Objective: The pathophysiology and management of chronic pain are reviewed in this two-part article, with an emphasis on pharmacological therapies and surgical interventions. Data Sources: A thorough literature review of published articles available in Medline from 1966 to 1996 on the topic of pain management, including diagnosis, pathophysiology, interventions, and treatment. Conclusions: Despite the development of new instruments and treatments to assess and manage pain, chronic pain is often poorly understood and inadequately addressed. Caregivers often lack sufficient skills to intervene promptly and effectively. Traditionally, drug therapy has relied on the nonsteroidal antiinflammatory drugs (NSAIDs) and opioid analgesics for chronic nociceptive pain. A newer analgesic choice for moderate to moderately severe pain is tramadol, a centrally acting agent with at least two complementary mechanisms of action and minimal gastrointestinal or renal toxicity. Adjuvant agents, including tricyclic antidepressants (TCAs), anticonvulsants, and local anesthetics, also help manage chronic neuropathic pain. Although significant advances in the understanding of chronic pain and its pathophysiological mechanisms and newer techniques (noninvasive and invasive) for chronic pain management have become available, reduced patient morbidity and improved quality of life may only be realized with an improved understanding of available resources.
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