Disentangling the complexities of persistent pain through a mechanistic approach

Persistent pain is a significant health problem. It is a complicated experience that may be regarded as a disease in its own right (Treede et al., 2019). As a disease it can be viewed from the perspective of disease pathogenesis (Gibbons, 2023). This highlights the multifactorial aetiology of persistent pain and the presence of multiple contributing mechanisms. These mechanisms are highly individualized in how they present, and how they interact with each other. This contributes to uncertainty for the clinician. The purpose of this paper is to provide an overview of the known mechanisms in persistent pain including tissue loading, pain, reward in pain, and immune dysregulation.