TY - CHAP M1 - Book, Section TI - Chapter 91. Medical Management of Chronic Pain A1 - Dews, Teresa E. A1 - Laham, Riad A1 - Ningegowda, Lokesh A1 - Huntoon, Marc A. A2 - Longnecker, David E. A2 - Brown, David L. A2 - Newman, Mark F. A2 - Zapol, Warren M. Y1 - 2012 N1 - T2 - Anesthesiology, 2e AB - Patients with chronic pain usually require multimodal (pharmacologic, behavioral, physical modalities, and procedural) therapies for pain that are chosen based on the underlying mechanism and the impact of the pain on function and suffering.Fear of reinjury, catastrophizing, and poor coping skills may undermine the success of any mode of therapy. Secondary gain (litigation, ongoing workers' compensation) may also undermine successful treatment.The success of opioid therapies in acute pain must be tempered by the realization that for chronic pain treatment, opioid-induced hyperalgesia, pharmacologic tolerance, drug diversion, patient outcomes, and legal issues must be balanced appropriately for optimal care. Continuous monitoring and attention to the physician-patient relationship is vital.Multiple new agents targeting ion channels and neurotransmitters are being developed, with improving efficacy. Optimal use of these agents requires a thorough understanding of their pharmacology as well as the ability to compare their effects through standardized study (allowing meta-analysis) and measures such as "number needed to treat" analysis.New studies examining combination therapy (eg, an opioid plus anticonvulsant agent) are likely to represent future practice because of the complexity of pain treatment and the realization that one agent is rarely sufficient.Several studies suggesting that physical modalities plus cognitive-behavioral interventions are equivalent to large surgical procedures are interesting. These studies point to a future blending of traditionally separate pain clinic and pain rehabilitative programs to include even more comprehensive approaches. SN - PB - The McGraw-Hill Companies CY - New York, NY Y2 - 2024/03/28 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=56657939 ER -