Important considerations

When faced with especially challenging chronic pain conditions, a comprehensive assessment and a pain-focused history and physical provide important information about the cause of the pain. The descriptors patients use when reporting the pain can help determine whether it is musculoskeletal or neuropathic.
Choosing the right medication is essential for maximizing your chances at success with these more difficult-to-treat syndromes. National guidelines provide evidence-based recommendations.19 The WHO analgesic ladder can help determine which level of medication is the right fit for the patient’s complaint. It is always wise to consider an extended-release opioid preparation if the patient is taking a number of short-acting opioids daily for consistent pain. Remember that the vast majority of patients on long-term opioids do not become addicted to their medications but are dependent on them to control their pain.

Ms. D’Arcy is a pain management and palliative-care nurse practitioner at Suburban Hospital in Bethesda, Md.

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All electronic documents accessed November 9, 2008.