Primary care
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Understanding the risks for substance use disorders (SUDs) and how to diagnose and treat is essential to the safe and effective treatment of patients with chronic noncancer pain (CNCP). Because of the common neurologic pathways underlying addiction and chronic pain and common comorbid mental health and psychosocial challenges, these conditions should be treated concurrently. Depending on setting and comfort level of the provider, primary care clinicians may have the resources to provide office-based treatment or may consider referral to specialty treatment. An awareness of the stigma facing patients with both CNCP and SUD is important to providing compassionate, patient-centered care.
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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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Chronic pain syndromes include chronic low back pain, tension type and migraine headaches, fibromyalgia, and osteoarthritis. Adjunctive therapies may provide real benefit by themselves, as well as when combined with one another and more traditional treatments such as medication and physical therapy. High-quality evidence, including systematic reviews, and/or clinical practice guidelines support the use of acupuncture, acupressure, massage, and/or mindfulness-based stress reduction (MBSR) in patients with one or more of these chronic pain syndromes.
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Chronic pain is a public health problem that affects millions of people; however, those with comorbid behavioral health issues are overrepresented in that number. Although pain can be caused by a variety of factors, it has traditionally been associated directly with physical pathology. We know there is variation in how patients report pain whether in the presence or absence of physical pathology; therefore, pain must be viewed as a complex issue. In this article, the authors review the relationship between pain and mental illness and discuss strategies and various modalities for addressing pain in the primary care setting.
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Health care providers are ethically obligated to provide effective management for patients suffering from chronic pain. Many patients have not had access to such management, and current bioethical principles are not sufficient to create the roadmap needed on how to improve current standard of care. Principles described in the emerging field of urban bioethics greatly enhance the toolbox available to providers regarding chronic pain management. Redefining the principles of autonomy, beneficence/nonmaleficence, and justice to agency, social justice, and solidarity is essential to having the framework needed to provide more ethical, equitable care.