Nonnarcotic methods of pain management

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Pain is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or [is] described in terms of uch dama e” when there is no h sical deran ement 1 The function of ain is to protect the body by making the organism aware of damaging events and to promote healing by causing sensitivity to movement or other stimuli that may delay recovery. However, pain is not always related to tissue damage and does not always serve a protective function. This is the case with neuropathic pain, which is caused by a lesion or disease of the somatosensory parts of the nervous system, and with some other chronic pain conditions, such as fibromyalgia and migraine.2 Acute and chronic pain may cause suffering and interfere with daily life, factors that influence the choice of treatment. Acute pain is the most common reason for visiting an emergency department,3 and surgical procedures are often associated with acute postoperative pain.4,5 Chronic pain also causes suffering, as reflected by the finding in the Global Burden of Disease Study 2013 that chronic low back pain was the leading cause of years lived with disability.6 In addition to the contribution of pain to disability, that study showed that the associated problem of opioid use disorders accounted for 5.8 million additional years lived with disability,6 an observation that underpins attempts to treat pain with drugs other than opioids. Long-term opioid administration has minimal effects on chronic pain and can cause tolerance, drowsiness, and dependence, as well as impaired memory, concentration, and judgment.7 For these reasons, the International Association for the Study of Pain recommends caution in prescribing opioids for chronic pain,8 and there has been an increased emphasis on the use of nonopioid pain management. The choice of treatment for pain depends on many factors, and the heterogeneity and large number of acute and chronic pain conditions preclude a general treatment algorithm. In cooperation with the World Health Organization, the International Association for the Study of Pain has developed a classification of chronic pain for the 11th revision of the International Classification of Diseases2 (Table 1), and a similar classification has been proposed for acute pain,5 providing the bases for facilitating treatment pathways.

Original languageEnglish
JournalNew England Journal of Medicine
Pages (from-to)2440-2448
Number of pages9
Publication statusPublished - 20 Jun 2019

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