To diminish these inequities surrounding pain management, providers should attempt to remove as much individual discretion from decision making as feasible. When possible, providers should utilize resources such as: checklist, guidelines, or system protocols to avoid the influences of implicit biases on their management. Providers need also recognize access limitations faced by patients and ensure any treatment regimen or follow-up planning is readily accessible.
Read how psychological symptoms can accompany thyroid disorders and possible treatment and management options
Educate patients, family, and friends about when and how to use intranasal naloxone and steps after administration.
In addition to a usual history and physical examination, in patients with chronic pain assess the following (Table 3):
Chronic pain has little in common with acute pain and should be considered as a separate medical condition. Some differences are:
e., beyond normal tissue healing time). Clinical evaluation of pain involves a thorough history, physical examination, and assessment of pain severity using a standardized pain intensity scale. Pain management is multimodal and can include analgesics, nonpharmacological analgesia, and interventional pain management strategies. The WHO analgesic ladder can help clinicians select an appropriate pain management strategy based on pain severity and response to existing management.
The gray area between dependence and addiction can be challenging for clinicians and patients. A 2012 article by Ballantyne, et.
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Chronic pain – pain that lasts or recurs for longer than 3 months – is not merely acute pain that does not resolve. Increasingly, chronic pain is recognized as a disease entity in and of itself, rather than as a symptom of another disease. Historically, pain has been viewed in a biomedical model, with a focus on identifying a specific pathologic cause of pain which can be treated through pharmacologic or interventional means.
Response to these results may include counseling, shortened follow-up intervals and urine testing, pill counts, referral for treatment of substance use disorder, or discontinuation of opioid therapy. See Appendix D for a guide to ordering and interpreting urine drug tests.
The hallmark of acute pain is tissue inflammation. Acute pain can be nociceptive or neuropathic. Accordingly, measures to reduce inflammation are helpful when developing a treatment plan for acute pain conditions. Some treatments to consider for acute pain include those listed in the table below:
Continued opioid use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by opioids.
Substance use disorder complicating the treatment of chronic pain. The prevalence of substance use disorder among patients with chronic pain is significant. Studies have repeatedly demonstrated that at least 20% of opioid-treated patients misuse or divert their medication.
Nociceptive stimuli induce behavioral, autonomic, and hormonal responses in infants similar to those seen in older individuals.