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Multimodal approaches and tailored therapies for pain management: the trolley analgesic model

Authors Cuomo A, Bimonte S, Forte CA, Botti G, Cascella M

Received 2 July 2018

Accepted for publication 2 October 2018

Published 19 February 2019 Volume 2019:12 Pages 711—714

DOI https://doi.org/10.2147/JPR.S178910

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 2

Editor who approved publication: Dr Michael Ueberall


Arturo Cuomo,1,* Sabrina Bimonte,1,* Cira Antonietta Forte,1 Gerardo Botti,2 Marco Cascella1

1Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS - Fondazione G Pascale, Naples, Italy; 2Scientific Direction, Istituto Nazionale Tumori, IRCCS - Fondazione G Pascale, Naples, Italy

*These authors contributed equally to this work

Abstract: Chronic pain is described as a manifestation of real or potential tissue damage. It is identified as a perception influenced by the complex interactions of biological, psychological, and social factors. Different types of pain and their comorbidities dramatically affect patients’ quality of life and their families. Due to diverse etiology and pathogenesis, pain management represents a controversial issue in clinical practice. In 1986, the WHO developed a three-step ladder model based on the use of analgesics for pain management according to pain intensity in a linear up or down movement. Despite its huge value for pain relief, this model has some limitations, and some controversies in the pharmacotherapy of pain management have arisen so far. To bypass these difficulties, the concept of WHO analgesic ladder has been contested and changed into a four bidirectional step model which postulates the use of the invasive procedures (neuromodulatory and neurosurgical procedures). Moreover, with the introduction of the neuromatrix theory for dealing the acute and the chronic pain, the WHO model was newly reinterpreted and changed into a platform analgesic model that includes multimodal pharmacological and alternative treatments applicable to all pain conditions, although excludes the precision therapies. Here, we summarize and revise these concepts in order to propose a new model termed “trolley analgesic model” that will allow adopting tailored therapies with dynamic multimodal approaches for pain management according to 1) the pain intensity, 2) the physiopathology of pain, 3) the complexity of symptoms, 4) the presence of comorbidity, and 5) the physiopathological factors and the social context.

Keywords: cancer and no-cancer pain management, personalized treatment, analgesic trolley, multimodal approaches


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