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For the Chapter in the Schwinghammer, Handbook (not Wells Handbook anymore) please go to Chapter 56, Pain Management.



  • image Understanding the pathogenesis of pain, helps to guide treatment and patient education.

  • image It is important, whenever possible, to ask patients if they have pain, to identify the source of pain, and to assess the characteristics of the pain.

  • image The etiology of pain may not always be identifiable.

  • image Whenever possible, a multidisciplinary approach and nonpharmacologic strategies should be incorporated.

  • image Chronic pain treatment should focus on self-management strategies and focus on active, rather than passive approaches.

  • image Selection of nonopioids and opioids should be based on the characteristics and type of pain as well as individual patient factors.

  • image Oral or topical analgesics are preferred over other dosage forms whenever feasible, but it is important to adjust the route of administration to the needs of the patient.

  • image Patients taking analgesics should be monitored for response (analgesia, functionality, quality-of-life) and side effects.

  • image Doses must be individualized for each patient and administered for an adequate duration of time. Around-the-clock regimens should be considered for acute and chronic pain. As-needed regimens should be used for breakthrough pain or when acute pain displays wide variability and/or has subsided greatly.

  • image Consider a trial of opioids in those with severe pain that have failed nonpharmacologic and nonopioid treatment when the anticipated benefits are expected to outweigh the risks.

  • image Use risk mitigation strategies (informed consent/patient agreements, urine drug monitoring [UDM], opioid overdose education and naloxone distribution, prescription drug monitoring program [PDMP] checks) prior to and periodically during opioid therapy, with frequency determined on the basis of patient risk and presence of aberrant drug-taking behaviors.


Preclass Engaged Learning Activity

Students are requested to watch the following videos on YouTube:

Understanding pain and what to do about it in less than 5 minutes—presented by Painaustralia


Tame the beast: It’s time to rethink persistent pain — Lorimer Moseley, David Moen, Sam Chisholm



If we know that pain and suffering can be alleviated, and do nothing about it, then we ourselves, become the tormentors.

—Primo Levi1

Humans have always known and sought relief from pain.2 Today, pain’s impact on society is still great, and pain remains a primary reason patients seek medical advice.3 In general, pain is defined as: “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.”4 However, as pain is subjective, many clinicians define pain as “whatever the patient says it is.”

Regrettably, many healthcare providers do not receive adequate training in the treatment of pain. Therefore, understanding the pathophysiology of pain and maintaining a thorough understanding of both nonpharmacologic and pharmacologic treatment ...

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