Chronic Pain

Steven P. Stanos, Mark D. Tyburski, R. Norman Harden

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Chronic pain assessment and management is based on a biopsychosocial approach. Successful physiatric assessment and management of pain includes a patient-centered approach that is based on an understanding of physiologic changes and psychosocial factors impacting the patient's presentation of pain and pain-related suffering, including high-impact chronic pain. Recent advances in understanding peripheral and central mechanisms of pain processing will help guide pharmacologic approaches, as well as interventional and nonpharmacologic strategies, including physical and occupational therapy, behavioral health (i.e., cognitive behavioral therapy), mindfulness-based stress reduction, and other mind-body interventions (i.e., meditation, biofeedback-assisted relaxation training, tai chi, and yoga). Pharmacotherapy may include opioid and nonopioid analgesics and adjuvants. Pharmacologic treatment plans should consider a mechanistic approach focused on peripheral and central pathophysiologic changes as targets for medications that may include oral, transdermal, and topical formulations. Opioid therapy should be based on a patient-centered assessment of risks for misuse, aberrant behaviors, and addiction. Guidelines, including the Centers for Disease Control and Prevention's (CDC's) opioid guideline, can be integrated into practice. The CDC guideline includes 12 evidence-based recommendations for acute prescribing and additional guidance on managing and accessing patients receiving chronic opioid therapy. A rational approach to treatment goals includes analgesia, improvement in mood, sleep, quality of life, and restoration of function. Different levels of care may include more unimodal interventions such as medications or injection procedures, to more multidisciplinary approaches where multiple interventions may be coordinated by the physiatrist, to a more structured, team-based, or interdisciplinary program where therapies and medical management are provided in the same facility to maximize communication and coordination of services.

Original languageEnglish (US)
Title of host publicationBraddom's Physical Medicine and Rehabilitation
PublisherElsevier
Pages748-773.e5
ISBN (Electronic)9780323625395
ISBN (Print)9780323625401
DOIs
StatePublished - Jan 1 2020

Keywords

  • biopsychosocial approach
  • chronic pain management
  • functional restoration
  • interdisciplinary pain care
  • pain physiology

ASJC Scopus subject areas

  • General Medicine

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