Studies has been recently carried out to prove epigenetics role in the causation of chronic pain [23], trying to clarify a pain-specific protein interaction network [24, 25].
However, the identification of subgroups is a difficult process, since it cannot yet be guided by a coherent theory of causation of back pain [ 13].
6 Consultations with CLBP patients have been characterized as a meeting of GP and patient models that are incommensurate with the patient using a physical model of pain causation versus the GP's model drawing on psychosocial factors 7 and this further complicates the application of guideline recommendations.
However, it is a chicken-and-egg problem to determine the direction of causation between pain and sleep disturbance.
Because the direction of causation between pain and sleep disturbance is still unclear and a recent perspectives indicate that poor sleep can interfere with pain processing [ 35], effective interventions to tackle sleep disturbance, such as cognitive behavioural therapy [ 36] should be included the overall management of the CLBP patient, to optimise treatment outcome.
A controversy exists about the mechanism of causation of the post-laminectomy pain syndrome.
These persons, rather than hearing the voices of a people long suffering under intolerable conditions, conditions that have claimed the lives of Freddie Gray, and countless others, have exclusively attributed the causation of the people's pain to the people themselves.
Finding reliable treatment for pain and its fundamental causation, including pain reported by patients recovering from post-surgical rotator cuff reconstruction, presents a very real set of challenges.
That does not prove causation, of course.
Causation, of course, is more difficult to interpret then correlation.
