PREFACE

In his Foreward to the first edition of this book,
Clinical Pain Management: A Practical Guide, Ron
Melzack emphasized that pain has many dimensions on
and that, despite advances in pain management and
understanding, chronic pain in particular continues
to be a major health concern.

This, unfortunately,is still the case and many challenging problems still
exist in managing and understanding chronic pain.
The Introductory chapter of this second edition of the book by its three editors, Drs.

Lynch, Craig and Peng, draws attention to the challenges that exist for people living with chronic pain conditions, for the clinician trying to provide effective management of the patient’s pain, for the scientist seeking to unravel the mechanisms underlying pain, and for society asa whole.

These challenges stem from the complex-ity and multidimensional nature of chronic pain,the limited understanding of the processes underly-
ing most chronic pain conditions, and the variety of diagnostic and therapeutic approaches advocated for pain management, some of which have little to no solid evidence base to support their use. Fur-thermore, chronic pain is in epidemic proportionsin most countries, with a prevalence of around 20% or even higher, and the problem is compounded by problems with access to care and socioeconomic fac tors.

Additionally, like many other chronic health disorders or diseases, the majority of chronic pain conditions are most common in the elderly. There-fore, unless effective steps are taken soon to address this crisis, their prevalence and associated problems will continue to grow over the coming decades be-cause demographic predictions indicate that the elderly will comprise a growing proportion of the population in most countries.
Chronic pain can indeed be considered a “silent” epidemic because most people, including policy-makers, have been unaware of this crisis and its ramifications.

As a consequence, chronic pain has remained neglected to a large extent, despite clinical and scientific publications and pain-related societies
and organizations pointing out its prevalence, the continuing difficulties and inequities with access to timely and appropriate care for many patients living with pain, and the enormous socioeconomic burden
of chronic pain. The societal costs of chronic pain are reflected in patients’ suffering and reduced qual-ity of life, increased rates of depression and suicide,disrupted relationships with family and friends, and
reduced employment or other responsibilities.

The economic burden is also huge, amounting to many
billions of dollars each year.

Unfortunately, it has taken media attention in recent years to the misuse
of drugs used for pain management, most notably opioids, to raise public awareness and to gain the at-tention of policymakers not only to the drug misuse,but also to the pain crisis itself and the socioeco-nomic toll of chronic pain in particular.

 It is hoped that this increased attention will translate into a
comprehensive series of approaches targeting the many aspects of the pain crisis and result in a bet-ter understanding of pain and improved access and healthcare management for patients suffering from
acute or chronic pain.

These approaches to address the pain crises have to include an increased emphasis on enhanced edu-cation of healthcare clinicians about pain because it has been well documented that most clinicians have only a limited knowledge base and understand-ing about pain and its management.

This book of- fers the opportunity for clinicians to improve their knowledge about pain and apply that knowledge for the benefit of their patients.

The three editors of this book have ensured that its second edition has
built upon the first edition which was distinctive in its integration of the clinical, psychosocial and basic science topics related to the different types of pain and their management. As a result of the up-to-date information outlined in the 44 chapters of its sec-ond edition, this book provides a valuable resource about pain from a variety of perspectives. It will be particularly valuable not only for clinicians to help them assist their patients experiencing an acute pain or suffering from chronic pain, but also for scientists who wish to gain more insights into these pain con-
ditions and their underlying processes.