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Practical approach to the management of chronic pain

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Comprehensive Therapy

Abstract

Chronic pain is a common and disabling complaint in most primary care practices. This article offers an explanation for the physiological basis of persistent chronic pain, provides practical guidelines to help distinguish among common pain syndromes, and recommends treatment strategies.

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References

  1. Mantyselka P, Kumpusalo E, Ahonen R, et al. Pain as a reason to visit the doctor: a study in a Finnish primary health care. Pain 2001;89:175–180.

    Article  PubMed  CAS  Google Scholar 

  2. Hasselström J, Liu-Palmgren J, Rasjö-Wrååk G. Prevalence of pain in general practice. Eur J Pain 2002;6:375–385.

    Article  PubMed  Google Scholar 

  3. Guereje O, von Korff M, Simon GE, Gater R. Persistent pain and well-being: a World Health Organization study in primary care. JAMA 1998;280:147–151.

    Article  Google Scholar 

  4. Blyth FM, March LM, Nicholas MK, Cousins MJ. Chronic pain, work performance and litigation. Pain 2003;103:41–47.

    Article  PubMed  Google Scholar 

  5. Potter M, Schafer S, Gonzalez-Mendez, E, et al. Oproids for chronic nonmalignant pain. Attitudes and practices of primary care physicians in the UCSF/Stanford Collaborative Research Network. J Fam Pract 2001;50:145–151.

    PubMed  CAS  Google Scholar 

  6. Carey TS, Garrett JM, Jackman A, Hadler N. Recurrence and care seeking after acute back pain: results of a long-term follow-up study. North Carolina Back Pain Project. Med Care 1999;37:157–164.

    CAS  Google Scholar 

  7. Croft PR, Macfarlane GJ, Papageogiou AC, et al. Outcome of low back pain in general practice: a prospective study. BMJ 1998;316:1356–1359.

    PubMed  CAS  Google Scholar 

  8. Thomas E, Silman AJ, Croft PR, et al. Predicting who develops chronic low back pain in primary care: a prospective study. BMJ 1999;318:1662–1667.

    PubMed  CAS  Google Scholar 

  9. Schiotz-Christensen B, Nielsen GL, Hansen VK, et al. Long-term prognosis of acute back pain in patients seen in general practice: a 1-year prospective follow-up study. Fam Pract 1999;16:223–232.

    Article  Google Scholar 

  10. Bennett GJ, Xie YK. A peripheral mononeuropathy in rat that produces disorders of pain sensation like those seen in man. Pain 1988;33:87–107.

    Article  PubMed  CAS  Google Scholar 

  11. Seltzer Z, Dubner R, Shir Y. A novel behavioral model of neuropathic pain disorders produced in rats by partial sciatic nerve injury. Pain 1990;43:205–218.

    Article  PubMed  CAS  Google Scholar 

  12. Guilbaud G, Gautron M, Jazat F, et al. Time course of degeneration and regeneration of myelinated nerve fibers following chronic loose ligatures of the rat sciatic nerve: can nerve lesions be linked to the abnormal pain-related behaviours. Pain 1993;53:147–158.

    Article  PubMed  CAS  Google Scholar 

  13. Behbehani MM, Dollberg-Stolik O. Partial sciatic nerve ligation results in an enlargement of the receptive field and enhancement of the response of dorsal horn neurons to noxious stimulation by an adenosine agonist. Pain 1994;58:421–428.

    Article  PubMed  CAS  Google Scholar 

  14. Thomas E, Silman AJ, Croft PR, et al. Predictors of early improvement in low back pain in primary care: a prospective study. BMJ 1999;318:1662–1667.

    PubMed  CAS  Google Scholar 

  15. Macfarlane GJ, Thomas E, Croft PR, et al. Predictors of early improvement in low back pain amongst consulters to general practice: the influence of premorbid and episode-related factors. Pain 1999;80:113–119.

    Article  PubMed  CAS  Google Scholar 

  16. Reis S, Hermoni D, Borkan JM. A new look at low back pain complaints in primary care: a RAMBAM Israeli Family Practice Research Network study. J Fam Pract 1999;48:299–303.

    PubMed  CAS  Google Scholar 

  17. Croft PR, Papageogiou AC, Ferry S, et al. Psychological distress and low back pain. Evidence from a prospective study in the general population. Spine 1995;20:2731–2737.

    Article  PubMed  CAS  Google Scholar 

  18. Scott SC, Goldberg MS, Mayo NE, Stock SR, Poitras B. The association between cigarette smoking and back pain in adults. Spine 1999;24:1090–1098.

    Article  PubMed  CAS  Google Scholar 

  19. Palmer KT, Syddall H, Cooper C, Coggon D. Smoking and musculoskeletal disorders: findings from a British national survey. Ann Rheum Dis 2003;62:33–36.

    Article  PubMed  CAS  Google Scholar 

  20. Velly AM, Gornitsky M, Philippe P. Contributing factors to chronic myofascial pain: a case-control study. Pain 2003;104:491–499.

    Article  PubMed  Google Scholar 

  21. Leighton DJ, Reilly T. Epidemiological aspects of back pain: the incidence and prevalence of back pain in nurses compared to the general population. Occup Med (Lond) 1995;45:263–267.

    Article  CAS  Google Scholar 

  22. Ihlebaek C, Eriksen HR, Ursin H. Prevalence of subjective health complaints (SHC) in Norway. Scand J Public Health 2002; 30:20–29.

    Article  PubMed  Google Scholar 

  23. Shootsky SA, Jaeger B, Oye RK. Prevalence of myofascial pain in general internal medicine practice. West J Med 1989;151:157–160.

    Google Scholar 

  24. Simons DG, Travell JG, Simons LS. Myofascial Pain and Dysfunction: The Trigger Point Manual, Vol. 1. 2nd edn. Lippincott Williams & Wilkins Baltimore, 1999.

    Google Scholar 

  25. Reginster JY. The prevalence and burden of arthritis. Rheumatology 2002;41(Suppl 1):3–6.

    Article  PubMed  Google Scholar 

  26. Steiner G, Smolen J. Autoantibodies in rheumatoid arthritis and their clinical significance. Arthritis Res 2004;4(Suppl 2):S1-S5.

    Article  Google Scholar 

  27. Hasselström J, Liu-Palmgren J, Rasjö-Wrååk G. Prevalence of pain in general practice. Eur J Pain 2002;6:375–385.

    Article  PubMed  Google Scholar 

  28. Boreau F, Doubrére J, Luu M. Study of verbal description in neuropathic pain. Pain 1990;42:145–152.

    Article  Google Scholar 

  29. Brett KM, Burt CW. Utilization of ambulatory medical care by women: United States. 1997–98. Vital Health Stat 2001;13:1–46.

    Google Scholar 

  30. Marcus DA. Gender differences in treatment-seeking chronic headache sufferers. Headache 2001;41:698–703.

    Article  PubMed  CAS  Google Scholar 

  31. Ramirez-Lassepas M, Espinosa CE, Cicero JJ, et al. Predictors of intracranial pathological findings in patients who seek emergency care because of headache. Arch Neurol 1997;54:1506–1509.

    PubMed  CAS  Google Scholar 

  32. Hasse LA, Ritchey N, Smith R. Predicting the number of headache visits by type of patient seen in family practice. Headache 2002;42:738–746.

    Article  PubMed  Google Scholar 

  33. Tepper S, Dahlöf CH, Dowson A, et al. Prevalence and diagnosis of migraine in a patients consulting their physician with a complaint of headache: data from the Landmark Study. Headache 2004;44:856–864.

    Article  PubMed  Google Scholar 

  34. Cady RK, Schreiber CP. Sinus headache or migraine?: considerations in making a differential diagnosis. Neurology 2002;48(9 Suppl 6):S10-S14.

    Google Scholar 

  35. Schreiber CP, Hutchinson S, Webster CJ, et al. Prevalence of migraine in patients with a history of self-reported or physician-diagnosed “sinus” headache. Arch Intern Med 2004;164:1769–1772.

    Article  PubMed  Google Scholar 

  36. Campo JV, Comer DM, Jansen-McWilliams L, Gardner W, Kelleher KJ. Recurrent pain, emotional distress, and health service use in childhood. J Pediatr 2002;141:76–83.

    Article  PubMed  Google Scholar 

  37. De Inocencio J. Musculoskeletal pain in primary pediatric care: analysis of 1000 consecutive general pediatric clinic visits. Pediatrics 1998;102:e63.

    Article  PubMed  Google Scholar 

  38. Ozge A, Bugdayci R, Sasmaz T, et al. The sensitivity and specificity of the case definition criteria in diagnosis of headache: a school-based epidemiological study of 5562 children in Mersin. Cephalalgia 2003;23:138–145.

    Article  PubMed  CAS  Google Scholar 

  39. Walker LS, Lipani TA, Greene JW, et al. Recurrent abdominal pain: symptom subtypes based on the Rome II criteria for pediatric functional gastrointestinal disorders. J Ped Gastroenterol Nutr 2004;38:187–191.

    Article  Google Scholar 

  40. Mikkelsson M, Salminen JJ, Kautiainen H. Non-specific musculoskeletal pain in preadolescents. Prevalence and 1-year persistence. Pain 1997;73:29–35.

    Article  PubMed  CAS  Google Scholar 

  41. Eriksen J, Jensen MK, Sjøgren P, Ekholm O, Rasmussen NK. Epidemiology of chronic non-malignant pain in Denmark. Pain 2001;2:249.

    Google Scholar 

  42. Gam AN, Warming S, Larsen LH, et al. Treatment of myofascial trigger-points with ultrasound combined with massage and exercise—a randomized controlled trial. Pain 1998;77:73–79.

    Article  PubMed  CAS  Google Scholar 

  43. Suomi R, Collier D. Effects of arthritis exercise programs on functional fitness and perceived activities of daily living measures in older adults with arthritis. Arch Phys Med Rehabil 2003;84:1589–1594.

    Article  PubMed  Google Scholar 

  44. De Jong Z, Munneke M, Zwinderman AH, et al. Is a long-term high-intensity exercise program effective and safe in patients with rheumatoid arthritis? Arthritis Rheum 2003;48:2415–2424.

    Article  PubMed  Google Scholar 

  45. Munneke M, de Jong Z, Zwinderman AH, et al. Adherence and satisfaction of rheumatoid arthritis patients with a long-term intensive dynamic exercise program (RAPIT Program). Arthritis Care Res 2003;49:665–672.

    Article  Google Scholar 

  46. Roddy E, Zhang W, Doherty M, et al. Evidence-based recommendations for the role of exercise in the management of osteoarthritis of the hip or knee—the MOVE consensus. Rheumatology (Oxford) 2005;44:67–73.

    Article  CAS  Google Scholar 

  47. Evers AW, Kraaimaat FW, van Riel PL, de Jong AJ. Tailored cognitive-behavioral therapy in early rheumatoid arthritis for patients at risk: a randomized controlled trial. Pain 2002;100:141–153.

    Article  PubMed  Google Scholar 

  48. Sharpe L, Sensky T, Timberlake N, Ryan B, Brewin CR, Allard S. A blind, randomized, controlled trial of cognitive-behavioral intervention for patients with recent onset rheumatoid arthritis: preventing psychological and physical morbidity. Pain 2001;89:275–283.

    Article  PubMed  CAS  Google Scholar 

  49. Keefe FJ, Blumenthal J, Baucom D, et al. Effects of spouse-assisted coping skills training and exercise training in patients with osteoarthritic knee pain: a randomized controlled study. Pain 2004;110:539–549.

    Article  PubMed  Google Scholar 

  50. Blumenauer B, Cranney A, Clinch J, Tugwell P. Quality of life in patients with rheumatoid arthritis: which drugs make a difference? Pharmacoeconomics 2003;21:927–940.

    Article  PubMed  Google Scholar 

  51. Sokka T, Möttönen T, Hannonen P. Disease-modifying antirheumatic drug use according to the “sawtooth” treatment strategy improves the functional outcome in rheumatoid arthritis: results of a long-term follow-up study with review of the literature. Rheumatology 2000;39:34–42.

    Article  PubMed  CAS  Google Scholar 

  52. Osiri M, Shea B, Robinson V, et al. Leflunomide for treating rheumatoid arthritis. Cochrane Database Syst Rev 2003;1:CD002047.

    PubMed  Google Scholar 

  53. Krishnan AM, Rayman G. New treatment for diabetic-neuropathy: symptomatic treatments. Curr Diabet Rep 2003;3:459–467.

    Article  Google Scholar 

  54. Dallocchio C, Buffa C, Mazzarello P, Chiroli S. Gabapentin vs. amitriptyline in painful diabetic neuropathy: an open-label pilot study. J Pain Symptom Manage 2000;20:280–285.

    Article  PubMed  CAS  Google Scholar 

  55. Marcus DA. Nonpharmacologic treatment of migraine. Trends in Evidence-based Neuropsychiatry 2001;3:50–55.

    Google Scholar 

  56. Holroyd KA, Cordingley GE, Pingel JD, et al. Enhancing the effectiveness of abortive therapy: a controlled evaluation of self-management. Headache 1989;29:148–153.

    Article  PubMed  CAS  Google Scholar 

  57. Holroyd KA, France JC, Cordingley GE. Enhancing the effectiveness of relaxation-thermal biofeedback training with propranolol hydrochloride. J Consult Clin Psychol 1995;63:327–330.

    Article  PubMed  CAS  Google Scholar 

  58. Richards SM, Scott DL. Prescribed exercise in people with fibromyalgia: parallel group randomised controlled trial. BMJ 2002;325:185–189.

    Article  PubMed  Google Scholar 

  59. Friedman DP. Perspectives on the medical use of drugs of abuse. J Pain Symptom Manage 1990;5(Suppl):S2-S5.

    PubMed  CAS  Google Scholar 

  60. Shannon CN, Baranowski AP. Use of opioids in non-cancer pain. Br J Hosp Med 1997;5:459–463.

    Google Scholar 

  61. Savage SR. Opioid use in the management of chronic pain. Med Clin North Am 1999;83:761–786.

    Article  PubMed  CAS  Google Scholar 

  62. Simon LS, Weaver AL, Graham DY, et al Anti-inflammatory and upper gastrointestinal effects of celecoxib in rheumatoid arthritis. A randomized controlled trial. JAMA 1999;282:1921–1928.

    Article  PubMed  CAS  Google Scholar 

  63. Segasothy M, Chin GL, Sia KK, et al. Chronic nephrotoxicity of anti-inflammatory drugs used in the treatment of arthritis. Br J Rheumatol 1995;34:162–165.

    Article  PubMed  CAS  Google Scholar 

  64. Segasothy M, Samad SA, Zulfigar A, Bennett WM. Chronic renal disease and papillary necrosis associated with the long-term use of nonsteroidal anti-inflammatory drugs as the sole or predominant analgesic. Am J Kidney Dis 1994;24:17–24.

    PubMed  CAS  Google Scholar 

  65. LeLorier J, Bombardier C, Burgess E, et al. Practical considerations for the use of nonsteroidal anti-inflammatory drugs and cyclo-oxygenase-2 inhibitors in hypertension and kidney disease. Can J Cardiol 2002;18:1301–1308.

    PubMed  CAS  Google Scholar 

  66. Deider J, Stampfer MJ, Hankison SE, Willett WC, Speizer FE. Curhan GC. Nonnarcotic analgesic use and risk of hypertension in US women. Hypertension 2002;40:604–608.

    Article  Google Scholar 

  67. Reid MC, Engles-Horton LL, Weber MB, Kerns RD, Rogers EL, O'Connor PG. Use of opioid medications for chronic noncancer pain syndromes in primary care. J Gen Intern Med 2002;17:173–179.

    Article  PubMed  Google Scholar 

  68. Chabal C, Erjavec MK, Jacobson L, et al. Prescription opiate abuse in chronic pain patients: clinical criteria, incidence, and predictors. Clin J Pain 1997;13:150–155.

    Article  PubMed  CAS  Google Scholar 

  69. Ossipov MH, Lai J, Vanderah TW, Porreca F. Induction of pain facilitation by sustained opioid exposure: relationship to opioid antinociceptive tolerance. Life Sci 2003;73:783–800.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Anesthesiology & Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA

    Dawn A. Marcus

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  1. Dawn A. Marcus
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Correspondence to Dawn A. Marcus.

Additional information

The author has stated that she does have a significant financial interest or other relationship (as a grant recipient from Elan, Eisai, and Pfizer) with a product manufacturer or provider of services discussed in this article. The author also discusses the use of off-label products, which includes antiepileptics and antidepressants for pain management.

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Marcus, D.A. Practical approach to the management of chronic pain. Compr Ther 31, 40–49 (2005). https://doi.org/10.1385/COMP:31:1:040

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