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Chronic Pain Management: an Evidence-Based Approach

Jennifer Reidy, MD, MS, FAAHPM and Delila Katz, PharmD, BCOP Reviewed 06/2018
 


BASICS

  • Chronic pain is pain persisting beyond the time of normal tissue healing, usually >3 months.

  • Over time, neuroplastic changes in the CNS transform pain into a chronic disease. Pain levels exce...

DIAGNOSIS

Two general categories of pain: 
  • Nociceptive pain (two types)

    • Somatic: skin, bone, soft tissue disease; described as well localized, sharp, stabbing, aching

    • Visceral: visceral inflammation/in...

TREATMENT

  • Goals of treatment are to restore function and decrease pain while balancing risks and benefits of therapies.

  • Interdisciplinary teams offer the most effective approach to treating the physica...

ONGOING CARE

FOLLOW UP RECOMMENDATIONS

Patient Monitoring

  • It can be difficult to identify appropriate pain relief–seeking behavior from inappropriate drug seeking, but consistent patient–clinician relat...

REFERENCES

1
1 Institute of Medicine, Committee on Advancing Pain Research, Care, and Education. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washi...

ADDITIONAL READING

SCOPE of Pain (Safe and Competent Opioid Prescribing Education)—free online modules from Boston University School of Medicine: https://www.scopeofpain.com 

CODES

ICD10

  • G89.29 Other chronic pain

  • G89.21 Chronic pain due to trauma

  • G89.28 Other chronic postprocedural pain

ICD9

  • 338.29 Other chronic pain

  • 338.21 Chronic pain due to trauma

  • 338.28 Other chronic postoper...

CLINICAL PEARLS

  • Start with the presumption that a patient’s pain is real, even if pathophysiologic evidence is initially lacking.

  • Emphasize that a pain-free life may not be possible but that better fun...

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