title: Chronic pain management in dermatology: pharmacotherapy and therapeutic monitoring with opioid analgesia.
abstract: A number of chronic dermatologic conditions may necessitate long-term adjunctive pain management in addition to treatment of the primary skin disease, such as hidradenitis suppurativa, lichen planus, and other systemic diseases associated with significant pain. Adequate management of chronic pain can represent a unique challenge, but remains an integral component of clinical treatment in relevant contexts. For nociceptive pain of moderate to severe intensity, opioid analgesics can be beneficial when other pain management strategies have failed to produce adequate relief. The decision to initiate long-term opioid therapy must be carefully weighed, and individualized treatment plans are often necessary to effectively treat pain while minimizing adverse effects. Part II of this 2-part continuing medical education article will describe the appropriate settings for initiation of opioid analgesia for dermatology patients and detail therapeutic strategies and patient monitoring guidelines.
authors.affiliation: Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Monica
authors.initials: M
authors.lastname: Enamandram
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: James P
authors.initials: JP
authors.lastname: Rathmell
authors.affiliation: Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: harvardskinstudies@partners.org.
authors.forename: Alexandra B
authors.initials: AB
authors.lastname: Kimball
mesh_terms: D000698:Analgesia / Q000009:adverse effects / Q000379:methods; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D059350:Chronic Pain / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D003880:Dermatology / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D009293:Opioid-Related Disorders / Q000517:prevention & control*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D018570:Risk Assessment; D012720:Severity of Illness Index; D012871:Skin Diseases / Q000150:complications / Q000175:diagnosis; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid
keywords: nonsteroidal antiinflammatory drugs; opioid analgesia; pain; postherpetic neuralgia