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52
Chronic pain
DAVID CLINE AND STEPHEN H. THOMAS
n Topics
n General approach and the chronic pain history
n Analgesic selections in chronic pain
n Pain medication contracts
n Chronic pain and drug-seeking behavior
n Introduction
Chronic pain, by definition, has been present for three months or more.
It should be considered as being distinct from acute pain, from both diagnostic
and treatment perspectives. This chapter is intended to provide information
for the acute care provider tasked with addressing chronic pain
conditions. Much of the discussion in this chapter is closely related to pain
syndromes (e.g. fibromyalgia, neck and back strain) considered in specific
chapters in this book. Since many chronic pain issues (e.g. drug-seeking
behavior) are pertinent across myriad diagnoses, this chapter’s purpose is
to introduce some concepts with broad relevance to acute care of the patient
with chronic pain. Although “drug-seeking” behavior can occur with acute
pain conditions (e.g. renal colic), symptom recurrence and chronicity are
common, so this chapter also considers the ED approach to the patient
making multiple visits.
n General approach and the chronic
pain history
The approach to the patient with chronic pain should indeed be different to
that for a patient with acute pain. For instance, in injury-related chronic pain,
the patient’s discomfort persists long after the healing process is complete.
This persistence of pain has impact on therapeutic decision-making. While