[Drug therapy of chronic pain. A practical approach]

The management of chronic pain has been distinctly facilitated by the introduction of slow-release forms of various types of analgesics. The WHO ladder continues to represent a useful guide for the management of the patient with chronic pain, but should neither be binding on the physician nor restrict his options. In principle, it makes good sense to gain experience with a small number of analgesics. For combatting severe pain, morphine is the most reliable weapon. For all medications, the principle applies that they should be used on a regular and purposeful basis. The next dose should be taken before the pain reappears. In the case of anxiety, depression or nausea, additional medications may often be indicated. In some patients, in particular those with neuropathic pain, pumps for long-term application, or invasive techniques may be needed. These patients could benefit considerably from the care provided by pain specialists or interdisciplinary pain clinics.