Feature Article

What a pain! Managing it through the continuum

Feature Article

What a pain! Managing it through the continuum

Roger Goucke, Mark Schutze

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Abstract

Managing chronic pain is a challenge for all doctors. Patients need to be encouraged to take control of their pain with a self-management plan and not rely on medication alone. Low back pain is discussed in the article as a model of pain.

Key Points

  • Pain is a complex concept to come to terms with – what may be very painful and distressing to one person may be only a mild ache to another.
  • There is increasing evidence that chronic or persistent pain can be classified as a disease in its own right.
  • Patients should be helped to institute a holistic, active, self-management program, something akin to a lifestyle change.
  • Part of the management plan will include addressing patient expectations.
  • Drug therapy should never be used alone. Address also lifestyle issues such as ensuring a healthy diet, exercising regularly, sleeping well and managing stress appropriately.
  • Escalating doses of opioids are more likely to increase the side effect profile than improve analgesia and will often reduce functional outcomes and quality of life.