Update on chronic pain management

Pain is a common presenting symptom to consultant physicians, both in the hospital and in the clinic or rooms. Biologically, pain serves as warning of tissue damage. But this is no longer the case when pain is present for months or years, especially when it has been fully investigated. There can be a substantial discrepancy between the magnitude of pain, disability and distress reported by a patient with chronic pain and the extent of tissue damage identified. From the 1990s until the mid-2010s, opioids were promoted as a safe and effective panacea for chronic non-cancer pain. This led to overprescribing with unfortunate consequences of misuse, abuse and overdose deaths. The response to the so-called 'opioid epidemic' has led to a renewed focus on how chronic pain should be managed. The aim of this article is to update fellows and trainees on the assessment and management of chronic pain in adult medical patients. In particular, we address the role of pharmacotherapy post-opioid epidemic (primarily antidepressants and anticonvulsants in neuropathic pain), the place of interventional procedures and the nature and effectiveness of pain self-management training in people with chronic pain, many of whom have had pain for a year or more and failed other treatments.