What are the recommended treatments for managing chronic pain?

From the Guidelines

Chronic pain management should prioritize a multimodal approach, focusing on non-pharmacological interventions such as cognitive behavioral therapy (CBT), physical therapy, and lifestyle modifications, as these have been shown to be effective in reducing pain and improving function 1.

Key Recommendations

• Cognitive behavioral therapy (CBT) is recommended for chronic pain management as it promotes patient acceptance of responsibility for change and the development of adaptive behaviors while addressing maladaptive behaviors 1.
• Physical and occupational therapy are also recommended for chronic pain, with a focus on stretching, strengthening, and proper body mechanics 1.
• Yoga is recommended for the treatment of chronic neck/back pain, headache, rheumatoid arthritis, and general musculoskeletal pain, as it has been shown to be effective in reducing pain and improving function 1.
• Hypnosis is recommended for neuropathic pain, as it has been shown to be effective in reducing pain intensity 1.

Medication Use

• Medications such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) may be used for pain management, but their use should be carefully considered and monitored due to potential risks and side effects 1.
• Opioids should not be considered first-line or routine therapy for chronic pain, except in cases of active cancer, palliative, and end-of-life care, due to their potential for serious harms and uncertain long-term benefits 1.

Lifestyle Modifications

• Regular low-impact exercise, such as swimming or walking, should be performed for 30 minutes daily to help reduce pain and improve function.
• Adequate sleep hygiene, proper nutrition, and maintaining a healthy weight are also important for supporting pain management efforts.

Psychological Interventions

• Cognitive behavioral therapy, mindfulness meditation, and stress management techniques should be used to address the psychological aspects of chronic pain.
• These interventions can help patients develop coping skills and improve their overall quality of life.

From the FDA Drug Label

The efficacy of the maximum recommended dose of pregabalin for the management of neuropathic pain associated with diabetic peripheral neuropathy was established in three double-blind, placebo-controlled, multicenter studies The efficacy of pregabalin for the management of postherpetic neuralgia was established in three double-blind, placebo-controlled, multicenter studies Treatment with pregabalin statistically significantly improved the endpoint mean pain score and increased the proportion of patients with at least a 50% reduction in pain score from baseline

The recommended treatments for managing chronic pain include:

• Pregabalin for the management of neuropathic pain associated with diabetic peripheral neuropathy and postherpetic neuralgia
• Dosing of pregabalin varies based on renal function and pain condition
• Pregabalin has been shown to statistically significantly improve the endpoint mean pain score and increase the proportion of patients with at least a 50% reduction in pain score from baseline 2 2
• Patients may also be permitted to take up to 4 grams of acetaminophen per day as needed for pain, in addition to pregabalin Key points to consider when treating chronic pain with pregabalin:
• Dose dependent adverse reactions may occur
• Patients with renal impairment may require dose adjustment
• Pregabalin has been shown to be effective in reducing pain intensity in patients with neuropathic pain associated with diabetic peripheral neuropathy and postherpetic neuralgia

From the Research

Recommended Treatments for Managing Chronic Pain

The management of chronic pain involves a multimodal approach, incorporating both pharmacological and non-pharmacological interventions. Some of the recommended treatments include:

• Non-pharmacologic therapies such as behavioral, cognitive, integrative, and physical therapies 3
• Cognitive behavioral therapy for reducing long-term pain and disability 3, 4, 5, 6
• Exercise, including endurance exercise, stretching, and strengthening for chronic neck pain and other conditions 3, 6
• Mindfulness-based stress reduction for patients with chronic low back pain 3
• Acupuncture for multiple pain conditions 3, 5
• Combination manipulation, manual therapy for chronic neck pain 3
• Animal-assisted therapy 3
• S-adenosyl-L-methionine for joint pain 3
• Neuromodulation 5
• Digital therapeutics as an emerging approach for managing chronic pain 5

Pharmacological Interventions

Pharmacological interventions are also crucial in managing chronic pain, and the choice of medication depends on the type of pain. For example:

• Acetaminophen and non-steroidal anti-inflammatory drugs for conditions primarily associated with nociception (e.g. osteoarthritis) 7
• Tricyclic compounds, serotonin-norepinephrine reuptake inhibitors, and α2δ ligands for conditions primarily associated with neuropathy or central sensitization (e.g. fibromyalgia) 7

Comprehensive Treatment Approach

A comprehensive treatment approach should focus on the whole patient, including comorbidities, cognitive/emotional/behavioral characteristics, social environment, and quality of life/functional impairment 7. The treatment plan can be developed based on pain subtype and psychosocial profile, incorporating pharmacotherapy and self-management modalities 7. Education, exercise, cognitive behavioral therapy, and many other non-pharmacological approaches, alone or combined with pharmacotherapy, have been shown to be effective for any type of pain 7.