The focus in chronic pain assessment differs from the evaluation of acute pain, which assumes a specific underlying injury or disease that treatment will cure. Begin chronic pain assessment with the history and physical examination. Important components of the initial evaluation are summarized in Table 3 and are detailed below.
Benzodiazepine and opioids – a safety concern. Generally, do not initiate opioid therapy in patients routinely using benzodiazepine therapy. Both drugs are sedating and suppress breathing. Together they can cause a fatal overdose.
Educate patients, family, and friends about when and how to use intranasal naloxone and steps after administration.
Psychiatric comorbidities. Review the past medical history and assess the presence of psychiatric conditions that could affect the patient’s response to chronic pain, communications with the patient about chronic pain, or treatment.
The following information pertains to adults. See “Pain management in children” for pediatric recommendations.
Principles for managing opioid use disorder in pain patients. The treatment of pain patients who exhibit evidence of opioid use disorder requires heightened monitoring, or discontinuation of opioid therapy and initiation of addiction treatment.
Oxycodone/acetaminophen Consider combination analgesics for the management of moderate to severe pain.
Nodules or swellings – these lumps can stop the thyroid gland from working properly, or are simply uncomfortable.
Lidocaine ointment Patch: postherpetic neuralgia Jelly: painful urethritis Ointment: minor burns, including sunburn, abrasions of the skin, and insect bites
Nociceptors detect a chemical, mechanical, or thermal noxious stimulus → conversion of stimulus to Shop Now an electric signal (action potential) ; → C fibers and Aδ fibers carry afferent input to the dorsal horn of the spinal cord → secondary nociceptive neurons in the spinothalamic tract carry afferent input to the thalamus in the CNS → pain perception and a response sent along efferent pathways, which results in pain modulation and/or a reaction [3]
Initiation of sublingual buprenorphine can provoke acute opioid withdrawal if not done correctly. Therefore, only prescribers trained in its use and in possession of an XDEA number (or working under guidance of such a prescriber) should initiate sublingual buprenorphine/naloxone. Once a patient is on it and stable, primary prescribers may take over chronic management.
Pain is the most common reason for which individuals seek health care. Effective pain management is a core responsibility of all clinicians, and is a growing priority among clinicians, patients, and regulators. Despite increased attention, many patients’ pain remains under-treated or incorrectly treated.
Avoid alcohol. Never mix alcohol and sleeping pills. Alcohol increases the sedative effects of the pills. Even a small amount of alcohol combined with sleeping pills can make you feel dizzy, confused or faint.
Non-pharmacologic therapy and non-opioid pharmacologic therapy are preferred for the treatment of chronic pain.11 There is insufficient evidence to support the use of long-term opioid use for chronic pain. Opioids carry substantial risks of harm.