What are the recommended treatments for pain management?

From the Guidelines

Pain management should prioritize a multi-modal approach, combining medications, physical therapies, and psychological interventions to minimize morbidity, mortality, and improve quality of life. For mild to moderate pain, over-the-counter medications like acetaminophen (Tylenol) at 325-650mg every 4-6 hours (maximum 3000mg daily) or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) at 200-400mg every 4-6 hours (maximum 3200mg daily) are recommended first-line treatments 1. Some key considerations for pain management include:

• Cognitive behavioral therapy (CBT) is recommended for chronic pain management (strong, moderate) 1
• Yoga is recommended for the treatment of chronic neck/back pain, headache, rheumatoid arthritis, and general musculoskeletal pain (strong, moderate) 1
• Physical and occupational therapy are recommended for chronic pain (strong, low) 1
• Hypnosis is recommended for neuropathic pain (strong, low) 1
• Clinicians might consider a trial of acupuncture for chronic pain (weak, moderate) 1
• Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain, with opioid therapy considered only if expected benefits outweigh risks 1
• Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are recommended as first-line agents for the treatment of musculoskeletal pain (strong, high) 1 For more severe pain, prescription medications may be necessary, including stronger NSAIDs, muscle relaxants like cyclobenzaprine (5-10mg three times daily), or in cases of neuropathic pain, medications such as gabapentin (starting at 300mg daily and gradually increasing) or duloxetine (30-60mg daily) 1. Opioid medications like hydrocodone or oxycodone should be reserved for severe, acute pain and used at the lowest effective dose for the shortest duration possible due to risks of dependence and side effects 1. Non-pharmacological approaches are equally important and include physical therapy, application of heat or cold, massage, acupuncture, and cognitive behavioral therapy, which work by addressing different pain pathways - medications reduce inflammation or alter pain signal transmission, while physical therapies improve function and psychological approaches help develop coping strategies for pain management 1.

From the FDA Drug Label

When managing patients taking opioid analgesics, particularly those who have been treated for a long duration and/or with high doses for chronic pain, ensure that a multimodal approach to pain management, including mental health support (if needed), is in place prior to initiating an opioid analgesic taper A multimodal approach to pain management may optimize the treatment of chronic pain, as well as assist with the successful tapering of the opioid analgesic [see Warnings and Precautions (5.13), Drug Abuse and Dependence (9.3)]. Carefully consider the potential benefits and risks of ibuprofen tablets and other treatment options before deciding to use ibuprofen tablets. Use the lowest effective dose for the shortest duration consistent with individual patient treatment goals [see WARNINGS] Mild to moderate pain: 400 mg every 4 to 6 hours as necessary for relief of pain.

Recommended treatments for pain management include:

• A multimodal approach to pain management, including mental health support (if needed) 2
• Ibuprofen 400 mg every 4 to 6 hours as necessary for relief of mild to moderate pain 3
• Opioid analgesics, such as morphine, for chronic pain management, with a patient-specific plan to taper the dose gradually 2 It is essential to tailor the dose to each patient and adjust as necessary to achieve acceptable control of symptoms while minimizing potential risks 3.

From the Research

Recommended Treatments for Pain Management

The management of pain is a complex process that involves a multidisciplinary approach, including pharmacological and non-pharmacological interventions. Some of the recommended treatments for pain management include:

• Pharmacological interventions, such as opioids, which are effective in alleviating moderate to severe acute pain and chronic cancer pain, as well as chronic noncancerous pain 4
• Adjuncts to opioid therapy, including acetaminophen, antiarrhythmics, anticonvulsants, antidepressants, antipsychotics, baclofen, benzodiazepines, capsaicin, calcium channel blockers, clonidine hydrochloride, central nervous system stimulants, corticosteroids, local anesthetics, N-methyl-D-aspartate receptor antagonists, nonsteroidal antiinflammatory drugs, pentoxifylline, and scopolamine, which can improve pain management and reduce opioid-induced adverse reactions 4
• Nonpharmacological interventions, such as acupuncture, electroacupuncture, massage, mindfulness, electroanalgesia, low-level light therapy, meditation, biofeedback, hypnosis, and relaxation techniques, which have shown potential in reducing postoperative pain, opioid consumption, stress, and anxiety 5
• Physical interventions, such as physical therapy, therapeutic exercise, yoga, bracing, heat, cold, elevation, compression, chiropractic interventions, massage, manual therapy, transcutaneous electrical nerve stimulation, and pulsed electromagnetic field therapy, which can be effective in managing acute pain in patients with opioid tolerance or dependence 5
• Behavioral and psychological modalities, such as positive affirmations, cognitive behavioral therapy, acceptance and commitment therapy, mindfulness, distraction, guided imagery, meditation, biofeedback, relaxation, hypnosis, breathing exercises, and energy healing, which can help patients manage chronic pain and improve their quality of life 5, 6, 7

Non-Pharmacological Interventions for Chronic Pain

Non-pharmacological interventions are critical adjunctive or stand-alone interventions for chronic pain conditions. Some of the non-pharmacological interventions that have been shown to be effective in managing chronic pain include:

• Psychological interventions, such as cognitive behavioral therapy-based interventions and emotion-based therapies, which can help patients manage chronic pain and improve their mental health 6
• Physical practices, such as exercise, massage, acupuncture, and yoga, which can reduce pain and improve physical function 6, 7
• Neuromodulation, which can be effective in managing chronic pain by modifying the brain's response to pain signals 6
• Digital therapeutics, which are emerging as a new approach for managing chronic pain and can provide patients with accessible and convenient treatment options 6