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Chronic Pain Management: An Evidence-Based Approach

Jennifer Reidy, MD, MS, FAAHPM and Delila Katz, PharmD, BCOP Reviewed 06/2019
 


BASICS

  • Chronic pain is typically defined as pain persisting beyond the time anticipated for normal tissue healing, usually >3 months.

  • Over time, neuroplastic changes in the CNS transform pain into a...

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/inju...

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

  • Maintain a nonjudgmental approach.

  • Assess...

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 GPJr, 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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