Pharmacologic and Nonpharmacologic Options for Chronic Pain

Las Vegas—When treating patients with chronic pain, providers should implement a comprehensive approach that includes pharmacologic and nonpharmacologic options, according to Eric Hsu, MD, associate clinical professor in the department of anesthesiology at the University of California, Los Angeles.

Still, Dr. Hsu said healthcare professionals must assess the benefits and risks of medications for each patient. He spoke at the Fall Managed Care Forum during a session titled Updated Strategies for the Management and Treatment of Chronic Pain. Purdue Pharma LP and Teva Pharmaceuticals supported the session with educational grants.

Dr. Hsu defined pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.” Acute pain lasts <6 weeks and is resolved with healing of the underlying incident or injury, subacute pain lasts from 6 to 12 weeks with most people returning to function within 3 months, and chronic pain lasts more than 12 weeks and degrades health and functional capability.

For cancer pain, the World Health Organization recommends a 3-step analgesic ladder that begins with non-opioid analgesics and adjuvant medications, continues with weak opioid analgesics, and ends with strong opioid analgesics.

“That is far from so-called comprehensive management,” Dr. Hsu said.

Non-opioid adjuvant medications include nonsteroidal anti-inflammatory drugs, cyclooxygenase-2 inhibitors, muscle relaxants, antidepressants, and anti-epileptics. Opioids are either short-acting or long-acting, while nonpharmacologic approaches include physiotherapy, exercise programs, massages, stretching, cognitive-behavioral therapy, and complementary and alternative medicine.

Dr. Hsu suggested that patients understand they are responsible for their medications, recommended unannounced drug tests if necessary, and mentioned that only 1 healthcare provider should prescribe pain medications. He added that providers should constantly assess analgesia, activities of daily living, adverse effects, and aberrant drug-related behavior.—Tim Casey