A Multimodal Approach to Pain Management

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Approximately 100 million adults in the United States experience chronic pain, and it is the number one cause of unemployment.
Approximately 100 million adults in the United States experience chronic pain, and it is the number one cause of unemployment.

Approximately 100 million adults in the United States experience chronic pain, and it is the number one cause of unemployment.1 

"Pain is the leading reason people seek medical attention, costing the nation $625 billion annually — more than heart disease, cancer, and diabetes combined," said Theresa Mallick-Searle, MS, RN-BC, ANP-BC, a nurse practitioner at the Stanford University Pain Management Center in Redwood City, California. 

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When providing pain management, healthcare practitioners should seek to identify and address the causes of their patients' pain by understanding what the pain means to them, according to Ms. Mallick-Searle.

Goals of treatment vary depending on whether the pain is acute, requiring aggressive treatment, or chronic, in which the objective should be prevention, she stated. In both scenarios, the outcome is the same: improving quality of life and decreasing suffering. 

"In addition to current therapies, new methods of managing pain are on the horizon that may help personalize pain management,” Ms. Mallick-Searle said. "Opioids are being reformulated to have less potential for addiction. Additionally, scientists are using the human genome to determine how individual patients will react to specific medications, which has positive implications for patient-centered treatment."

Types of Treatment

Ms. Mallick-Searle provided an overview of various types of pain management approaches including medications, interventions, behavioral modification, and complementary and alternative treatments. 

For acute pain relief, opioid analgesics are the current "gold standard," offering numerous routes of administration, immediate and extended-release formulations, and options for targeting 5 opioid receptors (mu, kappa, sigma, delta, and epsilon) to modify pain signals and diminish pain perception. However, chronic use can lead to adverse effects including tolerance, dependence, and addiction. 

Opioid withdrawal can lead to adverse effects such as psychomotor arousal in the form of irritability, restlessness, pacing, and sleeplessness; and autonomic arousal as indicated by mydriasis, yawning, sweating, diarrhea, lacrimation, rhinorrhea, mild tachycardia, and hypertension. Individuals undergoing opioid withdrawal may also experience muscle aching, joint pain, and stomach cramping. 

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