J Korean Med Assoc.  2010 Sep;53(9):815-823. 10.5124/jkma.2010.53.9.815.

Current pharmacological management of chronic pain

• Park JC
• Choi YS
• Kim JH

• KMID: 2188381
• DOI: http://doi.org/10.5124/jkma.2010.53.9.815

Abstract

Chronic pain is associated with disabling physical and emotional symptoms. Patients with chronic pain utilize more health services, have an impaired sense of well-being and frequently experience anxiety or depression. Unfortunately, treatment for chronic pain is not always correctly targeted, which leads to a reduced quality of life. Treatment of chronic pain involves a comprehensive approach using medication and functional rehabilitation. The usual approach for mild to moderate pain is to start with nonopioid analgesics. Also, trying antidepressant drugs for sleep loss and gabapentin for neuropathic pain or fibromyalgia is appropriate. For moderate to severe chronic pain, opioid analgesics can be used without any serious side effects if adequately used at the right dosage. It is important to provide guidance on the safe use of analgesics and other psychoactive drugs. Dosing of acetaminophen should be limited to avoid liver toxicity, and topical analgesics are preferred for focal pain. Full-dose nonsteroidal anti-inflammatory drugs should not be used for more than short periods, in order to avoid gastrointestinal, renal, and cardiovascular complications. Mechanisms of analgesia, drug selection, and recommendations for clinical usage for the management of chronic pain are reviewed in this paper.

Keyword

Chronic pain; Nonopioid analgesics; Opioids; Adjuvant analgesics

MeSH Terms

Acetaminophen
Amines
Analgesia
Analgesics
Analgesics, Non-Narcotic
Analgesics, Opioid
Antidepressive Agents
Anxiety
Chronic Pain
Cyclohexanecarboxylic Acids
Depression
Fibromyalgia
gamma-Aminobutyric Acid
Health Services
Humans
Liver
Neuralgia
Psychotropic Drugs
Quality of Life
Acetaminophen
Amines
Analgesics
Analgesics, Non-Narcotic
Analgesics, Opioid
Antidepressive Agents
Cyclohexanecarboxylic Acids
Psychotropic Drugs
gamma-Aminobutyric Acid

Figure

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  Figure 1 General approach to the chronic nonmalignant pain[1, 2].

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  Figure 2 Management Algorithm of chronic pain[1, 2].

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