Introductory Chapter: The Rationale for a Multimodal Approach to Pain Treatment

Abstract

The symptom pain is a perception affected by complex interconnections of biological, psychological, and social factors. Analgesic monotherapy can often provide pain relief in clinical conditions featuring non-severe pain. In other circumstances, such as those characterized by intractable cancer pain, or concerning acute/ chronic non-cancer neuropathic pain, the intensity and quality of the pain require individualized multidrug approaches, with different analgesics and adjuvants used in combination according to clinical practice guidelines published by international and regional professional associations [1]. Moreover, because pharmacological strategies may not be able to successfully treat all patients with acute or chronic pain, nonpharmacological strategies should be included in the analgesic program, supporting and strengthening drug therapy [2]. Again, especially, chronic pain represents a dynamic experience, profoundly changeable in a spatial-temporal manner; thus, standardized and fixed protocols are not universally applicable for pain therapy. From these premises, the individualized, dynamic, and multicomponent pathway is summarized by the concept of the multimodal approach to pain management and represents a real revolution in this field of medicine. This optimization strategy can allow managing the pain by treating this symptom in its variegated clinical expressions through multiple interventions. According to the concept of multimodal therapy, the objective of pain relief is possible by targeting different sites of the nociceptive pathway [3] and by managing the galaxy of pain-related conditions through pharmacologic and nonpharmacologic modalities [4]. However, several considerations should be addressed in order to better understand its rational application for both acute (e.g., postoperative) and chronic pain management.