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Chronic Pain Management: An Evidence-Based Approach

Carolyn Murphy, MD Reviewed 04/2024
 


BASICS

  • Chronic pain persists beyond the time anticipated for normal tissue healing (usually >3 months).

  • Over time, neuroplastic changes in the CNS transform pain into a chronic experience with emoti...

DIAGNOSIS

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

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

    • Visceral: visceral ...

TREATMENT

  • Goals of treatment are to restore function and decrease pain.

  • Treatment should always include exercise, cognitive-behavioral therapy (CBT), patient and family education, yoga, massage, relaxa...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

  • Maintain a nonjudgmental approach.

  • Assess and document benefits, risks, pain levels, functioning, and quality of life.

  • Universal precautions:

    • Infor...

REFERENCES

1
Fisher E, Moore RA, Fogarty AE, et al. Cannabinoids, cannabis, and cannabis-based medicine for pain management: a systematic review of randomised controlled trials Pain. 2021;162(Suppl 1)S...

ADDITIONAL READING

Nicola M, Correia H, Ditchburn G, et al. Defining pain-validation: the importance of validation in reducing the stresses of chronic pain. Front Pain Res (Lausa...

CODES

ICD10

  • G89.29 Other chronic pain

  • G89.21 Chronic pain due to trauma

  • G89.28 Other chronic postprocedural pain

SNOMED

  • 82423001 Chronic pain (finding)

  • 431481001 chronic pain due to injury (finding)

  • 27904700...

CLINICAL PEARLS

  • Start with the foundational belief that a patient’s pain is real.

  • Emphasize that a pain-free life may not be possible—better function and quality of life are shared goals.

  • Use a multidis...

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