Primary care
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Chronic pain is a common presenting problem in primary care offices. Primary pain disorders and chronic pain secondary to another underlying medical problem can significantly impact a patient's function and quality of life. ⋯ Through thorough patient interview, physical examination, diagnostics, and standardized assessment tools, primary care clinicians can create a robust care plan for patients with chronic pain. Given the multifaceted nature of chronic pain, it is a diagnosis that fits into chronic disease model of care managed appropriately in the primary care setting.
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This article examines the occurrence of chronic pain across the human lifespan from pediatrics and adolescents through adulthood and concludes with geriatrics (>65). As a subset of the adolescent and adult age group, the article also explores the impact of chronic pain involving the obstetric population. Within the age groups and populations, we explore available information regarding prevalence, epidemiology, and impact of chronic pain surrounding each group as well as some of the common pain conditions and syndromes unique to a given group. While not focusing on treatment, the article reviews physiologic and other factors impacting treatment in a given group.
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With benefits on pain and pain-related outcomes and low-risk profile, there has been an emphasis on nonpharmacologic management of chronic pain. Physical therapy uses exercises, manual therapies, and electrotherapy. Exercises include aerobic, strengthening, and flexibility exercises. ⋯ Occupational therapy focuses on ergonomics, joint protection, orthoses, and assistive devices. Limited evidence exists for taping, orthoses, assistive devices, thermotherapy, and education on pain-related outcomes. Weight loss in patients who are overweight or obese is effective for pain reduction in knee arthritis.
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Rising rates of prescription opioids for chronic pain from the 1990s along with a concomitant worsening overdose crisis led to rapid evaluation and public health strategies to curb problems with prescription opioids. Guideline development, grounded in solid theory but based on limited evidence that translated into rigid and discordant policies, has contributed to controversies in pain management, worsening the treatment experience for people experiencing chronic pain and highlighting existing inequities from a system clouded with systemic racism. Newer public health approaches need to evaluate root causes and be more holistic addressing inequities as well as using trauma-informed principles.