.

Question 11

How does pain interact with mental health?

Accepted Answer

Chronic pain and mental health are bidirectionally linked: depression is present in approximately 30-50% of people with chronic pain, and anxiety in approximately 30%; chronic pain approximately doubles the risk of depression; depression predicts worse pain outcomes and poorer response to treatment. Central sensitisation mechanisms overlap significantly with those of depression and anxiety. Treating co-morbid depression and anxiety substantially improves pain outcomes — making integrated biopsychosocial management essential.

Question 12

How does GMJ News cover chronic pain?

Accepted Answer

GMJ News covers ICD-11 chronic pain framework, evidence-based pain management guidelines, opioid access equity, neuropathic pain treatments and the biopsychosocial evidence base. Chronic pain management quality in Georgian hospitals — including adequate analgesia for cancer and post-operative patients — is directly relevant to PHIG's accreditation work and the Georgian Medical Journal.

GMJ News

Chronic Pain

Key messages

Key statistics

Glossary of key terms

Latest GMJ coverage

Frequently asked questions 12 Q&A — structured for Google featured snippets and AI discovery

Knowledge hub: guidelines, conventions and reports

Organizations working in migration and health

Related health topics

Company