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Below are a number of general principles that will assist GPs in better managing persistent pain1, 2, 3, 4, 5, 6:
General principles
- Keep the patient active and positive in order to maintain work skills and relationships.
- Ensure the patient plays an active role. Establish the patient’s role as pivotal in ongoing pain management.
- Engage the patient and their families in long-term care and self management. Establishing a treatment alliance is critical.
- Implement treatment strategies as early as possible. Pain is best treated early and effectively because, once established, it is more difficult to treat. In addition, aggressive management of acute pain may minimise the transition to chronic pain.
- Develop a treatment plan with the patient (and ‘multidisciplinary’ pain team)
- Define realistic goals and expectations. Complete relief of pain may be improbable for many presenting with chronic pain. Expectations that are not met are often accompanied by feelings of frustration and may lead to deconditioning.
- Investigate failed or ineffective treatment carefully before increasing the dose or changing therapy (See “Assessing ineffective treatment”)
- Consider and manage medication side effects appropriately e.g. constipation, nausea.
- Pain management is likely to involve a multimodal approach.A multimodal approach often is more effective than a single sequential treatment approach.
- Schedule treatment reviews for discussing and monitoring treatment outcomes and changing management strategies as required.
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