The Appropriate Treatment of Chronic Pain

Abstract

Chronic pain is a common healthcare problem worldwide that ranks as a predominant reason for consulting a physician, yet effective management of chronic pain remains suboptimal, often resulting in unnecessary suffering and decreased quality of life, lost productivity and excessive healthcare costs. To overcome the challenges associated with the management of chronic pain, increased awareness and both patient and physician education are required. Improving physician knowledge of pain assessment and management guided by recommendations for a comprehensive, multifactorial, personalised treatment approach involving pharmacological and non-pharmacological approaches is key to achieving effective pain relief. Guidelines for the management of non-cancer and cancer pain recommend thorough patient assessment before individualized therapy based on the type and intensity of pain. The availability of mechanism-specific analgesics has facilitated improvements in the treatment of chronic non-cancer pain, which may be of neuropathic, muscle, inflammatory, mechanical/compressive or mixed origin. Stepwise escalation of analgesic therapy (paracetamol, non-steroidal anti-inflammatory drugs, mild to strong opioids) according to the World Health Organization's three-step pain ladder remains the standard approach for the selection of treatment for chronic cancer pain, although there is now a greater awareness of the requirements for effective administration of opioids including dose titration, use of short versus long-acting opioids, opioid rotation, management of adverse effects, and ongoing monitoring. Selection of an effective, appropriate, personalized analgesic regimen for patients with chronic pain is achievable and is expected to enhance compliance, overall functioning and quality of life.

Genetics of chronic post-surgical pain: a crucial step toward personal pain medicine

“…The process of finding the appropriate treatment regimen for chronic pain often involves either escalating doses of a particular analgesic until a satisfactory level of pain control is achieved or switching to another medication. 15 Unlike the management of acute pain, the process of finding an appropriate treatment regimen for chronic neuropathic pain requires taking medications over many weeks to determine efficacy. Treatment strategies that implement physiotherapy, psychological and psychosocial interventions are often required in combination with analgesic medications; however, these are often not readily available or affordable for patients.…”

Anti-hyperalgesic effect of paracetamol in rat model of thermal hyperalgesia: implications for the treatment of neuropathic pain

“…Sometimes it can cause extreme discomfort and adversely affecting quality of life of the patient. 3,4 Two prominent symptoms of NP are allodynia i.e. even non noxious stimulus can elicit severe pain response and hyperalgesia i.e.…”

Prevalence and determinants of cannabinoid prescription for the management of chronic noncancer pain: a postal survey of physicians in the Abitibi-Temiscamingue region of Quebec

“…5,6 To date, the treatment of chronic noncancer pain remains suboptimal, mainly because of a lack of recognition of the condition, not enough training for health care professionals, absence of effective treatments, lack of access to pain treatment centres and suboptimal use of certain drugs. 1,5,[7][8][9][10] Different cannabinoid products have been found to be effective and safe for some chronic noncancer pain syndromes, such as neuropathic pain. [11][12][13][14] For other conditions, such as fibromyalgia and rheumatic pain, their use raises concerns or evidence is limited.…”