Michael E. Schatman, PhD, CPE

This month, we will consider what is probably an underutilized class of medications – anticonvulsants – in treating many types of chronic pain syndromes.

While treating our patients' depression is a crucial aspect of sound pain management practice in primary care, the analgesic effects of certain antidepressants, particularly for select types of chronic pain, should also not be underestimated.

Last month's Pain Perspectives focused on the benefits of psychotherapy in depressed patients with chronic pain. However, quality psychotherapy is not always available, and not all patients are open to it. This month, I will be looking at rational pharmacotherapy for the primary care physician in treating the depression that is generally an aspect of chronic pain syndromes.

In last month's Pain Perspectives, I discussed the importance of assessing patients with chronic pain for depression – as it is extremely prevalent in this population and has been found to interfere with physical treatment. This month, we will begin to look at what the primary care physician can do to ensure that their patients with chronic pain have their depression addressed adequately.

For patients dealing with chronic pain, the issues of their overall care can go beyond the body and into their minds. Addressing both areas can be key to helping them have normal everyday lives.

Taking one final look at the pros and cons of urine drug testing for opioid risk mitigation.

When opting for urine drug testing, doctors often choose between sending samples to a lab for examination or an immunoassay test.

A commonly asked question by physicians pertains to the ideal frequency of urine drug testing. The answer is an unequivocal "it depends".

Many clinicians and academicians believe that stipulation for random urine drug testing should be a part of any opioid agreement, with UDT serving the dual purposes of ensuring compliance with prescribed opioids as well as monitoring use of illicit drugs and non-prescribed medications.

The third part in a series looking at the risk associated with the prescribing of opioid medications.

Continuing looking at what has become a pervasive problem in the medical community.

While opioids represent an important tool in treating pain, it would be foolish to not acknowledge that opioids and opioid prescribing are fraught with potential hazards. However, through the development of a strong risk mitigation platform, primary care physicians can minimize the risks to their patients, as well as to their own practices.

Despite the negative publicity surrounding opioid analgesics in the management of chronic pain, the medications should not be omitted from any respectable pain physician's armamentarium.

Regardless of a primary care provider's situation, depression in patients with chronic pain cannot be ignored.

Perhaps the greatest obstacle to primary care physicians treating chronic pain is their perception of inadequacy in managing this patient population.

Family physicians have the opportunity to become leaders in the chronic pain care blueprint.

Since family physicians are more likely to adhere to a patient-centered biopsychosocial model than specialist physicians who treat chronic pain, primary care seems to be the logical "home" for its treatment.