Chronic Pain Management: An Evidence-Based Approach

Jennifer Reidy, MD, MS, FAAHPM

References

1. Institute of Medicine, Committee on Advancing Pain Research, Care, and Education. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education and Research. Washington, DC: The National Academies Press; 2011.
2. Alford DP, Krebs EE, Chen IA, et al. Update in pain medicine. J Gen Intern Med. 2010;25(11):1222–1226.
3. Dobscha SK, Corson K, Perrin NA, et al. Collaborative care for chronic pain in primary care: a cluster randomized trial. JAMA. 2009;301(12):1242–1252.
4. American Society of Anesthesiologists Task Force on Chronic Pain Management. Practice guidelines for chronic pain management: an updated report by the American Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine. Anesthesiology. 2010;112(4):810–833.
5. Manchikanti L, Abdi S, Atluri S, et al. American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opiod prescribing in chronic non-cancer pain: Part 2&#x2014θidance. Pain Physician. 2012;15(3 Suppl):S67–S116.
6. Bohnert AS, Valenstein M, Bair MJ, et al. Association between opioid prescribing patterns and opioid overdose-related deaths. JAMA. 2011;305(13):1315–1321.

ADDITIONAL READING

• Federation of State Medical Boards of the United States, Inc. Model policy for the use of controlled substances for the treatment of pain www.painpolicy.wisc.edu/sites/www.painpolicy.wisc.edu/files/model04.pdf.
• Washington State Agency Medical Director’s Group. Interagency guideline on opioid dosing for chronic non-cancer pain: an educational aid to improve care and safety with opioid therapy. www.agencymeddirectors.wa.gov.

CODES

ICD10

• G89.29 Other chronic pain
• G89.21 Chronic pain due to trauma
• G89.28 Other chronic postprocedural pain

CLINICAL PEARLS

• Start with the presumption that the patient’s pain is real, even if pathophysiologic evidence for it cannot be found.
• Emphasize that being pain-free may not be possible but that better function and quality of life can be shared goals.
• Use a multidisciplinary approach with nonpharmacologic therapies, exercise, patient self-management strategies and thoughtful medication use with clear goals, expectations, and documentation of care plan.
• Use universal precautions and systems-based practice to safely and effectively prescribe opioids for chronic pain.