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Review
. 2024 Jun;28(6):525-534.
doi: 10.1007/s11916-024-01249-z. Epub 2024 Apr 1.

Assessing Risk Factors and Comorbidities in the Treatment of Chronic Pain: A Narrative Review

Sage V Hebert  1 , Melanie A Green  1 , Sydney A Mashaw  1 , William D Brouillette  1 , Angela Nguyen  1 , Kylie Dufrene  1 , Anitha Shelvan  2 , Shilpadevi Patil  2 , Shahab Ahmadzadeh  2 , Sahar Shekoohi  3 , Alan D Kaye  2   4
Affiliations
Review

Assessing Risk Factors and Comorbidities in the Treatment of Chronic Pain: A Narrative Review

Sage V Hebert et al. Curr Pain Headache Rep. 2024 Jun.

Abstract

Purpose of review: Chronic pain affects a significant portion of the population globally, making it a leading cause of disability. Understanding the multifaceted nature of chronic pain, its various types, and the intricate relationship it shares with risk factors, comorbidities, and mental health issues like depression and anxiety is critical for comprehensive patient care. Factors such as socioeconomic status (SES), age, gender, and obesity collectively add layers of complexity to chronic pain experiences and pose management challenges.

Recent findings: Low SES presents barriers to effective pain care, while gender differences and the prevalence of chronic pain in aging adults emphasize the need for tailored approaches. The association between chronic pain and physical comorbidities like cardiovascular disease, chronic obstructive pulmonary disease (COPD), and diabetes mellitus reveals shared risk factors and further highlights the importance of integrated treatment strategies. Chronic pain and mental health are intricately linked through biochemical mechanisms, profoundly affecting overall quality of life. This review explores pharmacologic treatment for chronic pain, particularly opioid analgesia, with attention to the risk of substance misuse and the ongoing opioid epidemic. We discuss the potential role of medical cannabis as an alternative treatment with a nuanced perspective on its impact on opioid use. Addressing the totality and complexity of pain states is crucial to individualizing chronic pain management. With different types of pain having different underlying mechanisms, considerations should be made when approaching their treatment. Moreover, the synergistic relationship that pain states can have with other comorbidities further complicates chronic pain conditions.

Keywords: Anxiety; Chronic pain; Comorbidity; Obesity; Opioids; Risk factors; Socioeconomic status.

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