Managing Chronic Pain: Practical Considerations to Improve Treatment Outcomes - Episode 19
As the panelists conclude their discussion, one common theme they discuss is the fact that the treatment of chronic pain is something that takes considerable time, effort, and thought by health care professionals based on each individual patient’s needs.
“Don’t overstep your bounds,” says Charles E. Argoff, MD. “Please keep in mind that everyone is different, and so don’t have a mindset that everyone is going to respond to the same cocktail, to the same multimodal approach.”
Christopher Gharibo, MD, adds, “The pain score is not a primary outcome marker. It’s one of the outcome markers. Really, the core outcome is function.” He continues, “Pain is multimechanistic, so, therefore, focus on the anatomy including the peripheral nervous system, the central nervous system, the ascending pathways, and the descending pathways. That doesn’t mean that you’re going to target them all, but you need to target the ones that matter through a combination approach that’s not too complicated.”
In support of what he called a “high-touch and low-tech approach,” Vitaly Gordin, MD, notes, “Really talking to the patient, learning which aspect of their lifestyle is the most affected by this disease is very important.” He adds, “Really talking to the patient, learning what characterizes the patient’s response, how the disease affects the patient is very, very important.
Citing the traditional motto of “Do no harm,” Joseph Pergolizzi, MD, says that is particularly true of doctors treating patients already in pain. “These are somewhat fragile patients, as I said, that chronic pain is not monogamous.” He adds, “Keep your hat on. Understand you’re a specialist. If you’re a primary care doing it, just reach out for help.”
Pergolizzi also says the role of opioids in pain treatment and in society as a whole is also important to keep track of.
“We need to have in place proper opioid risk management strategies that are comprehensive that include education and that set appropriate expectations so that we understand where and what we are trying to get out of our opioids. They should be driven by functionality and not pain scores.”