Update on chronic pain management.

Area of Science:

• Medical Science
• Pain Management
• Clinical Medicine

Background:

• Chronic pain is a prevalent condition often presenting with significant discrepancies between reported symptoms and identified tissue damage.
• Opioid analgesics were widely promoted for chronic non-cancer pain from the 1990s to mid-2010s, leading to widespread misuse and overdose deaths.
• The opioid crisis has prompted a re-evaluation of chronic pain management strategies.

Purpose of the Study:

• To provide an updated overview for medical fellows and trainees on the assessment and management of chronic pain in adult patients.
• To discuss pharmacotherapy options beyond opioids, including antidepressants and anticonvulsants for neuropathic pain.
• To review interventional procedures and the effectiveness of pain self-management training for chronic pain.

Main Methods:

• Literature review and synthesis of current evidence on chronic pain assessment and treatment.
• Focus on post-opioid epidemic pharmacotherapy, interventional pain management, and self-management training.
• Discussion of management strategies for patients with chronic pain, particularly those with prolonged symptoms and treatment failures.

Main Results:

• Pharmacotherapy, including antidepressants and anticonvulsants, plays a key role in managing neuropathic pain post-opioid epidemic.
• Interventional procedures offer additional options for chronic pain management.
• Pain self-management training demonstrates effectiveness for individuals with chronic pain, especially after other treatments have failed.

Conclusions:

• Effective chronic pain management requires a multimodal approach, moving beyond the overreliance on opioids.
• Antidepressants, anticonvulsants, interventional procedures, and self-management training are vital components of contemporary chronic pain care.
• This review equips clinicians with updated knowledge to manage complex chronic pain cases effectively and safely.