Chronic pain management: evaluation of chronic pain

Chronic pain (CP) is a heterogeneous group of conditions classified as neuropathic, muscular, visceral, inflammatory, or mixed. The pathogenesis is not completely understood, but neuroanatomic changes and central sensitization, in which the central nervous system amplifies pain transmission, are associated maladaptations. When treating a patient with CP, first classify the type of pain, if possible; assess its intensity; and assess its influence on health, well-being, and comorbidities. Then develop a treatment plan. At each visit, clinicians should assess analgesia (pain level/relief), affect (mood assessment), and activities of daily living (functional status); obtain a pill count, if appropriate; optimize adjuvant therapy; and evaluate for adverse effects and aberrant drug-related behavior. Accurate documentation of behavioral indicators of pain, responses to interventions, and management strategies is extremely important in facilitating continuity of care and patient safety.