Managing Chronic Pain: Where Do We Start?

According to Dr Zacharoff, there are no existing paradigms for long-term chronic pain treatment. He urges attendees to think during the course of Pain Week about what it is they can do for those long-term pain patients.

LAS VEGAS–A majority of healthcare practitioners (HCPs) treating patients with chronic pain feel significant pressure today, reported Kevin L. Zacharoff, MD, in his presentation at PAINWeek 2016.This pressure could be alleviated by following existing guidelines. However, the sheer number of guidelines available renders it difficult for HCPs to navigate through them and identify which to follow.

In his presentation, “Stop the Carousel, I Want To Get Off: The Pressures of Managing Chronic Pain Patients in Clinical Practice,” Dr Zacharoff’ sets a goal of providing attendees with a checklist of what to seek out during the meeting and getting their questions answered by the end of the week.

In an interview with Clinical Pain Advisor, Dr Zacharoff mentioned that a possible solution to the lack of consensus for guidelines was to direct them to non-expert HCPs. “There are only somewhere between 4200 and 4600 board-certified pain specialists in the United States,” he said. “If there are between 70 and 100 million patients with chronic pain, they cannot all be seen by the pain management specialist, “ he noted.

“I would like to see some kind of practical guidelines that could be developed from a reputable organization that gives some guidance to family practitioners and internists,” Dr Zacharoff added.

For noncancer pain, it is more complicated, he added. He would like to see some guidelines from organizations that those clinicians see as “their pinnacle.” He cited the American Academy of Family Physicians and the American College of Physicians. “Unfortunately, it is not coming from them,” he noted.

“This is all falling on the shoulders of people in the frontline, people in primary care. These consensuses have to come from the organizations that have the [ears of] clinicians and primary care physicians.”

In 2009, the American Pain Society and the American Academy of Pain Medicine published a set of guidelines for the management of chronic noncancer pain with chronic opioid therapy. These 2 organizations usually “butted heads with each other,” but yet “collectively created this set of guidelines that were published in the Journal of Pain and Pain Medicine,” according to Dr Zacharoff.

Dr Zacharoff initially thought this would settle the issue, but then realized that primary care providers are often not exposed to these journals.

He then proposed another way to get consensus: introduce pain management into education. Dr Zacharoff touched on the lack of a formal curriculum in pain management, with only 4% of medical schools providing such training; he is currently creating a pain management curriculum at Stony Brook University in New York.

Dr Zacharoff also used the analogy of younger generations who are accustomed to buckling up as soon as they get into their car. Older individuals had to “change their paradigm” about wearing a seatbelt.

It is imperative to “teach people in training about these things as if they were seatbelts and airbags,” added Dr Zacharoff, “so that they are not considered things that people need to change – it [will] just [be] bred into them.”

“We need to have a set of practices that are reproducible, that [HCPs] can then incorporate into their future practice, because they are really the ones [who] are going to make a difference.”   Dr Zacharoff challenged attendees to determine which guidelines to follow by identifying those that make sense to them. 

Dr Zacharoff touched on the lack of a formal curriculum in pain management, with only 4% of medical schools providing such training. Dr Zacharoff is creating such a semester-long curriculum at Stony Brook University in New York.


  1. Kevin L. Zacharoff, MD. Stop the carousel, I want to get off: the pressures of managing chronic pain patients in clinical practice. Presented at: Pain Week 2016. Las Vegas, NV; September 6-10, 2016.

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