Final Thoughts on Chronic Pain Management

Though moderator Peter Salgo, MD, notes the panel “could go on probably for years” about the multilevel problems with assessing, diagnosing, and managing chronic pain, he gives each of the panelists only 30 seconds to provide one final comment on the topic.

“Despite all the problems with pain management and opioid pharmacotherapy, chronic pain is way undertreated, underdiagnosed, undertreated, and it needs to occur in the primary care setting as early as possible before significant chronic pain, neuroplastic imprinting occurs,” Christopher Gharibo, MD, tells the primary care audience. “It’s in your offices, and you have the opportunity to educate yourself at the onset and then treat it early on in a multi-mechanistic fashion.”

Arriving at Gharibo’s point from a different standpoint, Jeffrey A. Gudin, MD, reminds primary care clinicians, “There is a standard in pain management: If you’re going to use controlled substances, you have a responsibility to use them safely and appropriately.”

“You must do a comprehensive history and physical exam on your patient. You must communicate with the referring physician. You must review old records,” Gudin advises. “Critical and landscape-changing to the way we monitor patients is look at their urine drug (tests) for the medications that you’re prescribing and for any illicit substances. Have that medication treatment agreement that we briefly mentioned here, and, by all means, you have it at your fingertips.”

Revisiting the “multi” buzzword, Joseph Pergolizzi, MD, notes that “if you do chronic pain medicine, you can put ‘multi’ in front of anything and it tastes good, so multimodal, multidisciplinary, multi-mechanistic analgesic routes, etc.”

“Chronic pain, unfortunately, from a point-prevalence standpoint, is only going to get larger, (so) primary care doctors are going to need to adopt these skills earlier,” Pergolizzi says. “They’re going to need to come up with their own gestalt of when they’re going to refer to chronic pain specialists, because there aren’t a lot of chronic pain specialists out there — at least when we look at the magnitude of chronic pain from a point prevalence in the United States.”