Rethinking chronic pain in a primary care setting

Abstract

Chronic pain substantially impacts patient function and quality of life and is a burden to society at large in terms of increased health care utilization and loss of productivity. As a result, there is an increasing recognition of chronic pain as a public health crisis. However, there remains wide variability in clinical practices related to the prevention, assessment, and treatment of chronic pain. Certain fundamental aspects of chronic pain are often neglected including the contribution of the psychological, social, and contextual factors associated with chronic pain. Also commonly overlooked is the importance of understanding the likely neurobiological mechanism(s) of the presenting pain and how they can guide treatment selection. Finally, physicians may not recognize the value of using electronic medical records to systematically capture data on pain and its impact on mood, function, and sleep. Such data can be used to monitor onset and maintenance of treatments effects at the patient level and evaluate costs at the systems level. In this review we explain how these factors play a critical role in the development of a coordinated, evidence-based treatment approach tailored to meet specific needs of the patient. We also discuss some practical approaches and techniques that can be implemented by clinicians in order to enhance the assessment and management of individuals with chronic pain in primary care settings. ARTICLE HISTORY

Integrating data from randomized controlled trials and observational studies to predict the response to pregabalin in patients with painful diabetic peripheral neuropathy

“…The parameters in the ARMAX models reinforced the reciprocal influences between pain and sleep interference [42] and dose in previous weeks [43, 44]. They also showed the relevance of selected psychosocial variables (e.g., calm and relaxed, full of energy) for certain subgroups of patients, but not others, as has been shown in other studies [8, 17]. Other variables such as age, gender, pDPN duration, and pregabalin monotherapy were the only significant predictors in one of the responder subgroups, although such characteristics are often used as a basis for subgroup analyses in clinical studies of pain [11, 17, 45–48].…”

The Global Spine Care Initiative: model of care and implementation

“…A single clinician may suit the needs at one location, whereas in another location that might not have a primary care provider with all the necessary competencies, a team of clinicians, when combined, could have the knowledge and skills to provide primary spine care. Different provider types have the potential to offer primary spine care depending on their education (e.g., medical doctors, doctors of osteopathy, doctors of chiropractic, physical therapists, physician assistants, nurse practitioners, other clinicians) [74,[80][81][82][83][84]90] Step 5 -Outcomes…”

Factors mediating the impacts of child abuse and intimate partner violence on chronic pain: a cross-sectional study

“…The prevalence of chronic pain among women who have experienced IPV have been found to range from 38 to 94.5% [ 18 – 21 ]. The negative consequences of living with chronic pain include depleted emotional reserves [ 22 ], lower quality of life [ 23 ], poorer interpersonal and family functioning [ 24 ], and decreased productivity [ 25 ]. Disability related to chronic pain is common among abused women and limits their ability to carry out important social roles and lead satisfying lives [ 20 , 26 ].…”