North Carolina medical journal
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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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Evidence supports the safety and efficacy of acupuncture compared with no treatment, but it is unclear what role the placebo effect plays in acupuncture's efficacy. In determining whether acupuncture is indicated for a given individual or patient population, clinicians should consider acupuncture's effectiveness compared with no acupuncture--as well as the effectiveness, safety, and cost of alternative types of treatment.
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Health care providers often face the challenge of deciding when and how to prescribe opioids for patients with chronic noncancer pain. In patients for whom opioid treatment is appropriate, the risks can be mitigated by an initial risk assessment, informed consent, regular monitoring, and treatment within a medical home.
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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.