Management of Persistent Nonmalignant Pain

Introduction

Patients who are involved in their pain management plan and who understand and accept responsibility for their health typically have the best response to medical interventions. There are many potential therapeutic strategies (see Table) that may be developed into a multimodality approach guided by appropriate and realistic goals for the patient.  These goals typically include: reducing the pain severity, improving and/or restoring function, and improving mood and sleep patterns. Additional treatment goals may include: (1) reducing misuse or overuse of medication; (2) returning to productive activity at home, socially, and/or at work; (3) increasing the patient’s ability to self-manage pain and related problems; (4) reducing or eliminating the use of ongoing healthcare services for the primary pain complaint; and (5) minimizing treatment cost without sacrificing quality of care. In many cases, restoration of function may be the single most important goal for monitoring treatment success.

The multimodal approach to persistent pain management includes the use of numerous therapeutic modalities, including education, physical therapy, and psychological interventions, in combination with appropriate pharmacologic therapy. Complementary and alternative therapies may also be considered.  Many of these approaches require active patient involvement to build self- reliance and a sense of control over the pain. An individualized treatment plan should be developed for each patient.