Chronic pain is a symptom associated with ongoing physical or mental illness or a combination of both that may not have a clear, identifiable pathophysiology. Assessment of chronic pain varies in the clinical presentation related to age, gender, racial, and cultural differences. Headache, low back pain, musculoskeletal pain, and neuropathic pain are the most common types of chronic pain complaints by patients. Pharmacologic therapy is based on best practice standards, published clinical trials, and guidelines by professional organizations. Current medications reviewed include opioids, anticonvulsants, antidepressants, clonidine, local anesthetics, muscle relaxants, N-methyl-D-aspartate antagonists, and nonsteroidal anti-inflammatory drugs.
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References
1.
1. LeResche L. Gender, cultural, and environmental aspects of pain. In: Loeser JD, ed. Bonica's Management of Pain. 3rd ed. Philadelphia: Lippincott Williams and Wilkins ; 2001:191-195.
2.
2. Riley JL, Wade JB, Robinson ME, Price DD. The stages of pain processing across the adult lifespan . J Pain. 2000;1: 162-170 .
3.
3. Cook AJ, Chastain DC. The classification of patients with chronic pain: age and sex differences . Pain Res Manage. 2001;6(3): 142-151 .
4.
4. Riley JL, Wade JB, Myers CD, Sheffield D, Papas RK, Price DD. Racial/ethnic differences in the experience of chronic pain . Pain. 2002;100: 291-298 .
5.
5. Turk DC. Biopsychosocial perspective on chronic pain. In: Gatchel RJ, Turk DC, eds. Psychological Approaches to Pain Management: A Practitioner's Handbook. New York: Guilford ; 1996:3-32.
6.
6. Skevington SM, Carse MS, Williams AC. Validation of the WHOQOL-100: pain management improves quality of life for chronic pain patients . Clin J Pain. 2001;17: 264-275 .
7.
7. Bolay H, Moskowitz MA. Mechanisms of pain modulation in chronic syndromes . Neurology. 2002;59(suppl 2): S2-S7 .
8.
8. Terman GW, Bonica JJ. Spinal mechanisms and their modulation. In: Loeser JD, ed. Bonica's Management of Pain. 3rd ed. Philadelphia: Lippincott Williams and Wilkins ; 2001:73-152.
9.
9. Mannion RJ, Woolf CJ. Pain mechanisms and management: a central perspective . Clin J Pain. 2000;16(suppl 3): S144-S156 .
10.
10. Millan MJ. Descending control of pain . Prog Neurobiol. 2002;66(6): 355-474 .
11.
11. Wiesenfeld-Hallin Z, Xu XJ. The role of spinal cholecystokinin in chronic pain states . Pharmacol Toxicol. 2002;91(6): 398-403 .
12.
12. Zinder O, Dar DE. Neuroactive steroids: their mechanism of action and their function in the stress response . Acta Physiol Scand. 1999;167: 181-188 .
14. McCaig L, Burt C. National hospital ambulatory medical care survey: 1999 emergency department summary . Adv Data. 2001;320: 1-34 .
15.
15. Goadsby PJ, Lipton RB, Ferrari MD. Migraine: current understanding and treatment . N Engl J Med. 2002;346(4): 257-270 .
16.
16. Silberstein DS, Rosenberg J. Multispecialty consensus on diagnosis and treatment of headache . Neurology. 2000;54: 1553 .
17.
17. Goetzel RZ, Hawkins K, Ozminkowski RJ, Wang S. The health and productivity cost burden of the top 10 physical and mental health conditions affecting six large U.S. employers in 1999 . J Occup Environ Med. 2003;45(1): 5-14 .
18.
18. Deyo RA, Weinstein JN. Low back pain . N Engl J Med. 2001;344(5): 363-370 .
19.
19. Guideline for the Management of Pain in Osteoarthritis, Rheumatoid Arthritis, and Juvenile Chronic Arthritis. Glenview, Ill: American Pain Society ; 2002.
20.
20. Sola AE, Bonica JJ. Myofascial pain syncromes. In: Loeser JD, ed. Bonic's Management of Pain. 3rd ed. Philadelphia, Pa: Lippincott Williams and Wilkins , 2001.
21.
21. Crofford LJ, Clauw DJ. Fibromyalgia: where are we a decade after the American College of Rheumatology classification criteria were developed . Arthritis Rheum. 2002;46(5): 1136-1138 .
22.
22. Arnold LM, Keck PE, Welge JA. Antidepressant treatment of fibromyalgia: a meta-analysis and review . Psychosomatics. 2000;41(2): 104-113 .
23.
23. Backonja MM. Painful neuropathies. In: Loeser JD, ed. Bonica's Management of Pain. 3rd ed. Philadelphia: Lippincott Williams and Wilkins ; 2001:370-411.
24.
24. Vailancourt PD, Langevin HM. Painful peripheral neuropathies . Med Clin North Am. 1999;83(3): 627-642 .
25.
25. Lee KJH, Kirchner JS. Complex regional pain syndrome and chronic pain management in the lower extremity . Foot Ankle Clin N Am. 2002;7: 409-419 .
26.
26. Wasner G, Schattschneider J, Binder A, Baron R. Complex regional pain syndrome, diagnostic, mechanisms, CNS involvement and therapy . Spinal Cord. 2003;41: 61-75 .
27.
27. Hogan QH, Abram SE. Neural blockade for diagnosis and prognosis . Anesthesiology. 1997;86(1): 216-241 .
28.
28. Greenwall BD, Narcessian EJ. Opioids for managing patient with chronic pain: community pharmacists' perspectives and concerns . J Pain Symptom Manage. 1999;17: 369-375 .
29.
29. Joranson DE, Gilson AM. Pharmacist's knowledge of and attitudes toward opioid pain medications in relation to federal and state policies . J Am Pharm Assoc. 2001;41: 213-220 .
30.
30. Brushwood DB. From confrontation to collaboration: collegial accountability and the expanding role of pharmacists in the management of chronic pain . J Law Med Ethics. 2001;29: 69-93 .
31.
31. Fishman SM, Bandman TB, Edwards A, Borsook D. The opioid contract in the management of chronic pain . J Pain Symptom Manage. 1999;18: 27-37 .
32.
32. Fishman SM, Mahajan G, Jung SW, Wilsey BL. The trilateral opioid contract: bridging the pain clinic and the primary care physician through theopioid contract . J Pain Symptom Manage.2002;24: 335-344 .
33.
33. O'Mahony S, Coyle N, Payne R. Current management of opioid related side effects . Oncology. 2001;15(1): 61-77 .
34.
34. Bernard SA, Bruera E. Drug interactions in palliative care . J Clin Oncol. 2000;18(8): 1780-1799 .
35.
35. Anderson R, Saiers JH, Abram S, Schlicht C. Accuracy in equianalgesic dosing conversion dilemmas . J Pain Symptom Manage. 2001;21(5): 397-406 .
36.
36. Pereira J, Lawlor P, Vigano A, Dorgan M, Bruera E. Equianalgesic dose ratios for opioids: a critical review and proposals for long-term dosing . J Pain Symptom Manage. 2001;22: 672-687 .
37.
37. Savage SR. Opioid use in the management of chronic pain . Med Clin North Am. 1999;83: 761-786 .
38.
38. Jeal W, Benfield P. Transdermal fentanyl: a review of its pharmacological properties and therapeutic efficacy in pain control . Drugs. 1997;53(1): 109-138 .
39.
39. Quigley C.Wiffen P. A systematic review of hydromorphone in acute and chronic pain . J Pain Symptom Manage. 2003;25: 169-178 .
40.
40. Caldwell JR, Rapoport RJ, Davis JC, et al. Efficacy and safety of a once-daily morphine formulation in chronic, moderate to severe osteoarthritis pain: results from a randomized, placebo-controlled, double-blind trial and an open label extension trial . J Pain Symptom Manage. 2002;23: 278-291 .
41.
41. Roth SH, Fleischman RM, Burch FX, et al. Around the clock controlled release oxycodone therapy for osteoarthritis related pain . Arch Intern Med. 2000;160: 853-860 .
42.
42. Wheeler WL, Dickerson ED. Clinical applications of methadone . Am J Hospice Palliat Care. 2000;17(3): 196-203 .
43.
43. Inturrisi C. Clinical pharmacology of opioids for pain . Clin J Pain. 2002;18(suppl 4): S3-S13 .
44.
44. Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain. 4th ed. Glenview, Ill: American Pain Society ; 1999.
45.
45. Rowbotham MC, Twilling L, Davies PS, Reisner L, Taylor K, Mohr D. Oral opioid therapy for chronic peripheral and central neuropathic pain . N Engl J Med. 2003;348(13): 1279-1281 .
46.
46. Peng PW, Sandler AN. A review of the use of fentanyl analgesia in the management of acute pain in adults . Anesthesiology. 1999;90(2): 576-599 .
47.
47. Hanks GW, Conno F, Cherny N, et al. Morphine and alternative opioids in cancer pain: the EAPC recommendations . Br J Cancer. 2001;84(5): 587-593 .
48.
48. Sarhill N, Walsh D, Nelson KA. Hydromorphone: pharmacology and clinical applications in cancer patients . Support Care Cancer. 2001;9(2): 84-96 .
49.
49. Latta K, Ginsberg B, Barkin RL. Meperidine: a critical review . Am J Ther. 2002;9: 53-68 .
50.
50. Backonja M, Glanzman RL. Gabapentin dosing for neuropathic pain: evidence from randomized placebo controlled clinical trials . Clin Ther. 2003;25(1): 81-104 .
51.
51. Serpell MG. Gabapentin in neuropathic pain syndromes: a randomized, double-blind, placebo controlled trial . Pain. 2002;99(3): 557-566 .
52.
52. Spruce MC, Potter J, Coppini DV. The pathogenesis and management of painful diabetic neuropathy: a review . Diabet Med.2003;20(2): 88-98 .
53.
53. Ribbers GM, Geurts AC, Stam HJ, Mulder T. Pharmacologic treatment of complex regional pain syndrome I: a conceptual framework . Arch Phys Med Rehabil. 2003;84(1): 141-146 .
54.
54. Sawynok J, Esser MJ, Reid AR. Antidepressants as analgesics: an overview of central and peripheral mechanism of action . J Psychiatr Neurosci. 2001;26: 21-29 .
55.
55. Nutt DJ. The neuropharmacology of serotonin and noradrenaline in depression . Int Clin Psychopharm. 2002;17(suppl 1): S1-S12 .
56.
56. Davis MP, Srivastava M. Demographics, assessment and management of pain in the elderly . Drugs Aging. 2003;20(1): 23-57 .
57.
57. Olmedo R, Hoffman RS. Withdrawal syndromes . Emerg Med Clin North Am. 2000;18(2): 273-288 .
59. Gammaitoni AR, Alvarez NA, Galer BS. Safety and tolerability of the lidocaine patch 5%, a targeted peripheral analgesic: a review of literature . J Clin Pharmacol. 2003;43: 111-117 .
60.
60. Bennet G, Burchiel K, Buchser E, et al. Clinical guidelines for intraspinal infusion: report of an expert panel . J Pain Symptom Manage. 2000;20: S37-S43 .
62. Gracies JM, Nance P, Elovic E, McGuireJ, Simpson DM. Traditional pharmacological treatments for spasticity part II: general and regional treatments . Muscle Nerve1997;(suppl 6): S92-S120 .
63.
63. Fromm GH. Baclofen as an adjuvant analgesic . J Pain Symptom Manage. 1994;9: 500-509 .
64.
64. Coffey RJ, Edgar TS, Fansisco GE. Abrupt withdrawal from intrathecal baclofen: recognition and management of a potenially life-threatening syndrome . Arch Phys Med Rehabil. 2002;83: 735-741 .
65.
65. Peng CT, Ger J, Yang CC. Prolonged severe withdrawal symptoms after acute symptoms from overdose and chronic baclofen use . J Toxicol Clin Toxicol. 1998;36(4): 359-362 .
66.
66. Burchiel KJ, Hsu KP. Pain and spasticity after spinal cord injury: mechanism and treatment . Spine. 2001:26(suppl 24): S146-S160 .
67.
67. Winchell GA, King JD, Chavez-Eng CM, Constanzer ML, Korn SH. Cyclobenzaprine pharmacokinetics including the effects of age, gender, and hepatic insufficiency . J Clin Pharmacol. 2002;42: 61-69 .
68.
68. Hawkins C, Hanks GW. The gastroduodenal toxicity of nonsteroid anti-inflammatory drugs: a review of the literature . J Pain Symptom Manage. 2000;20(2): 140-151 .
69.
69. Catella-Lawson F, McAdam B, Morrison BW, et al. Effects of specific inhibition of cyclooxygenase-2 on sodium balance, hemodynamics, and vasoactive eicosanoids . J Pharmacol Exp Ther. 1999;289: 735-741 .
70.
70. Whelton A, Schulman G, Wallemark C, et al. Effects of celecoxib and naproxen on renal function in the elderly . Arch Intern Med. 2000;160: 1465-1470 .
71.
71. Swan SK, Rudy DW, Lasseter KC, et al. Effect of cycloooxygenase-2 inhibition on renal function in elderly persons receiving a low-salt diet . Ann Intern Med. 2000;133: 1-9 .
72.
72. Ripamounti C, Bianchi M. The use of methadone in cancer pain . Hematol Oncol Clin North Am. 2002;16(3): 543-555 .
