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Overview of the treatment of chronic non-cancer pain

Ellen WK Rosenquist, MD
Section Editor
Mark D Aronson, MD
Deputy Editor
Marianna Crowley, MD


Chronic pain is among the most common reasons for seeking medical attention and is reported by 20 to 50 percent of patients seen in primary care [1,2]. A number of pharmacologic and nonpharmacologic therapies are available for patients with chronic pain. An overview of these treatments is presented here. The evaluation of chronic pain is discussed separately. (See "Evaluation of chronic pain in adults".)

The assessment and management of pain from cancer is discussed separately. (See "Assessment of cancer pain" and "Overview of cancer pain syndromes" and "Cancer pain management: General principles and risk management for patients receiving opioids" and "Cancer pain management with opioids: Optimizing analgesia" and "Cancer pain management: Adjuvant analgesics (coanalgesics)".)


Treatment options for chronic pain generally fall into six major categories: pharmacologic, physical medicine, behavioral medicine, neuromodulation, interventional, and surgical approaches. Optimal patient outcomes often result from multiple approaches utilized in concert, coordinated via a multidisciplinary team [3]. Collaborative care models in primary care can improve pain management and patient outcomes [4,5]. Medication should not be the sole focus of treatment, but should be used when needed, in conjunction with other treatment modalities, to meet treatment goals [6].

Patients with chronic pain require ongoing evaluation, education and reassurance, as well as help in setting reasonable expectations for response. Currently available treatment modalities on average result in only about a 30 percent decrease in pain [7]. But even a partial response of 30 percent can be clinically significant and improve the patient's quality of life [8].


Pharmacologic approaches are the most widely used therapeutic options to ameliorate persistent pain. The major categories of pharmacologic agents for pain management include nonopioid analgesic medications, opioids and adjuvants (used to treat the side effects associated with pain medications or potentiate analgesia):

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Literature review current through: Nov 2017. | This topic last updated: Nov 30, 2017.
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