North Carolina medical journal
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Chronic pain and mental health: moving beyond the conceptualization of pain as the fifth vital sign.
Current approaches to the assessment and treatment of chronic pain continue to rely predominantly on the medical model. However, the comorbidity of chronic pain with psychiatric conditions underscores the need for a biopsychosocial and interdisciplinary approach to pain that can bridge the gap between scientific understanding and medical practice.
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This article reviews the public health consequences of current approaches to chronic pain management, particularly those related to prescription of opioid analgesics and other controlled medications. This article also reviews factors contributing to these negative trends and discusses potential strategies for reversing them.
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Opioid analgesics are commonly used for the management of chronic noncancer pain. Although they can be beneficial for select patients, opioids are also at the heart of a nationwide epidemic of misuse and diversion.
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The use of opioids to treat chronic noncancer pain is controversial because of concerns about safety, efficacy, and the potential for addiction and abuse. Clinicians must therefore continue to seek out alternatives to opioids, such as nonsteroidal anti-inflammatory drugs, acetaminophen, muscle relaxants, benzodiazepines, and antidepressants.
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Management of chronic pain is often difficult. Interventional approaches, such as joint injections and nerve blocks, can reduce dependence on opioid therapy, polypharmacy, and long-term costs; they can also dramatically improve pain control and function. However, interventional techniques must be used ethically and judiciously as part of a comprehensive approach to patient-centered care.