Chronic pain is described as a manifestation of real or potential tissue damage. It is identified as a perception influenced by the complex interactions of biological, psychological, and social factors. Different types of
pain and their comorbidities dramatically affect patients' quality of life and their families. Due to diverse etiology and pathogenesis,
pain management represents a controversial issue in clinical practice. In 1986, the WHO developed a three-step ladder model based on the use of
analgesics for
pain management according to
pain intensity in a linear up or down movement. Despite its huge value for
pain relief, this model has some limitations, and some controversies in the
pharmacotherapy of
pain management have arisen so far. To bypass these difficulties, the concept of WHO
analgesic ladder has been contested and changed into a four bidirectional step model which postulates the use of the invasive procedures (neuromodulatory and
neurosurgical procedures). Moreover, with the introduction of the neuromatrix theory for dealing the acute and the
chronic pain, the WHO model was newly reinterpreted and changed into a platform
analgesic model that includes multimodal pharmacological and alternative treatments applicable to all
pain conditions, although excludes the precision
therapies. Here, we summarize and revise these concepts in order to propose a new model termed "trolley
analgesic model" that will allow adopting tailored
therapies with dynamic multimodal approaches for
pain management according to 1) the
pain intensity, 2) the physiopathology of
pain, 3) the complexity of symptoms, 4) the presence of comorbidity, and 5) the physiopathological factors and the social context.