3 critical factors to help guide your management of chronic pain

Troy Parks
Staff Writer
AMA Wire
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Chronic pain is “common and complicated,” a new educational module on safe opioid prescribing for chronic pain begins. The interactive module helps physicians who use opioid analgesics for pain management or work with patients living with chronic pain gain a comprehensive understanding of the factors impacting chronic pain, the burden of chronic pain in the U.S. and treatment goals and modalities to reduce opioid-related harm.

In the United States, one in three people suffer from chronic pain and one in 12 struggle to cope with moderate to severe pain, the module notes. And complaints of pain account for up to 20 percent of outpatient visits with a price tag of more than $600 billion in health care expenses, lost income, decreased productivity and several other expenses every year.

The module points out three critical factors to understanding patients with chronic pain and the treatment options available.

Variables that affect the individual chronic pain experience. In some cases, especially involving neural injury, pathologic and maladaptive responses within somatosensory pain-signaling pathways develop and persist after the acute injury has healed, creating ongoing pain signals. Some patients are predisposed to increased sensitization of pain pathways as a result of genetic and epigenetic factors.

Stressors that affect patients. Patients often struggle with stressors in their personal lives at work or home that can worsen chronic pain. Socially and culturally determined constructs of pain, suffering and disability also influence an individual’s response to pain, and the presence of co-morbid mental health disorders can exacerbate pain and further complicate treatment.

Differing treatments for patients with pain. Unfortunately, treatments designed for acute, self-limited pain are usually inadequate and may be inappropriate for chronic pain. The treatment of chronic pain often requires a multidimensional approach. Ultimately, the goals in these patients are to reduce pain, restore function, improve quality of life and cultivate well-being. Many treatment strategies are available, including psycho-behavioral approaches, procedural or interventional techniques, physical and other manual therapies, and medications.

Other features of the module include educational chapters such as:

  • How do opioids work?
  • Human variation in opioid responses
  • What is the difference between opioid misuse and addiction?
  • Risk factors for opioid misuse and risk mitigation strategies
  • When are opioids indicated?
  • Opioid tapering

The module is available on the AMA Education Center, along with another module that takes a more in-depth look at what every physician should know about the opioid morbidity and mortality crisis. Both modules are free.

The AMA Task Force to Reduce Opioid Abuse was started in 2014 and includes the representation of more than two dozen state and specialty medical societies. The task force is working to: increase physicians' registration and use of effective Prescription Drug Monitoring Programs; enhance physicians' education on effective, evidence-based prescribing; reduce the stigma of chronic pain and promote comprehensive assessment and treatment; reduce the stigma of substance-use disorder and enhance access to treatment; and expand access to naloxone in the community and through co-prescribing.

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