North Carolina medical journal
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The use of opioids to treat chronic noncancer pain is controversial because of concerns about safety, efficacy, and the potential for addiction and abuse. Clinicians must therefore continue to seek out alternatives to opioids, such as nonsteroidal anti-inflammatory drugs, acetaminophen, muscle relaxants, benzodiazepines, and antidepressants.
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Chronic pain and mental health: moving beyond the conceptualization of pain as the fifth vital sign.
Current approaches to the assessment and treatment of chronic pain continue to rely predominantly on the medical model. However, the comorbidity of chronic pain with psychiatric conditions underscores the need for a biopsychosocial and interdisciplinary approach to pain that can bridge the gap between scientific understanding and medical practice.
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This article reviews the public health consequences of current approaches to chronic pain management, particularly those related to prescription of opioid analgesics and other controlled medications. This article also reviews factors contributing to these negative trends and discusses potential strategies for reversing them.
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Evidence supports the safety and efficacy of acupuncture compared with no treatment, but it is unclear what role the placebo effect plays in acupuncture's efficacy. In determining whether acupuncture is indicated for a given individual or patient population, clinicians should consider acupuncture's effectiveness compared with no acupuncture--as well as the effectiveness, safety, and cost of alternative types of treatment.
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Health care providers often face the challenge of deciding when and how to prescribe opioids for patients with chronic noncancer pain. In patients for whom opioid treatment is appropriate, the risks can be mitigated by an initial risk assessment, informed consent, regular monitoring, and treatment within a medical home.