In some cases, inflexible application of these guidelines has led to patient abandonment and poor outcomes. With the widespread adoption of the CDC opioid-prescribing guidelines in 2016 11, rates of opioid prescriptions have decreased. ![]() However, due to high rates of opioid prescribing over the last 20-30 years, there are still many patients who remain on chronic opioid therapy. Opioids carry substantial risk for harm, and are not recommended for the majority of patients with chronic pain. The current nation-wide opioid epidemic adds another layer of complexity in the management of chronic pain. This care can be challenging and resource-intensive, and many clinicians are reluctant or ill-equipped to provide it. While multidisciplinary subspecialty pain services are increasingly available, primary care clinicians will continue to manage the majority of patients with chronic pain. These numbers will only increase as our population ages, amplifying the need for effective, accessible interventions to manage chronic pain and preserve function. ![]() Chronic pain is the leading cause of long-term disability in the US. The cost of pain management is approximately $90 billion annually. Fifty to eighty million Americans experience daily pain symptoms. The prevalence of chronic pain in the US is difficult to estimate, but its impact is profound. Despite increased attention, many patients’ pain remains under-treated or incorrectly treated. Effective pain management is a core responsibility of all clinicians, and is a growing priority among clinicians, patients, and regulators. Pain is the most common reason for which individuals seek health care. ![]() The nationwide opioid epidemic adds complexity to the management of chronic pain. Primary care clinicians manage the majority of patients with chronic pain. Pain is often undertreated or incorrectly treated.Ĭhronic pain affects 50-80 million Americans. Assess comorbid conditions, including medical and psychiatric conditions, substance use, pain beliefs and expectations, and suicidality ( Table 3). Assess pain characteristics, pain treatment history, quality of life and functional impact, pain beliefs, and psychosocial factors. Perform a history and physical examination. Use a biopsychosocial approach in assessment and management.Ĭhronic pain assessment. ![]() It is a distinct condition that is better understood as a disease process than as a symptom. Chronic pain is not acute pain that failed to resolve. Do not prescribe opioids for sprains, lacerations, skin biopsies, or simple dental extractions. Consider opioids for moderately-severe to severe acute or procedural pain, but if used, limit dose and duration. Avoid opioids for mild to moderate acute pain. Acute pain is associated with tissue damage. Improve quality of life and function in patients experiencing pain, while reducing the morbidity and mortality associated with pain treatments, particularly opioid analgesics. Provide a framework for comprehensive pain evaluation and individualized multimodal treatment. Adults with acute or chronic pain, including cancer patients, without progressive or terminal disease, treated in an outpatient setting, excluding hospice and end-of-life care.
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