RT Book, Section
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.
SR Print(0)
ID 56657939
T1 Chapter 91. Medical Management of Chronic Pain
T2 Anesthesiology, 2e
YR 2012
FD 2012
PB The McGraw-Hill Companies
PP New York, NY
SN 978-0-07-178513-6
LK accessanesthesiology.mhmedical.com/content.aspx?aid=56657939
RD 2024/04/19
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.