Editor's Memo
by Forest A. Tennant, MD, DrPH
 It’s time that chronic pain
be classified and identified as a chronic disease just like asthma, diabetes,
arteriosclerosis, and schizophrenia. Why? A major reason is that chronic pain beautifully
fits the classic paradigm of primary, secondary, and tertiary prevention and which is
commonly applied to chronic diseases.
Primary prevention is preventing development of the disease. Just as a vaccine may
prevent hepatitis, adequate post-operative or post-traumatic analgesia may promote
healing, immune enhancement, and prohibit emergence of a chronic pain syndrome.
Secondary prevention is detecting the disease at an early, pre-clinical stage and
taking steps to stop the clinical emergence of the entity. While high blood sugar or tumor
on a mammogram are obvious examples, nothing is more obvious than obesity or a physical
disability to alert the physician that chronic pain is just around the corner.
Classic tertiary prevention is treating or controlling the clinical disease in a manner
to prevent complications. Now that we know that severe chronic pain may produce such
devastating complications as suicidal ideation, brain atrophy, endocrine changes, immune
suppression, and cardiovascular abnormalities such as hypertension and tachycardia, we
have more than ample reason to aggressively control severe pain to prevent a whole cascade
of adverse events. Without question the epidemic of under-treatment needs to come to a
fast and sure conclusion.
At this time I call for placement of chronic pain in the classic primary, secondary, and
tertiary prevention paradigm because it will help researchers and practitioners to better
focus on our goals. This is the practical way to go.
Forest A. Tennant, MD, DrPH
Editor in Chief
— Jul/Aug 2003
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