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  • Print publication year: 2008
  • Online publication date: December 2009

Chronic pain

from General considerations

Summary

The approach to the patient with chronic pain should indeed be different to that for a patient with acute pain. Patients with chronic pain conditions tend to take analgesics for far longer than the few days or weeks that suffice for acute pain. Opioids and NSAIDs are often ineffective or contraindicated for chronic pain conditions. Effective analgesia in chronic pain may be gained by the use of antidepressants or anticonvulsants in patients who lack depressive symptoms or seizures. There are many forms of pain contract, but the common element to all is an agreement on a plan for managing chronic pain. One of the most important components of a pain contract is the patient's pledge to safekeep their medicines. Clinicians should be aware that sometimes patients with legitimate pain are relegated to drug-seeking behavior in order to achieve the pain relief to which they are entitled.

References

1. Hayden JA, van Tulder MW, Malmivaara AV, et al. Meta-analysis: exercise therapy for nonspecific low back pain.Ann Intern Med. 2005;142(9):765–775.
2. Martell BA, O’Connor PG, Kerns RD, et al. Systematic review: opioid treatment for chronic back pain: prevalence, efficacy, and association with addiction. Ann Intern Med. 2007;146(2):116–127.
3. Koes BW, Scholten RJ, Mens JM, et al. Efficacy of non-steroidal anti-inflammatory drugs for low back pain: a systematic review of randomised clinical trials. Ann Rheum Dis. 1997;56(4):214–223.
4. van Tulder MW, Koes BW, Bouter LM. Conservative treatment of acute and chronic nonspecific low back pain. A systematic review of randomized controlled trials of the most common interventions. Spine. 1997;22(18):2128–2156.
5. van Tulder MW, Scholten RJ, Koes BW, et al. Nonsteroidal anti-inflammatory drugs for low back pain: a systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine. 2000;25(19):2501–2513.
6. Hur C, Chan AT, Tramontano AC, et al. Coxibs versus combination NSAID and PPI therapy for chronic pain: an exploration of the risks, benefits, and costs. Ann Pharmacother. 2006;40(6):1052–1063.
7. Freynhagen R, Busche P, Konrad C, et al. [Effectiveness and time to onset of pregabalin in patients with neuropathic pain.] Schmerz. 2006;20(4):285–288, 290–282.
8. Millard WB. Grounding frequent flyers, not abandoning them: drug seekers in the ED. Ann Emerg Med. 2007;49(4):481–486.
9. Marco JMC, Larkin G. From Hippocrates to HIPAA: privacy and confidentiality in emergency medicine. Ann Emerg Med. 2005;45(1):53–67.