Year: 2025
Type: article
Abstract: BackgroundChronic pain often occurs amidst multimorbidity.The proposed cumulative strain model postulates diverse but interlinked biological mechanisms of strain playing a role in the causation of multiple chronic conditions, including chronic pain.Modulators of strain include mindbody, connection, activity, nutrition and biomedical aspects.These modulators can be targeted therapeutically to bring a shift towards wellness. ObjectiveThe aim of this paper is to highlight common mechanisms underpinning chronic conditions and prompt consideration of how these mechanisms might be targeted therapeutically in primary care. DiscussionThe recognition of common underlying mechanisms and treatments for chronic conditions, including chronic pain, opens the way for consideration of generic chronic condition programs in primary care, and hence a reduced requirement for condition-specific specialist referrals.THE CURRENT EPIDEMIC of chronic conditions and multimorbidity threatens to overwhelm the capacity of health systems in Australia and across the developed world.The biomedical model that has delivered strongly in the treatment of acute conditions has largely failed in the context of chronic care.Addressing chronic conditions as multiple 'single diseases', rather than with an integrated approach, brings health system inefficiency and suboptimal outcomes for individuals.This article is written by clinicians from a tertiary multidisciplinary chronic pain team.Our perspective reflects the rarity of seeing a patient with pain but no other chronic conditions at the service.In addition to chronic pain, a typical patient might present with depression, type 2 diabetes, obesity, asthma, hypertension and gastroesophageal reflux disease.The perspective is also informed by the view that the whole-person approach used for the treatment of chronic pain at the service has relevance to multiple chronic conditions. 1 A cumulative strain model (Figure 1) is proposed that recognises shared biological mechanisms underlying many chronic conditions.This underlines the untapped potential for generalisable treatments, particularly with respect to behavioural and lifestyle interventions.The model also acknowledges a select role for evidence-based, condition-specific biomedical treatments.
Authors: Chris Hayes, Laura Bruggink, Hema Rajappa, Katherine Brain, Matthew Pols
Institution: University of Newcastle Australia
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4408246279