Consider referring any patient with chronic pain to a psychologist or therapist to address the psychological effects of chronic pain.

Neuropathic pain: pain caused by abnormal neural activity that arises secondary to injury, disease, or dysfunction of the nervous system

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In addition to a usual history and physical examination, in patients with chronic pain assess the following (Table 3):

Obtain a urine drug screen at least once per year and any time when concerns arise for inappropriate use, the use of other substances, or diversion.

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The principles of pain management are detailed in this article. Acute pain management, chronic noncancer pain management, and pain management in palliative care are detailed separately.

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Some evidence shows that patients with complex persistent dependence may tolerate transition to buprenorphine better than a tapering down of the opioid dose. When complex persistent dependence is suspected, a more clinically useful approach may be to transition to buprenorphine and then taper down the dose.

The most serious potential adverse effect is respiratory depression accompanied by symptoms of sedation and confusion. It may occur with high dose administration in opioid naïve patients. Opioids, at therapeutic doses, depress respiratory rate and tidal volume.

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Some evidence exists for methadone use in this population as well. However, it is less promising than buprenorphine.

Some medicines must be stopped gradually. Also, be aware that you may have some short-term rebound insomnia for a few days after you stop taking sleeping pills.

A successful regimen may Shop Now combine low doses of different types of pain medications to treat different mechanisms of perceived pain simultaneously, increasing medication effectiveness while limiting the risk of toxicity.