Drug Therapy for Chronic Pain

In many patients with chronic pain there is often a disparity between the degree of analgesic relief claimed by the patient and the ability to function better. The reasons for this are presented in a construct that suggests areas for consideration in any patient who is being considered for chronic analgesic use. Issues that influence perceived benefit are outlined. The importance of drug tolerance, dosage compliance, and patient’s involvement in treatment are stressed. The use of contracts as an integral part of documented patient participation is outlined. Mechanisms that help in the handling of difficult patients are described. The use of physician extenders, anticipation of inappropriate patient behaviors, and prior expression of sanctions are shown to be helpful. The use of medications as part of the multidimensional care of the patient with chronic pain is discussed. This article presents practical solutions for difficulties encountered in managing patients with chronic pain.