Treatment must be multi-dimensional, not only pharmacological. Effective therapy should control chronic pain in order to improve function at work, home, socially and in pleasurable pursuits. Complete analgesia is not possible for many patients.


Lifestyle interventions should include exercise, weight management, smoking cessation, sleep hygiene.

Follow-up


  1. Follow-up. Reassessment should center on achieving shared treatment goals and improved function.
    - Frequency. Patients should be seen frequently (weekly to monthly) during initial evaluation and treatment, and at least quarterly thereafter. [1D]*
    - Assessment. Reassess physical, psychological and social domains regularly, particularly progress toward improved function. [1D]*
    - Ineffective treatments. Stop ineffective treatment modalities (e.g., NSAIDs, opioids). [1D]*
    - Opioids and problem use. Monitor patients receiving opioid analgesics for misuse with checks of State registries (PMP) for prescription fills (e.g., in Michigan called MAPS) and random urine
    comprehensive drug screens by EIA-GCMS. [1ID]*
    - Referral. Referral to pain management specialist should be considered for failure to achieve
    treatment goals, intolerance of therapies, need for interventional management, need for multidisciplinary treatment, need for excessive opioid doses, suspicion of addiction, or opioid misuse. [1B]*
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