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KEY CONCEPTS
Understanding the pathogenesis of pain should guide treatment and patient education.
Whenever possible ask patients if they have pain to identify the source of pain and to assess the characteristics of the pain.
The etiology of pain may not always be identifiable.
A multidisciplinary approach that includes incorporation of nonpharmacologic strategies for pain management should be undertaken.
Chronic pain treatment should focus on self-management strategies and focus on active rather than passive approaches.
Selection of nonopioids and opioids should be based on the characteristics and type of pain as well as individual patient factors.
Oral or topical analgesics are preferred over other dosage forms whenever feasible, but it is important to adjust the route of administration based on the patient's needs.
Patients taking analgesics should be monitored for response (analgesia, functionality, quality-of-life) and medication adverse effects.
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.
Consider a trial of opioids in those with severe pain who have failed nonpharmacologic and nonopioid treatment only when the anticipated benefits are expected to outweigh the risks.
Use risk mitigation strategies such as informed consent/patient agreements, urine toxicology monitoring, opioid overdose education and naloxone distribution (OEND), and prescription drug monitoring programs (PDMP) checks when necessary.
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BEYOND THE BOOK
Watch the following videos on YouTube to learn more about this topic:
Understanding pain and what to do about it in less than 5 minutes—presented by Painaustralia
URL: https://tinyurl.com/yxjyltp6
Tame the beast: It’s time to rethink persistent pain—Lorimer Moseley, David Moen, Sam Chisholm
URL: https://tinyurl.com/y2nbtbb2
The mystery of chronic pain—Elliot Krane
URL: https://www.ted.com/talks/elliot_krane_the_mystery_of_chronic_pain?language=en
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If we know that pain and suffering can be alleviated, and do nothing about it, then we ourselves, become the tormentors.
—Primo Levi1
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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 why 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.”
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Regrettably, many healthcare providers do not receive adequate training in pain management. Therefore, understanding its pathophysiology and maintaining a thorough understanding of both nonpharmacologic and pharmacologic treatment modalities are important factors in addressing pain control.
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Data collected by the National Health Interview Survey suggest that greater than 50 million persons in the United States live with chronic pain.5 Of whom, 7.5% report ...