title: Rethinking chronic pain in a primary care setting.
abstract: Chronic pain substantially impacts patient function and quality of life and is a burden to society at large in terms of increased health care utilization and loss of productivity. As a result, there is an increasing recognition of chronic pain as a public health crisis. However, there remains wide variability in clinical practices related to the prevention, assessment, and treatment of chronic pain. Certain fundamental aspects of chronic pain are often neglected including the contribution of the psychological, social, and contextual factors associated with chronic pain. Also commonly overlooked is the importance of understanding the likely neurobiological mechanism(s) of the presenting pain and how they can guide treatment selection. Finally, physicians may not recognize the value of using electronic medical records to systematically capture data on pain and its impact on mood, function, and sleep. Such data can be used to monitor onset and maintenance of treatments effects at the patient level and evaluate costs at the systems level. In this review we explain how these factors play a critical role in the development of a coordinated, evidence-based treatment approach tailored to meet specific needs of the patient. We also discuss some practical approaches and techniques that can be implemented by clinicians in order to enhance the assessment and management of individuals with chronic pain in primary care settings.
authors.affiliation: a Swedish Pain Services , Swedish Health System , Seattle , WA , USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Stanos
authors.affiliation: b Global Medical Affairs , Pfizer Inc ., New York , NY , USA.
authors.forename: Marina
authors.initials: M
authors.lastname: Brodsky
authors.affiliation: c Department of Neurology , Albany Medical Center , Albany , NY , USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Argoff
authors.affiliation: d Department of Anesthesiology , The University of Michigan , Ann Arbor , MI , USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Clauw
authors.affiliation: e Suburban Hospital , Bethesda , MD , USA.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: D'Arcy
authors.affiliation: b Global Medical Affairs , Pfizer Inc ., New York , NY , USA.
authors.forename: Sean
authors.initials: S
authors.lastname: Donevan
authors.affiliation: f Department of Family Medicine , Indiana University School of Medicine , Indianapolis , IN , USA.
authors.forename: Kevin B
authors.initials: KB
authors.lastname: Gebke
authors.affiliation: g Department of Rehabilitation Medicine , University of Washington , Seattle , WA , USA.
authors.forename: Mark P
authors.initials: MP
authors.lastname: Jensen
authors.affiliation: h Warrior Centric Health, LLC , Rutgers Robert Wood Johnson Medical School , New Brunswick , NJ , USA.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Lewis Clark
authors.affiliation: i University of California San Diego , San Diego , CA , USA.
authors.forename: Bill
authors.initials: B
authors.lastname: McCarberg
authors.affiliation: b Global Medical Affairs , Pfizer Inc ., New York , NY , USA.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Park
authors.affiliation: j Department of Anesthesiology and Pain Medicine , University of Washington , Seattle , WA , USA.
authors.forename: Dennis C
authors.initials: DC
authors.lastname: Turk
authors.affiliation: b Global Medical Affairs , Pfizer Inc ., New York , NY , USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Watt
mesh_terms: D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D059350:Chronic Pain / Q000145:classification / Q000209:etiology / Q000628:therapy*; D000529:Complementary Therapies; D005356:Fibromyalgia / Q000628:therapy; D006801:Humans; D009437:Neuralgia / Q000628:therapy; D059226:Nociceptive Pain / Q000628:therapy; D059408:Pain Management / Q000379:methods*; D011320:Primary Health Care / Q000379:methods*
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal
keywords: Chronic pain; evidenced-based; framework; primary care; treatment