Management and Pharmacotherapy of Chronic Pain Syndromes Including Opioid Pharmacotherapy

Abstract

Emphasizing the importance of an interdisciplinary approach in the treatment and management of patients with chronic pain syndromes (CPS), this article reviews, first, non-pharmacologic approaches and modalities for CPS patients, and next, pharmacologic approaches for CPS patients. Flexibility and the use of multiple modalities are emphasized. The article concludes with the controversial subject of the use of long-term analgesic opioid pharmacotherapy in patients with chronic benign pain syndromes.

Chronic Benign Pain

“…Notwithstanding the prevalence of CBP in a wide range of conditions, its treatment and management seem to remain somewhat mysterious to practitioners at all levels of training and experience. Perhaps discomfort, lack of early training, and lack of later expertise 47 ' 48 inhibit clinicians from optimal pain management practice in general, and especially from optimal pharmacotherapeutic pain management practice (including the judicious and appropriate use of opioids in CBP syndromes 38 as "medications" and not as "drugs"). By focusing on those CBP entities discussed in this article and extending them to the diagnosis and management of other CBP syndromes, we hope to provide useful concepts and information for the care of patients with CBP, as they constitute a significant part of many clinicians' practices.…”