A cumulative strain model for chronic pain and multimorbidity

BACKGROUND: Chronic 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. OBJECTIVE: The 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. DISCUSSION: The 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.