Professional education for complexity-informed pain care

When Chronic Pain Recovery Stalls,
Look Beyond the Pain Score.

Pain complexity is more than pain intensity. It's the physical, functional, emotional, cognitive, social, and healthcare-related factors that accumulate over time and make recovery harder to understand and manage.

PainComplexity.com provides a framework for clinicians and care teams to see the bigger picture — and the Pain Recovery Profile™, the structured starting point for putting it into practice.

By Marisela Cigliuti, BSN, RN, CCDS — registered nurse & clinical documentation specialist.

Schedule a Free Provider Consultation →
For clinicians and care teams

Does this sound familiar?

You have patients who —

  • Continue to struggle despite appropriate treatment
  • Have seen multiple providers without lasting improvement
  • Feel overwhelmed, discouraged, or unsure what to try next
  • Have recovery barriers that don’t fit neatly into a diagnosis or pain score

The challenge may not be identifying the pain. It may be understanding what’s making recovery harder.

The real question

Pain intensity asks one question. Recovery asks another.

Chronic pain assessment often answers:

  • Where does it hurt?
  • How intense is the pain?
  • What is the diagnosis?

A useful starting point — but it may not explain what’s shaping recovery or what the plan should prioritize.

But when recovery stalls, the more useful questions are often about:

  • Flare patterns
  • Function
  • Confidence
  • Healthcare experiences
  • Daily life
  • Recovery readiness

Pain intensity isn't the same as pain complexity. Someone can have severe pain with a straightforward recovery picture — or moderate pain with a recovery picture that's genuinely complicated. Complexity describes what's accumulated around the pain, not how much it hurts.

Recovery isn’t shaped by pain alone.

About the framework

The Pain Complexity Screening Tool™

The PCST is a pilot-stage framework designed to help organize the factors that may be making recovery more difficult into meaningful domains — supporting clearer clinical conversations and more individualized care planning.

It is intended to support, not replace, clinical judgment.

Research grounding

Grounded in current pain science

Pain functions as a protective signal, not just a tissue-damage indicator. A 2026 narrative review reframes pain as a response to a “need state” for safety — a reinterpretation of Patrick Wall's original proposition that pain is “better classified as an awareness of a need state than as a sensation.” Fatigue, anxiety, and disrupted sleep that travel alongside pain are better understood as co-actions of the same protective system than as separate, unrelated conditions. [1]

Chronic pain is common, and more common with age. A 2026 meta-analysis of 52 studies (nearly 290,000 participants) found an overall pooled prevalence of 26.99%, rising from 24.23% in adults 18–45 to 46.68% in adults over 45. [2]

Mood symptoms accompany chronic pain at high rates. A 2025 meta-analysis of 376 studies (347,468 individuals, 50 countries) found clinically significant depression in 39.3% and anxiety in 40.2% of adults with chronic pain — highest among those with fibromyalgia and nociplastic pain patterns. [3]

Pain Profile uses a 12-item subset of the framework; Pain Recovery Profile™ uses the complete 25-item version. Both are still in pilot validation (see current pilot) — what they organize reflects domains the literature already treats as central to why recovery stalls, not categories invented without grounding.

References

  1. Jones LE. Pain as a whole person experience – embracing biopsychosocial clinical reasoning. PAIN Research. 2026;41:44–56. doi:10.11154/pain.41.44
  2. Saxena AK, Singh N, Chilkoti GT, Gulabani M, Malhotra RK. Prevalence of chronic pain in the general population: A systematic review and meta-analysis. Indian J Med Res. 2026;163:355–370. doi:10.25259/IJMR_1935_2025
  3. Aaron RV, Ravyts SG, Carnahan ND, et al. Prevalence of Depression and Anxiety Among Adults With Chronic Pain: A Systematic Review and Meta-Analysis. JAMA Netw Open. 2025;8(3):e250268. doi:10.1001/jamanetworkopen.2025.0268
The process

A Structured Approach to Pain Recovery Conversations

Current pilot: We're evaluating how the Pain Recovery Profile™ helps clinicians organize recovery barriers and support more individualized care conversations. Referrals and free Pain Profiles are available now, at pilot scope and capacity.

Learn

Pain Complexity Framework

Explore the broader factors that may influence recovery and care needs.

About the framework →
Apply

Pain Recovery Profile™

Currently available through provider referral during the pilot — not yet a self-serve option.

Develop

Pilot & Validation

Both profiles are still in pilot validation. We're evaluating how they help organize recovery barriers and support more individualized care conversations.

Educate

Care Planning Thursdays

Live, case-based learning in clinical reasoning and complexity-informed care planning.

View upcoming education →
Schedule a Free Provider Consultation →
The goal

Why This Matters

Understanding pain is important. Understanding why recovery has stalled may be even more important.

The goal isn’t to create another score. The goal is to support better conversations, clearer care planning, and more individualized recovery strategies.

Scope and clarity

Pain Complexity is not:

  • a diagnosis
  • a measure of pain severity
  • a determination of tissue damage
  • a psychiatric diagnosis
  • a prediction of treatment response
  • a replacement for clinical judgment

It's a framework for organizing the broader factors that may influence a person's recovery experience and care needs.

Prefer live, case-based learning? Join Care Planning Thursdays.

Upcoming education

Care Planning Thursdays

The first series begins September 2026. Each session includes a focused teaching topic, structured complexity mapping, a de-identified case reflection, care-planning discussion, and Q&A.

Initial 4-session series: September · October · November · December — one session per month.

The inaugural series will focus on:

Pain intensity vs pain complexity Recovery readiness Complex case review Flare instability & function Treatment fatigue Scope, referral & collaborative care Measuring progress beyond pain reduction
Register for Care Planning Thursdays — $49 →

Seats are limited for case discussion. Registration details announced to the interest list first.

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I have had the pleasure of working with Marisela on projects to disseminate information and awareness about chronic pain/neuroplastic pain in both the Hispanic community & with the perinatal population (pregnancy & postpartum). Marisela is highly skilled and knowledgeable in these areas, and is a great asset to the community!

Eva Schonfeld Reichel, LCSW

Psychotherapist, CBT of Central and South Florida  ·  Founding Board Member & Student Membership Chair, CBT Alliance of Florida

About the educator

Marisela Cigliuti, BSN, RN, CCDS

Marisela Cigliuti, BSN, RN, CCDS — registered nurse and pain recovery educator

Marisela Cigliuti, BSN, RN, CCDS brings together nursing, neurology, complex-care review, clinical documentation, pain education, and lived experience with persistent pain. The framework emerged from watching how fragmented pain care can become across providers, specialties, and treatment episodes.

Her pain education work is also informed by training in Pain Reprocessing Therapy, Emotional Awareness and Expression Therapy, mindfulness, trauma-informed care, and her own lived experience with persistent pain.

The education is informed by the Pain Complexity Screening Tool™ framework — a structured approach for identifying recovery barriers that may affect function, engagement, treatment matching, and care planning. It is a care-planning framework, not a diagnostic instrument, and it never replaces clinical judgment.

For healthcare organizations

When complexity is identified, care can finally match it.

Clearer recovery picture

Barriers that stall progress get named instead of guessed at.

Better-matched care plans

Support, referrals, and pacing reflect what's actually in the way — not a generic protocol.

A clearer reason to reconsider the plan

When progress stalls, the framework offers another way to examine what may be missing from the current picture.

Better-matched care planning

Recovery barriers can be identified and discussed more explicitly, helping teams consider whether the current plan reflects the patient's actual needs.

Professional inquiries

Training questions, case-review interest, speaking, collaboration, or referrals

For professional inquiries, schedule a free provider consultation or use the professional inquiry form below. You can also connect on social media — all are checked personally.

Contact Us — professional inquiry form

This form is not for emergencies or patient-specific clinical advice. Do not submit protected health information, medical records, or identifiable patient details.