chronic pain
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Etiology
- somatic pain
- visceral pain
- secondary factors perpetuating pain after resolution of a disease process
- damaged sensory nerves
- sympathetic efferent activity
- painful muscle contraction
- psychologic conditions can perpetuate or cause pain
- emotional trauma
- physical or sexual abuse
- substance abuse
Epidemiology
- disproportionately affects the elderly, minorities, & those with socioeconomic disadvantages[39]
Pathology
- chronic pain may be associated with neuroinflammation, microglial activation, & neurogeneration
History
- about the pain
- pain onset
- pain location
- pain quality & intensity
- relieving & exacerbating factors
- functional status
- effect of pain on functional status
- mental health
- depression
- anxiety
- somatization[4]
- substance abuse
- verbal, physical or sexual abuse
Laboratory
- no specific role for diagnostic testing because abnormalities identified may not be related to the patient's pain[4]
- urine drug screen for monitoring use of controlled substances
- CSF markers
- patients with chronic pain have increased CSF total tau, CSF sTREM2 & CSF TNF-alpha
- CSF ptau181 increases with duration chronic pain, while CSF beta-amyloid 1-42 decreases with chronic pain[58]
Radiology
- brain imaging should not be used to prove whether a patient has chronic pain[36]
Complications
- depression is common
- suicide risk (hazzard ratio 1.4-3.0)
- cancer pain[41]
- suicide risk for non cancer pain highest for
- migraine (RR=1.34)
- psychogenic pain (RR=1.58)
- undertreatment
- cognitive impairment, age > 95 years, black or Asian race less likely to receive opiate[9]
Management
eliminate barriers to functional improvement
- behavioral, social or systems issues
- telephone-based pain management can improve symptoms in patients with chronic musculoskeletal pain[21]
- mean pain score was 3.57 (out of 10) vs 4.59
- asking about pain tolerability has advantages over a 10 point scale[44]
- multimodal pain management strategy[4]
non-pharmaceutical measures
- multimodal pain management strategy[4]
- cognitive behavior therapy (CBT)[24][25][40]
- self management strategies that reduce pain[24]
- adaption for education level[39]
- group-based approach may provide benefit[40]
- CBT provides improvement in pain & quality of life without changing opioid use[48]
- physical therapy, massage, chiropractic manipulation
- ice & heat therapy
- aerobic exercise
- exercise may mitigate morbidity of chronic pain through enhancement of pain tolerance[56]
- transcutaneous nerve stimulation (TENS)[4]
- impantation of a spinal cord stimulator for intractable back or leg pain[43]
- acupuncture can help alleviate chronic pain, but much of the benefit can be explained by a placebo effect[10]
- not much better than sham procedure[19]
- treatment agreements for patients on long-term controlled substances[20]
- may diminish misuse & improve safety
- required by some state medical boards[20]
- nurse care manager[24]
- green eyeglasses may reduce anxiety & opiate use in patients with chronic pain[49]
- physician empathy associated with lesser pain intensity & less disability[60]
pharmaceutical stategies for treating chronic pain
- protocol-driven analgesic therapy[24]
- multimodal strategy including acetaminophen, NSAID, gabapentenoid, antidepressant, opiate &/or possibly cannabis[4]
pharmaceuticals
- acetaminophen: up to 1000 mg every 8 hours (3000 mg/day)
- non-steroidal anti-inflammatory drugs (NSAIDs)
- refs[2][11] do not exclude NDSAIDs in pain ladder for 85 yo with cancer pain
- antidepressants for neuropathic pain
- tricyclic antidepressants
- doxepin 75-400 mg/day
- amitriptyline 25-300 mg/day
- imipramine 75-400 mg/day
- nortriptyline 40-150 mg/day
- desipramine 50-300 mg/day
- irritable bowel syndrome, neuropathic pain, chronic tension headache (low-certainty evidence)[51]
- serotonin & norepinephrine reuptake inhibitors (SNRIs)
- venlafaxine
- duloxetine[4][5] only antidepressant effective for chronic pain[53]
- chronic back pain, postoperative pain, fibromyalgia, neuropathic pain (moderate-certainty evidence)[51]
- depression with comorbid chronic pain, knee osteoarthritis (low-certainty evidence)[51]
- tricyclic antidepressants
- anticonvulsants for neuropathic pain
- phenytoin (Dilantin) 300 mg QHS
- carbamazepine (Tegretol) 200-300 mg every 6 hours
- clonazepam (Klonopin)
- gabapentin (Neurontin):
- pregabalin
- mexiletine 150-300 mg every 6-12 hours
- opiates
- use in combination with other analgesics or not at all
- avoid use of opiates for chronic neuropathic pain[4]
- start short-acting opiate PRN
- titrate as needed
- extra precautions when prescribing at or above 50 morphine mg equivalents per day[26]
- switch to long-acting opiate when PRN dose is stable adverse effects are tolerable[8]
- oral opiates preferred; do not use intramuscular[4]
- sublingual or subcutaneous if oral route not feasible[4]
- prevention & treatment of constipation (all patients on chronic opioids)[4]
- stimulant laxative (senna, bisacodyl) with or without docusate
- osmotic agent (polyethylene glycol, sorbitol, lactulose)
- naldemedine, naloxegol, or naltrexone
- tolerance does NOT develop to constipating effects[4]
- prescribe doses of opiate > 80-120 mg/day morphine equivalent only for patients with meaningful pain & functional improvement with treatment, in consultation with a pain management specialist[22][26]
- discuss benefits & harms of continued opioid treatment with patients at least every 3 months
- little evidence of improved function, enhanced quality of life, or diminished pain[4][23]; overall functional status, quality of life, & pain actually worse with chronic opiates[4]
- 40% of deaths from unintentional drug overdose are caused by prescription opioids[7]
- opioid use increases risk of falls & fractures, hospitalization & doubles mortality[7]
- increased mortality (RR=1.64) relative to use of antidepressants or anticonvulsants[31]
- urine drug testing before initiation of opiates & yearly thereafter[26]
- avoid combination of opiates & benzodiazepines[26]
- coprescribing naloxone with opioids
- patients taking >= 50 morphine mg equivalents per day
- patients also taking benzodiazepine (if combination unavoidable)
- may diminish opioid-related emergency department visits[32]
- reduction or cessation of long-term opiate therapy may improve pain, function, & quality of life[35]
- opioids no better than nonopioid drugs for chronic back pain or chronic pain related to hip osteoarthritis or knee osteoarthritis[38]
- transdermal fentanyl safest opiate in renal failure & liver failure[4]
- start lower dose patch with liver failure
- use only in opioid-tolerant patients[4]
- hydromorphine reasonable choice if renal failure
- reduce dose with liver failure
- meperidine is not recommended due to increased risk for seizures
- tramadol has drug interactions with other serotoninergic agents
- methadone 1/2life averages 25 hours[52]
- use in combination with other analgesics or not at all
- buprenorphine, rather than a full agonist opioid, for chronic pain, given its lower risk for overdose or misuse
- medical marijuana when other options have failed[4][42]
- may result in a decrease in use of other analgesics[50]
- investigational
- cold analgesia can block pain signaling
Notes
- poor medication management most common reason for lawsuits against pain physicians[37]
- few payouts, no payouts for termination of opioid prescription
- systematic review assessing the effectiveness & harms of plant-based treatments for chronic pain[45]
- alternative medicine increasingly used for treatment of chronic pain[59]
More general terms
More specific terms
- chronic abdominal pain
- chronic daily headache
- chronic musculoskeletal pain
- chronic pelvic pain syndrome (CPPS)
- neuropathic pain
- wind-up pain
References
- ↑ Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 56-58
- ↑ 2.0 2.1 Trescot AM et al, Opioids in the management of chronic non-cancer pain: an update of American Society of the Interventional Pain Physicians' (ASIPP) guidelines. Pain Phys 2008 Mar-Apr;11(2S):S5-62. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18443640 Corresponding guideline updated Dec 2012 (NGC)
- ↑ Veterans Administration Memorandum Dec 24, 2009 Recent VHA Findings regarding chronic pain conditions and suicide risk
- ↑ 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 4.11 4.12 4.13 4.14 4.15 4.16 4.17 4.18 Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018, 2021.
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - ↑ 5.0 5.1 FDA News release, Nov. 4, 2010 FDA clears Cymbalta to treat chronic musculoskeletal pain http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm232708.htm
- ↑ Prescriber's Letter 17(12): 2010 COMMENTARY: Opioids for Chronic Non-Cancer Pain CHART: Equianalgesic Dosing of Opioids for Pain Management Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=261201&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 7.0 7.1 7.2 Okie S. A flood of opioids, a rising tide of deaths. N Engl J Med 2010 Nov 18; 363:1981 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21083382
Campbell CI et al. Age and gender trends in long-term opioid analgesic use for noncancer pain. Am J Public Health 2010 Dec; 100:2541. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20724688
Solomon DH et al. The comparative safety of analgesics in older adults with arthritis. Arch Intern Med 2010 Dec 13/27; 170:1968. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21149752
Solomon DH et al. The comparative safety of opioids for nonmalignant pain in older adults. Arch Intern Med 2010 Dec 13/27; 170:1979. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21149754
Graf J. Analgesic use in the elderly: The "pain" and simple truth. Arch Intern Med 2010 Dec 13/27; 170:1976. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21149753
Becker WC and O'Connor PG. The safety of opioid analgesics in the elderly: New data raise new concerns. Arch Intern Med 2010 Dec 13/27; 170:1986. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21149755
Katz MH. Long-term opioid treatment of nonmalignant pain: A believer loses his faith. Arch Intern Med 2010 Sep 13; 170:1422. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20837826 - ↑ 8.0 8.1 Becker WC, O'Connor PG. The safety of opioid analgesics in the elderly: New data raise new concerns: Comment on "The Comparative Safety of Opioids for Nonmalignant Pain in Older Adults". Arch Intern Med 2010; 170(22):1986-1988. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21149755
Papaleontiou M, Henderson CR, Turner BJ, et al. Outcomes associated with opioid use in the treatment of chronic noncancer pain in older adults: a systematic review and meta-analysis. J Am Geriatr Soc 2010; 58(7):1353-1369. Epub 2010 Jun 1. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20533971 - ↑ 9.0 9.1 Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019 - ↑ 10.0 10.1 Vickers AJ et al. Acupuncture for chronic pain: Individual patient data meta-analysis. Arch Intern Med 2012 Oct 22; 172:1444. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22965186 <Internet> http://archinte.jamanetwork.com/article.aspx?articleid=1357513
Avins AL. Needling the status quo. Arch Intern Med 2012 Oct 22; 172:1454. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22965282 <Internet> http://archinte.jamanetwork.com/article.aspx?articleid=1357516 - ↑ 11.0 11.1 Swetz KM, Kamal AH. In the clinic. Palliative care. Ann Intern Med. 2012 Feb 7;156(3) PMID: https://www.ncbi.nlm.nih.gov/pubmed/22312158
- ↑ American Geriatrics Society Panel on Pharmacological Management of Persistent Pain in Older Persons. Pharmacological management of persistent pain in older persons. J Am Geriatr Soc. 2009 Aug;57(8):1331-46 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19573219
- ↑ Ilgen MA et al Noncancer Pain Conditions and Risk of Suicide. JAMA Psychiatry. 2013;():1-6 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23699975 <Internet> http://archpsyc.jamanetwork.com/article.aspx?articleid=1689535
- ↑ Eccleston C, Williams AC, Morley S. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev. 2009 Apr 15;(2):CD007407 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19370688
- ↑ Cooper JW, Burfield AH. Assessment and management of chronic pain in the older adult. J Am Pharm Assoc (2003). 2010 May-Jun;50(3):e89-99 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20452902
- ↑ Chronic pain http://www.emedicinehealth.com/chronic_pain/article_em.htm
- ↑ VA/DoD Clinical Practice Guidelines Management of Opioid Therapy (OT) for Chronic Pain http://www.healthquality.va.gov/Chronic_Opioid_Therapy_COT.asp
- ↑ 18.0 18.1 Prescriber's Letter 21(3): 2014 Urine Drug Testing in Chronic Pain Patients Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=300318&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 19.0 19.1 Vickers AJ and Linde K. Acupuncture for chronic pain. JAMA 2014 Mar 5; 311:955 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24595780
- ↑ 20.0 20.1 20.2 Prescriber's Letter 21(4): 2014 Treatment Agreements for Chronic Pain Patients. Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=300424&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 21.0 21.1 Kroenke K et al Telecare Collaborative Management of Chronic Pain in Primary Care. A Randomized Clinical Trial. JAMA. 2014;312(3):240-248 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25027139 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1887761
Ohl ME and Rosenthal GE Advancing Telecare for Pain Treatment in Primary Care. JAMA. 2014;312(3):235-236 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25027137 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1887741 - ↑ 22.0 22.1 Franklin GM et al Opioids for chronic noncancer pain. Neurology September 30, 2014 vol. 83 no. 14 1277-1284 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25267983 <Internet> http://www.neurology.org/content/83/14/1277
- ↑ 23.0 23.1 Reuben DB et al National Institutes of Health Pathways to Prevention Workshop: The Role of Opioids in the Treatment of Chronic Pain. Ann Intern Med. Published online 13 January 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25581341 <Internet> http://annals.org/article.aspx?articleid=2089371
Chou R, Turner JA, Devine EB et al The Effectiveness and Risks of Long-Term Opioid Therapy for Chronic Pain: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med. Published online 13 January 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25581257 <Internet> http://annals.org/article.aspx?articleid=2089370 - ↑ 24.0 24.1 24.2 24.3 24.4 Bair MJ et al. Evaluation of stepped care for chronic pain (ESCAPE) in veterans of the Iraq and Afghanistan conflicts: A randomized clinical trial. JAMA Intern Med 2015 Mar 9 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25751701 <Internet> http://archinte.jamanetwork.com/article.aspx?articleid=2174941
- ↑ 25.0 25.1 Makris UE, Abrams RC, Gurland B, Reid MC. Management of persistent pain in the older patient: a clinical review. JAMA. 2014 Aug 27;312(8):825-36. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25157726
- ↑ 26.0 26.1 26.2 26.3 26.4 26.5 Centers for Disease Control and Prevention (CDC) Proposed 2016 Guideline for Prescribing Opioids for Chronic Pain. Federal Register. Dec 14, 2015 https://www.federalregister.gov/articles/2015/12/14/2015-31375/proposed-2016-guideline-for-prescribing-opioids-for-chronic-pain
Draft CDC Guideline for Prescribing Opioids for Chronic Pain
United States, 2016 http://www.regulations.gov/#!documentDetail;D=CDC-2015-0112-0002 - ↑ Dowell D, Haegerich TM, Chou R CDC Guideline for Prescribing Opioids for Chronic Pain. United States, 2016 http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1er.htm
Olsen Y The CDC Guideline on Opioid PrescribingRising to the Challenge. JAMA. Published online March 15, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26978227 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=2503503
Lee TH Zero Pain Is Not the Goal. JAMA. Published online March 15, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26978460 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=2503504 - ↑ Volkow ND, McLellan AT Opioid Abuse in Chronic Pain - Misconceptions and Mitigation Strategies. N Engl J Med 2016; 374:1253-1263March 31, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27028915 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMra1507771
- ↑ Manchikanti L, Abdi S, Atluri S et al American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic non-cancer pain: Part I--evidence assessment. Pain Physician. 2012 Jul;15(3 Suppl):S1-65. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22786448 Free Article
Manchikanti L, Abdi S, Atluri S et al American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic non-cancer pain: Part 2--guidance. Pain Physician. 2012 Jul;15(3 Suppl):S67-116. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22786449 Free Article (corresponding NGC guideline withdrawn Dec 2017) - ↑ Nuckols TK, Anderson L, Popescu I et al Opioid prescribing: a systematic review and critical appraisal of guidelines for chronic pain. Ann Intern Med. 2014 Jan 7;160(1):38-47. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24217469
- ↑ 31.0 31.1 Ray WA, Chung CP, Murray KT, Hall K, Stein CM. Prescription of Long-Acting Opioids and Mortality in Patients With Chronic Noncancer Pain. JAMA. 2016 Jun 14;315(22):2415-23. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27299617
- ↑ 32.0 32.1 Coffin PO, Behar E, Rowe C et al Nonrandomized Intervention Study of Naloxone Coprescription for Primary Care Patients Receiving Long-Term Opioid Therapy for Pain. Ann Intern Med. Published online 28 June 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27366987 <Internet> http://annals.org/article.aspx?articleid=2531366
Walley AY, Green TC Mainstreaming Naloxone Through Coprescription to Patients Receiving Long-Term Opioid Therapy for Chronic Pain. Ann Intern Med. Published online 28 June 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27367047 <Internet> http://annals.org/article.aspx?articleid=2531367 - ↑ Sullivan MD How Chronic Pain Treatment Falls Short of Patient-Centered Care. NEJM Catalyst. May 18, 2017 http://catalyst.nejm.org/chronic-pain-care-falls-short/
- ↑ Davis LG, Pangarkar S, Paige NM Treating Chronic Pain-Where We Have Been and Where We Are Going. Expert Commentary. deprecated reference - National Guideline Clearinghouse. July 3, 2017
- ↑ 35.0 35.1 Frank JW, Lovejoy TI, Becker WC et al Patient Outcomes in Dose Reduction or Discontinuation of Long-Term Opioid Therapy: A Systematic Review. Ann Intern Med. 2017. July 18. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28715848 <Internet> http://annals.org/aim/article/2643842/patient-outcomes-dose-reduction-discontinuation-long-term-opioid-therapy-systematic
Dowell D, Haegerich TM Changing the Conversation About Opioid Tapering. Ann Intern Med. 2017. July 18. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28715842 <Internet> http://annals.org/aim/article/2643843/changing-conversation-about-opioid-tapering - ↑ 36.0 36.1 Davis KD, Flor H, Greely HT et al Brain imaging tests for chronic pain: medical, legal and ethical issues and recommendations. Nature Reviews Neurology (2017) Online 08 September 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28884750 <Internet> http://www.nature.com/nrneurol/journal/vaop/ncurrent/full/nrneurol.2017.122.html
- ↑ 37.0 37.1 Abrecht CR, Brovman EY, Greenberg P, Song E, Rathmell JP, Urman RD. A contemporary medicolegal analysis of outpatient medication management in chronic pain. Anesth Analg. 2017;125:1761-1768. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29049120 https://psnet.ahrq.gov/resources/resource/31498
- ↑ 38.0 38.1 Krebs EE, Gravely A, Nugent S et al Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain. The SPACE Randomized Clinical Trial. JAMA. 2018;319(9):872-882 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29509867 https://jamanetwork.com/journals/jama/article-abstract/2673971
- ↑ 39.0 39.1 39.2 Thorn BE, Eyer JC, Van Dyke BP et al. Literacy-adapted cognitive behavioral therapy versus education for chronic pain at low-income clinics: A randomized controlled trial. Ann Intern Med 2018 Feb 27; <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29482213 <Internet> http://annals.org/aim/article-abstract/2673506/literacy-adapted-cognitive-behavioral-therapy-versus-education-chronic-pain-low
Kerns RD. Shining the LAMP on efforts to transform pain care in America. Ann Intern Med 2018 Feb 27; [e-pub] <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29482222 <Internet> http://annals.org/aim/article-abstract/2673752/shining-lamp-efforts-transform-pain-care-america - ↑ 40.0 40.1 40.2 Niknejad B, Bolier R, Henderson CR Jr et al Association Between Psychological Interventions and Chronic Pain Outcomes in Older Adults. A Systematic Review and Meta- analysis. JAMA Intern Med. Published online May 7, 2018. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29801109 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2680318
- ↑ 41.0 41.1 Petrosky E, Harpaz R, Fowler KA et al Chronic Pain Among Suicide Decedents, 2003 to 2014: Findings From the National Violent Death Reporting System. Ann Intern Med. 2018. Sept 11. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/30208405 <Internet> http://annals.org/aim/fullarticle/2702061/chronic-pain-among-suicide-decedents-2003-2014-findings-from-national
Ilgen M Pain, Opioids, and Suicide Mortality in the United States. Ann Intern Med. 2018. Sept 11. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/30208406 <Internet> http://annals.org/aim/fullarticle/2702063/pain-opioids-suicide-mortality-united-states - ↑ 42.0 42.1 Caulley L, Caplan B, Ross E. Medical Marijuana for Chronic Pain N Engl J Med 2018; 379:1575-1577. Oct 18, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30332574 Free full text https://www.nejm.org/doi/full/10.1056/NEJMclde1808149
- ↑ 43.0 43.1 Lamer TJ, Moeschler SM, Gazelka HM et al. Spinal stimulation for the treatment of intractable spine and limb pain: A systematic review of RCTs and meta-analysis. Mayo Clin Proc 2019 Aug; 94:1475-1487. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31279543 https://www.mayoclinicproceedings.org/article/S0025-6196(19)30131-4/fulltext
- ↑ 44.0 44.1 Markman JD, Gewandter JS, Frazer ME. Comparison of a pain tolerability question with the numeric rating scale for assessment of self-reported chronic pain. JAMA Netw Open 2020 Apr 1; 3:e203155. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32310281 Free PMC Article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2764594
- ↑ 45.0 45.1 McDonagh MS, Wagner J, Ahmed AY, et al. Living Systematic Review on Plant-Based Treatments for Chronic Pain - Quarterly Progress Report: December 2020 (Prepared by the Pacific Northwest Evidence-based Practice Center under Contract No. 75Q80120D00006.) AHRQ Publication No. 21-EHC013. Rockville, MD: Agency for Healthcare Research and Quality; January 2021. https://effectivehealthcare.ahrq.gov/products/plant-based-chronic-pain-treatment/living-review
- ↑ McDonagh MS, Wagner J, Ahmed AY et al Living Systematic Review on Plant-Based Treatments for Chronic Pain - Quarterly Progress Report: December 2020 (Prepared by the Pacific Northwest Evidence-based Practice Center under Contract No. 75Q80120D00006.) AHRQ Publication No. 21-EHC013. Rockville, MD: Agency for Healthcare Research and Quality; January 2021 https://effectivehealthcare.ahrq.gov/products/plant-based-chronic-pain-treatment/living-review
- ↑ Chou R, Fu R, Dana T, Pappas M, Hart E, Mauer KM. Interventional Treatments for Acute and Chronic Pain: Systematic Review. Comparative Effectiveness Review No. 247. (Prepared by the Pacific Northwest Evidence-based Practice Center under Contract No. 75Q80120D00006.) AHRQ Publication No. 21-EHC030. Rockville, MD: Agency for Healthcare Research and Quality; September 2021. https://effectivehealthcare.ahrq.gov/products/interventional-treatments-pain/research
- ↑ 48.0 48.1 DeBar L, Mayhew M, Benes L et al. A primary care-based cognitive behavioral therapy intervention for long-term opioid users with chronic pain: A randomized pragmatic trial. Ann Intern Med 2021 Nov 2; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34724405 https://www.acpjournals.org/doi/10.7326/M21-1436
- ↑ 49.0 49.1 Lou N For Chronic Pain Patients, Consider Green-Tinted Glasses? Mixed results with green light therapy for fibromyalgia MedPage Today October 24, 2022 https://www.medpagetoday.com/meetingcoverage/asa/101375
- ↑ 50.0 50.1 Bicket MC et al. Use of cannabis and other pain treatments among adults with chronic pain in US states with medical cannabis programs. JAMA Netw Open 2023 Jan 6; 6:e2249797. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36607641 Free article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2800119
- ↑ 51.0 51.1 51.2 51.3 Ferreira GE et al. Efficacy, safety, and tolerability of antidepressants for pain in adults: Overview of systematic reviews. BMJ 2023 Feb 1; 380:e072415. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36725015 PMCID: PMC9887507 Free PMC article https://www.bmj.com/content/380/bmj-2022-072415
Stannard C, Wilkinson C. Rethinking use of medicines for chronic pain. BMJ 2023 Feb 1; 380:170. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36724987 https://www.bmj.com/content/380/bmj.p170 - ↑ 52.0 52.1 George J Buprenorphine for Chronic Pain, Not Full Agonist Opioids, New VA Guidance Says. Unintended consequences of the recommendation need to be evaluated, experts maintain. MedPage Today February 13, 2023 https://www.medpagetoday.com/neurology/painmanagement/103090
Sandbrink F et al The Use of Opioids in the Management of Chronic Pain: Synopsis of the 2022 Updated U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline. Ann Intern Med. 2023. Feb 14 PMID: https://www.ncbi.nlm.nih.gov/pubmed/36780654 https://www.acpjournals.org/doi/10.7326/M22-2917 - ↑ 53.0 53.1 Birkinshaw H, Friedrich CN, Cole P et ak Antidepressants for pain management in adults with chronic pain: a network meta-analysis. Cochrane Library. 2023. May 10. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37160297 https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD014682.pub2/full
- ↑ Shirvalkar P, Prosky J, Chin G et al First-in-human prediction of chronic pain state using intracranial neural biomarkers. Nat Neurosci. 2023. May 22 PMID: https://www.ncbi.nlm.nih.gov/pubmed/37217725 https://www.nature.com/articles/s41593-023-01338-z
- ↑ Ari M, Alexander JT, Weyer G Prescribing Opioids for Pain. JAMA. 2023;329(20):1789-1790. April 24. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37093596 https://jamanetwork.com/journals/jama/fullarticle/2804388
- ↑ 56.0 56.1 Arnes AP, Nielsen CS, Stubhaug A et al Longitudinal relationships between habitual physical activity and pain tolerance in the general population. PLOS; 2023. May 24. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37224163 PMCID: PMC10208467 Free PMC article https://doi.org/10.1371/journal.pone.0285041
- ↑ MEDICAL BOARD OF CALIFORNIA GUIDELINES FOR PRESCRIBING CONTROLLED SUBSTANCES FOR PAIN.July 2023. https://www.mbc.ca.gov/Download/Publications/pain-guidelines.pdf
- ↑ 58.0 58.1 Sadlon A, Takousis P, Ankli B et al. Association of chronic pain with biomarkers of neurodegeneration, microglial activation, and inflammation in cerebrospinal fluid and impaired cognitive function. Ann Neurol 2023 Oct 3; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37787094 https://onlinelibrary.wiley.com/doi/10.1002/ana.26804
- ↑ 59.0 59.1 Nahin RL et al. Use of complementary health approaches overall and for pain management by US adults. JAMA 2024 Jan 25; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/38270938 https://jamanetwork.com/journals/jama/fullarticle/2814472
- ↑ 60.0 60.1 Licciardone JC, Tran Y, Ngo K et al. Physician empathy and chronic pain outcomes. JAMA Netw Open 2024 Apr 1; 7:e246026. PMID: https://www.ncbi.nlm.nih.gov/pubmed/38602675 PMCID: PMC11009829 Free PMC article. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2817441