Complex and Chronic Pain

Pain often occurs with acute injury, but typically subsides with healing so individuals can return to their original quality of life. In other cases, pain may persist and become a chronic condition. The challenge is in knowing when to intervene before the pain no longer responds to effective interventions.

When pain symptoms don’t resolve as expected, early biopsychosocial intervention is recommended to prevent the problem from becoming a chronic condition. Warning signs often observed in emerging pain cases include:

  • Escalating opioid use
  • Failed clinical interventions
  • Delays in returning to work
  • Maladaptive pain behaviors
  • An expanding list of diagnoses
  • Pain, rather than function, becoming the focus of treatment

It is important to understand that complex pain has biological, psychological and social components, and is a chronic, progressively debilitating condition rather than a simple biological response to an injury. Complicating the prognosis is the fact that not all pain conditions progress down the same predictable path. This is because pain is interpreted and experienced by individuals based on their unique pain tolerance, fears, cultural and experiential background. The subjective experience of pain affects one’s life and adds stress to it. Likewise, life and stress affect one’s pain.

Complex and Chronic Pain Treatment and Complications

In addition to common causes like back injuries and repetitive motion, many medical conditions, such as arthritis, lupus, multiple sclerosis and even stress, can have generalized pain as a common symptom. It is important to evaluate for such conditions when the reason for a diagnosis of chronic pain is unclear. Similarly, it is vital to understand the psychological and social factors that can affect one’s expectations, medical decision making and recovery from complex pain.

The main challenge in addressing complex pain is distinguishing the specific factors in play and selecting the right multidisciplinary treatment plan to interrupt the progression toward a chronic pain condition. For many injured workers, this treatment approach is absent, leading to worsened condition. Studies have proven that an evidence-based, multidisciplinary treatment of chronic pain to be most successful. No other approach has consistently demonstrated positive outcomes with respect to decreased health care utilization, reduction of opioid use, increased function and return to work.


Success requires a skilled interdisciplinary treatment team working with a biopsychosocial approach to address the entire condition. Paradigm’s model incorporates a biopsychosocial orientation, injured worker and physician engagement, consistent use of evidence-based medical guidelines and multidisciplinary treatment managed by diagnosis clarification, coordinated care and informed monitoring interventions.