[THE MISTAKE OF CUT AND PASTE FROM ACUTE PAIN TO CHRONIC PAIN]

What is a physician to do when the tools in his toolbox fail him? In the field of chronic pain, we are told that imaging studies are often so non-specific as to barely distinguish between symptomatic and asymptomatic individuals. "Advanced pain management techniques and off-label use of popular pain medicines do not withstand the rigors of controlled clinical trials and in many cases have been shown to be harmful. We are informed by the CDC that we are in the midst of a deadly "physician-driven" epidemic of prescribed opioid use disorder. The British Medical Society refers to "our silent addicts" explaining that pregabalin is the "new valium". The manufacturers of oxycodone, pregabalin and duloxetine have been successfully sued for up to $650 million for having overstated the benefits and understated the risks of their products. There has been a huge accumulation of scientific literature over 30 years demonstrating that pain-related beliefs, attitudes and behaviors are the most powerful predictors of outcome: more so than depression, anxiety, PTSD or personality type. All this confusion begs for a change of approach and treatment platform. This article wishes to introduce the reader to a different set of safer, more evidence-based tools to consider when faced with a problematic chronic pain patient.