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Chronic Pain Management: An Evidence-Based Approach

Jennifer Reidy, MD, MS, FAAHPM and Vandana Nagpal, MD, FACP Reviewed 06/2020
 


BASICS

  • Chronic pain is a common presenting complaint in primary care. It is typically defined as pain persisting beyond the time anticipated for normal tissue healing, usually >3 months.

  • Over time, ...

DIAGNOSIS

Two general categories of pain: 
  • Nociceptive pain (response to tissue damage): two types

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

    • Viscer...

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 differentiate appropriate pain relief–seeking behavior from inappropriate drug seeking.

  • Maintain a nonjudgmental approach.

  • ...

REFERENCES

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. Washing...

ADDITIONAL READING

  • Bohnert ASB, Guy GP Jr, Losby JL. Opioid prescribing in the United States before and after the Centers for Disease Control and Prevention’s 2016 opioid guideline. Ann Intern Med. &#...

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—better function and...

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