Pain management by the family physician: the family practice pain education project.
Pain is a common complaint of patients who visit a family physician, and its appropriate management is a medical mandate. The fundamental principles for pain management are: placing the patient at the center of care; adequately assessing and quantifying pain; treating pain adequately; maximizing function; accounting for culture and gender differences; identifying red and yellow flags early; understanding and differentiating tolerance, dependence and addiction; minimizing side effects; and being familiar with and using CAM therapies when good evidence of efficacy exists. The pharmacologic management of pain requires thorough knowledge of nonsteroidal anti-inflammatory drugs, cyclo-oxygenase-2-specific inhibitors, and opioids. A table of equianalgesic dosages is useful because patients may need to move from one opioid to another. Accompanying this article are papers discussing 5 common pain disorders seen by family physicians, including: neck pain, low back pain, joint pain, pelvic pain, and cancer/end of life pain. The family physician who learns these principles of pain management and the algorithms for these common pain disorders can serve patients well.
Bope
Edward T
ET
Riverside Family Practice Residency Program, Riverside Methodist Hospital, Columbus, OH 43214, USA. bopee@ohiohealth.com
Douglass
Alan B
AB
Gibovsky
Alan
A
Jones
Tanya
T
Nasir
Laeth
L
Palmer
Trish
T
Panchal
Sunil
S
Rainone
Francine
F
Rives
Peter
P
Todd
Knox
K
Toombs
James D
JD
D000700:Analgesics / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D018771:Arthralgia / Q000175:diagnosis / Q000188:drug therapy; D001416:Back Pain / Q000175:diagnosis / Q000188:drug therapy; D003695:Delivery of Health Care; D004305:Dose-Response Relationship, Drug; D005194:Family Practice / Q000193:education; D005260:Female; D006801:Humans; D008297:Male; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D019547:Neck Pain / Q000175:diagnosis / Q000188:drug therapy; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D017699:Pelvic Pain / Q000175:diagnosis / Q000188:drug therapy; D010821:Physicians, Family; D012737:Sex Factors
D000700:Analgesics; D000701:Analgesics, Opioid; D009020:Morphine