Managing chronic-pain patients in the new millennium: clinical basis and regulatory viewpoint from Texas, U.S.A.
Chronic pain is a very significant health care problem. It is estimated that 9% of the US adult population suffers from moderate to severe noncancer-related pain. It is very difficult to objectively and quantitatively measure a patient's pain and response to treatment. This routinely results in under or overtreatment of pain in these patients. The authors' goal is to provide physicians with practical recommendations and guidelines for the treatment of the chronic-pain patient. This article also summarizes the neurobiology of pain and contrasts acute vs. chronic pain, and it explores the complex interplay between the physical manifestations of chronic pain and its emotional ramifications. In addition, this article offers clinician guidelines for the evaluation and treatment of chronic pain; treatment recommendations based on the current neurobiological understanding of pain; and numerous guidelines and position statements published by various physician associations, physician licensing boards, and local, state, and federal laws. A "Patient Pain Management Contract" and "Pain Treatment Functional Outcome Scale" are exhibited.
Mehendale
Anand W
AW
Neurology, Addiction Medicine, Neurobiology Research Unit, Phoenix Medical Associates, Kerrville, Texas 78028, USA. mehendaleneuro@aol.com
Patrick
Donald
D
Goldman
Mark
M