Chronic Non-cancer Pain
Chronic non-cancer pain is a heterogeneous, physical, and psychological condition that impairs quality of life, resulting in significant physical disability and emotional distress. It includes the nociceptive, nociplastic, neuropathic, and mixed pain types. Pharmacists have a vital role to play in this setting by optimizing the use of analgesic and adjunct medications and appropriately de-prescribing when harm outweighs benefits. The assessment is multi-faceted and includes characterizing the pain, determining patient-centered goals, reviewing pharmacotherapy, and assessing for psychosocial distress using subjective and objective measures. Treatment must be multi-modal and individualized for the specific pain type and patient factors. Chronic non-cancer pain should always include non-pharmacological strategies to address the sensory-emotional complexities of pain. Follow-up assessments should include assessments of adherence, pain control, adverse drug reactions, and disease complications. Patient assessment in the context of opioid use warrants a careful evaluation of risk factors for addiction and overdose, the presence of adverse effects or toxicity, and progression toward patient-identified functional goals and quality of life.
KeywordsChronic non-cancer pain Nociceptive pain Nociplastic pain Neuropathic pain Pain scale Acetaminophen NSAIDs Opioids α2-δ ligand TCA SNRI Cannabinoids
- 2.Merskey H, Bogduk N, editors. Classification of chronic pain. 2nd ed.. IASP Task Force on Taxonomy. Seattle: IASP Press; 1994.Google Scholar
- 4.International Association for the Study of Pain (IASP): Pain Definitions. https://www.iasp-pain.org/Education/Content.aspx?ItemNumber=1698#Nociceptivepain. Accessed June 4, 2018.
- 5.IASP Pain Definitions. https://www.iasp-pain.org/Education/Content.aspx?ItemNumber=1698#Nociceptivepain. Accessed June 4, 2018.
- 11.Fordyce WE. Behavioral methods for chronic pain and illness. St. Louis: CV Mosby; 1976.Google Scholar
- 12.Turk DC, Meichenbaum D, Genest M. Pain and behavior medicine: a cognitive-behavioral perspective. New York: Guilford Press; 1983.Google Scholar
- 16.Screener T. Screener and opioid assessment for patients with pain-revised (SOAPP ® -R). Heal (San Fr). 2008:1–4.Google Scholar
- 20.Guidance for Assessment and Monitoring: Individuals using opioid medications. Alberta College of Pharmacists. Accessed June 6, 2018. https://pharmacists.ab.ca/guidance-assessment-and-monitoring-individuals-using-opioid-medications.
- 21.Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain. Canada: National Opioid Use Guideline Group (NOUGG); 2010 [2018June06]. Available from: http://nationalpaincentre.mcmaster.ca/opioid/.
- 22.Yi P, Pryzbylkowski P. Opioid induced hyperalgesia. Pain Med. 2015;16(S1):1.Google Scholar
- 28.Maizels M, McCarberg B. Antidepressants and antiepileptic drugs for chronic non-cancer pain. Am Fam Physician. 2005;71(3)Google Scholar