Chronic pain management

Abstract

Chronic pain-pain that lasts longer than three to six months-affects over 75 million Americans, making it one of the most common and debilitating health problems in the United States today. Although chronic pain is a common reason for seeking medical care, it is often undertreated, and patients may be exposed to potentially toxic and/or addictive side effects of currently available medications. Treatment failure may lower patients' quality of life and increase their economic burden. Providing adequate analgesia for patients with moderate to severe pain may require the use of multiple medications, often at high dosages. This can lead to unwanted adverse effects, which can become intolerable for some patients. Chronic use of systemic NSAIDs is associated with multiple adverse effects, including gastrointestinal upset, gastric ulcer formation, renal dysfunction, and increased cardiovascular risk. While the use of opiate narcotics and related analgesics may be helpful for acute pain, chronic use of these medications can lead to dependence and/or abuse. Opiate drugs produce sedation, tolerance, constipation, and allergic and pseudoallergic reactions. Due to a high rate of suboptimal treatment response and unwanted side effects from these medications, clinicians are seeking alternative therapy to manage chronic pain. New research had led to a better understanding of the pathophysiology and mechanisms of pain transmission, suggesting the possibility of using alternative drug classes to treat chronic pain. Two major drug classes being increasingly used to treat chronic pain are antidepressants and anticonvulsants. Thus, this article examines the evidence for using these drugs as treatment for nonmalignant chronic pain.