Chronic Pain Guidelines

Pain does not discriminate; it affects every person at one time or another. For some, injury heals itself and pain goes away on its own. However, for many people, pain becomes an all-consuming aspect of their lives. Chronic pain is defined as pain that lasts longer than three consecutive months or past the time of normal tissue healing outside of active cancer treatment, palliative care, and end-of-life care. Treatment of pain varies from patient to patient according to how long, how severe, and how debilitating it is. Guidelines for treating patients with chronic pain must focus on the American Medical Association's (AMA) primary obligation to patients and which specifies the duties of physicians to humanity.

Approximately 100 million adults in the U.S. suffer from common chronic pain conditions. What physicians must fully understand is pain is more than just a physical experience; it is an emotional experience as well that has the power to touch every aspect of a person's life. "Catastrophizing" is a predictor of pain, which is defined as a negative emotional and cognitive response to pain that involves elements of magnification, helplessness, and pessimism. Because pain tolerance is different for every individual, there is no one-size-fits-all approach to chronic pain management. What scarcely affects one patient can cause extreme pain to another. This "tolerance" may also be contributed to how long a person has had to deal with chronic pain, and how long and well they adjusted to the "new normal" that is their life.

Chronic pain not only affects the individual for whom the condition is associated with, but it also causes isolation and strained relationships with family members and friends. This is another area of stress that a person's body, both emotionally (e.g. depression) and physically, must deal with. Chronic pain is seen as a serious and costly public health issue, where physicians must manage an individual's suffering from both the physical and emotional aspects of the condition.

Guidelines for treating chronic pain include a physician's duty to not only offer solutions to limit a patient's pain, but to also carefully observe a patient's reaction to opioids. Opioids are commonly prescribed for pain, with an ever-growing increase in the number of prescriptions that are written each year in the United States. The challenge remains that physicians have a duty to humanity (i.e. patients should receive appropriate pain treatment) and a duty to the patient's well-being (i.e. patients should be carefully monitored so that they do not become dependent upon pain medications).

Guidelines for the management of chronic pain have been laid out by the Centers for Disease Control and Prevention (CDC) with the recommendations that the following must be taken into consideration for each patient on an individual basis:

• It must be determined when to initiate or continue opioids for chronic pain
• Opioid selection, dosage, duration, follow-up, and discontinuation
• Assessing risk and addressing harms of opioid use

Opioids should not be considered first-line or routine therapy for chronic pain outside of active cancer, palliative, and end-of-life care. While there is limited evidence of long-term benefits from nonopioid therapies, there are short-term benefits and the risk of these medications are much lower. This does not mean that patients should settle for nonopioids that do not benefit them, but it does suggest that physicians evaluate each patient individually to determine if a nonopioid prescription is a better first-line therapy.

Clinical practice guidelines must focus on the benefits of patient health. Chronic pain is often unbearable and debilitating to the sufferer, causing the quality of life to diminish continually over time. Pain management, combined with physician counsel and expertise, is necessary for the millions of Americans who suffer from chronic pain.