Chronic pain: Start with belief

The foundation of the clinician's approach to chronic pain should be to believe the patient, said Jane Murray, MD, Clinical Professor, Family and Community Medicine, University of Kansas.

"We have all been burned and scammed by patients complaining of chronic pain, but we have to believe all of them initially," she said.

The JCHAO calls pain the fifth vital sign and has called for routine pain assessment and management in all office visits, she noted.

Chronic pain is pain that goes on for more than 6 months and is often of unknown etiology, as opposed to acute pain, which lasts less than 6 months and has a known etiology, she stated.

The approach to the chronic pain patient should involve a careful history, which will be very important in helping the physician maintain or doubt his or her initial belief.

While maintaining belief in the patient, it is also important to remember that "pain provides gain" in some patients, said Dr Murray. For instance, chronic pain patients receive emotional and psychological benefits such as empathy and attention as well financial benefits such as workman's compensation. In short, the management of chronic pain is complex.

There is no one single approach to pain management. "Narcotics are a valuable tool and we should be comfortable using them, but there are a lot of options," she said. Medication should be also given immediately if appropriate. Don't defer giving pain relief unless there is overwhelming evidence of falsehood, she said.