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Considering Medication Options for 3 Main Types of Chronic Pain

Medication Options for Chronic Pain

Considering Medication Options for 3 Pathophysiologies of Chronic Pain

 
Medication Options for Chronic Pain

Appropriate management of chronic pain may often require pharmacologic interventions as well as nonpharmacologic interventions, such as psychological therapies, rehabilitative/physical therapies, and complementary/alternative medicine approaches.1,2 Among pharmacologic interventions, prescription opioids are not always the best choice for the treatment of chronic pain.3,4

This animation reviews the most appropriate medication therapies for each of the 3 main types of pain. In general, treatment guidelines recommend that prescription opioids be reserved for patients with moderate to severe pain after inadequate response to nonopioid therapy or when other pharmacotherapies are contraindicated.2-7 Current FDA guidance is to prescribe extended-release and long-acting opioids only for patients with pain severe enough to require daily, around-the-clock, long-term treatment, and for whom alternative treatment options are inadequate.8

It should be emphasized that no patient should receive opioid therapy without a specific, documented diagnosis.9

References

  1. Institute of Medicine of the National Academies. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press; 2011.
  2. Passik SD. Issues in long-term opioid therapy: unmet needs, risks, and solutions. Mayo Clin Proc. 2009;84(7):593-601. PMID: 19567713
  3. Chou R, Fanciullo GJ, Fine PG, et al; American Pain Society–American Academy of Pain Medicine Opioids Guidelines Panel. Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009;10(2):113-130. PMID: 19187889
  4. US Department of Veterans Affairs, US Department of Defense. VA/DoD Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain. Version 2.0. Washington, DC: US Dept of Veterans Affairs, US Dept of Defense; 2010. http://www.va.gov/PAINMANAGEMENT/docs/CPG_opioidtherapy_summary.pdf. Accessed May 20, 2014.
  5. Washington State Agency Medical Directors’ Group (AMDG). Interagency Guideline on Opioid Dosing for Chronic Non-cancer Pain: An Educational Aid to Improve Care and Safety With Opioid Therapy. 2010 Update. Olympia, WA: Washington State Agency Medical Directors Group; 2010. http://www.agencymeddirectors.wa.gov/Files/OpioidGdline.pdf. Accessed May 20, 2014.
  6. Manchikanti L, Abdi S, Atluri S, et al; American Society of Interventional Pain Physicians. American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic non-cancer pain: part 2—guidance. Pain Physician. 2012;15(3 suppl):S67-S116. PMID: 22786449
  7. Utah Department of Health. Utah Clinical Guidelines on Prescribing Opioids for Treatment of Pain. Salt Lake City, UT: Utah Dept of Health; 2009. http://www.dopl.utah.gov/licensing/forms/OpioidGuidlines.pdf. Accessed May 20, 2014.
  8. Gourlay DL, Heit HA, Almahrezi A. Universal precautions in pain medicine: a rational approach to the treatment of chronic pain. Pain Med. 2005;6(2):107-112. PMID: 15773874
  9. US Food and Drug Administration. New safety measures announced for extended-release and long-acting opioids: ER/LA opioid analgesic class labeling changes and postmarket requirements [letter to ER/LA opioid application holders]. September 10, 2013. http://www.fda.gov/downloads/Drugs/DrugSafety/InformationbyDrugClass/UCM367697.pdf. Accessed May 20, 2014.