View source for Pain management

{{Short description|Interdisciplinary approach for easing pain}}
{{About|pain management across medicine|cancer-related pain management specifically|Cancer pain|the album by Bubba Sparxxx|Pain Management (album)}}
{{Infobox occupation
| name= Pain Medicine Physician
| image=
| caption=
| official_names=Physician
| type= [[Specialty (medicine)|Specialty]]
| activity_sector= [[Medicine]]
| competencies=
| formation=
* [[Doctor of Medicine]] (M.D.)
* [[Doctor of Osteopathic medicine]] (D.O.)
* [[Bachelor of Medicine, Bachelor of Surgery]] (M.B.B.S.)
* [[Bachelor of Medicine, Bachelor of Surgery]] (MBChB)
| employment_field= [[Hospital]]s, [[clinic]]s
| related_occupation=
}}
[[File:Mu-opioid receptor.png|thumb|Active and inactive [[μ-opioid receptor]]s<ref name="pmid10683246">{{Cite journal |vauthors=Zhorov BS, Ananthanarayanan VS |date=March 2000 |title=Homology models of mu-opioid receptor with organic and inorganic cations at conserved aspartates in the second and third transmembrane domains |journal=Archives of Biochemistry and Biophysics |volume=375 |issue=1 |pages=31–49 |doi=10.1006/abbi.1999.1529 |pmid=10683246}}</ref>]]

[[File:OuchFlintGoodrichShot1941.jpg|thumb|Image of visual pain]]
'''Pain management''' is an aspect of [[medicine]] and [[health care]] involving relief of [[pain]] ('''pain relief''', '''analgesia''', '''pain control''') in various dimensions, from [[acute (medicine)|acute]] and simple to [[chronic condition|chronic]] and challenging. Most [[physician]]s and other [[health professional]]s provide some pain control in the normal course of their practice, and for the more complex instances of pain, they also call on additional help from a specific [[medical specialty]] devoted to pain, which is called '''pain medicine'''<!--or very rarely '''algiatry''', but that term is too rare to be appropriate to include in this Wikipedia lede opener-->.

Pain management often uses a [[interdisciplinarity|multidisciplinary]] approach for easing the suffering and improving the [[quality of life]] of anyone experiencing pain,<ref>{{Cite book |url=https://archive.org/details/chronicpainmanag0000hard |title=Chronic pain management: the essentials |vauthors=Hardy PA |publisher=Greenwich Medical Media |year=1997 |isbn=978-1-900151-85-6 |location=U.K. |page=[https://archive.org/details/chronicpainmanag0000hard/page/10 10] |url-access=registration}}</ref>  whether acute pain or [[chronic pain]]. Relieving pain (analgesia) is typically an acute process, while managing chronic pain involves additional complexities and ideally a multidisciplinary approach.

A typical multidisciplinary pain management team may include: [[medical practitioner]]s, [[pharmacist]]s, [[clinical psychologist]]s, [[physiotherapist]]s, [[occupational therapist]]s, [[recreational therapist]]s, [[physician assistant]]s, [[nurse]]s, and [[dentist]]s.<ref>{{Cite book |url=https://archive.org/details/painmanagementin0000main |title=Pain management: an interdisciplinary approach |vauthors=Main CJ, Spanswick CC |publisher=Churchill Livingstone |year=2000 |isbn=978-0-443-05683-3 |quote=Pain management: an interdisciplinary approach. |url-access=registration}}</ref> The team may also include other [[mental health]] specialists and [[massage therapist]]s. Pain sometimes resolves quickly once the underlying [[trauma (medicine)|trauma]] or [[pathology]] has healed, and is treated by one practitioner, with drugs such as pain relievers ([[analgesic]]s) and occasionally also [[anxiolytic]]s.

Effective management of [[chronic pain|chronic (long-term) pain]], however, frequently requires the coordinated efforts of the pain management team.<ref>{{Cite book |title=Pain management: A practical guide for clinicians |vauthors=Thienhaus O, Cole BE |publisher=CRC Press |year=2002 |isbn=978-0-8493-0926-7 |veditors=Weiner RS |page=29 |chapter=The classification of pain |chapter-url=https://books.google.com/books?id=L2CSdeiMZi4C&q=%22the+classification+of+pain%22+thienhaus&pg=PA27}}</ref>  Effective pain management does not always mean total eradication of all pain. Rather, it often means achieving adequate quality of life in the presence of pain, through any combination of lessening the pain and/or better understanding it and being able to live happily despite it. Medicine treats [[injury|injuries]] and diseases to support and speed healing. It treats distressing symptoms such as pain and discomfort to reduce any [[suffering]] during treatment, healing, and [[dying]].

The task of medicine is to relieve suffering under three circumstances. The first is when a painful injury or pathology is resistant to treatment and persists. The second is when pain persists after the injury or pathology has healed. Finally, the third circumstance is when medical science cannot identify the cause of pain. Treatment approaches to chronic pain include [[pharmacology|pharmacological]] measures, such as [[analgesic]]s (pain killer drugs), [[antidepressant]]s, and [[anticonvulsant]]s; interventional procedures, [[physical therapy]], [[physical exercise]], application of ice or heat; and [[psychological]] measures, such as [[biofeedback]] and [[cognitive behavioral therapy]]. {{citation needed|date=December 2024}}

==Defining pain==
{{See also|Threshold of pain|Pain tolerance}}
In the nursing profession, one common definition of pain is any problem that is "whatever the experiencing person says it is, existing whenever the experiencing person says it does".<ref>{{Cite book |title=Pain: clinical manual |vauthors=Pasero C, McCaffery M |publisher=Mosby |year=1999 |isbn=0-8151-5609-X |location=St. Louis}}{{pn|date=April 2025}}</ref>

Pain management includes patient and communication about the pain problem.<ref name="Consumer Reports pain relief April 2016">{{Cite web |last=Consumer Reports |date=April 28, 2016 |title=Pain Relief: What You Need to Know |url=http://www.consumerreports.org/pain-relief/pain-relief-what-you-need-know/ |access-date=26 May 2016 |website=Consumer Reports}}</ref> To define the pain problem, a health care provider will likely ask questions such as:<ref name="Consumer Reports pain relief April 2016" />
* How intense is the pain?
* How does the pain feel?
* Where is the pain?
* What, if anything, makes the pain lessen?
* What, if anything, makes the pain increase?
* When did the pain start?
After asking such questions, the health care provider will have a description of the pain.<ref name="Consumer Reports pain relief April 2016" /> Pain is often rated on a scale from 1 to 10, known as the Numeric Rating Scale (NRS);<ref>{{cite web | url=https://physiotherapy.ca/divisions/pain-science/numeric-rating-scale-nrs-11/ | title=Numeric Rating Scale (NRS-11) }}</ref> 

Rating	Pain Level
*0	No Pain
*1 – 3	Mild Pain (nagging, annoying, interfering little with ADLs)
*4 – 6	Moderate Pain (interferes significantly with ADLs)
*7 – 10	Severe Pain (disabling; unable to perform ADLs)

This pain scale is based on a person reporting their pain intensity, with 0 representing no pain experienced and 10 indicating the worst possible pain.<ref name=":10">{{Cite web |last=Society |first=Canadian Paediatric |title=Best practices in pain assessment and management for children {{!}} Canadian Paediatric Society |url=https://cps.ca/documents/position/pain-assessment-and-management |access-date=2025-04-09 |website=cps.ca |language=en}}</ref> The NRS is a common tool used by clinicians and in research to understand personal pain levels and monitor changes over time.<ref name=":10" /> In the clinical context, pain management will then be used to address that pain.<ref name="Consumer Reports pain relief April 2016" />

==Adverse effects==
There are many types of pain management. Each have their own benefits, drawbacks, and limits.<ref name="Consumer Reports pain relief April 2016" />

A common challenge in pain management is communication between the health care provider and the person experiencing pain.<ref name="Consumer Reports pain relief April 2016" /> People experiencing pain may have difficulty recognizing or describing what they feel and how intense it is.<ref name="Consumer Reports pain relief April 2016" /> Health care providers and patients may have difficulty communicating with each other about how pain responds to treatments.<ref name="Consumer Reports pain relief April 2016" /> There is a risk in many types of pain management for the patient to take treatment that is less effective than needed or which causes other difficulties and side effects.<ref name="Consumer Reports pain relief April 2016" /> Some treatments for pain can be harmful if overused.<ref name="Consumer Reports pain relief April 2016" /> A goal of pain management for the patient and their health care provider is to identify the amount of treatment needed to address the pain without going beyond that limit.<ref name="Consumer Reports pain relief April 2016" />

Another problem with pain management is that pain is the body's natural way of communicating a problem.<ref name="Consumer Reports pain relief April 2016" /> Pain is supposed to resolve as the body heals itself with time and pain management.<ref name="Consumer Reports pain relief April 2016" /> Sometimes pain management covers a problem, and the patient might be less aware that they need treatment for a deeper problem.<ref name="Consumer Reports pain relief April 2016" />

== Physical approaches ==

=== Physical medicine and rehabilitation ===
[[Physical medicine and rehabilitation]] (PM&R), a [[medical specialty]], uses a range of physical techniques, such as [[Heat therapy|heat]] and [[electrotherapy]], as well as therapeutic exercises and behavioral therapy in the management of pain.{{citation needed|date=December 2024}} PM&R techniques are usually part of an interdisciplinary or multidisciplinary program that might also include pharmaceuticals.<ref name="Geertzen JH, Van Wilgen CP.">{{Cite journal |vauthors=Geertzen JH, Van Wilgen CP, Schrier E, Dijkstra PU |date=March 2006 |title=Chronic pain in rehabilitation medicine |journal=Disability and Rehabilitation |volume=28 |issue=6 |pages=363–367 |doi=10.1080/09638280500287437 |pmid=16492632 }}</ref> Spa therapy has shown positive effects in reducing pain among patients with chronic [[low back pain]], but its evidence base is limited.<ref>{{Cite journal |vauthors=Bai R, Li C, Xiao Y, Sharma M, Zhang F, Zhao Y |date=September 2019 |title=Effectiveness of spa therapy for patients with chronic low back pain: An updated systematic review and meta-analysis |journal=Medicine |volume=98 |issue=37 |article-number=e17092 |doi=10.1097/MD.0000000000017092 |pmc=6750337 |pmid=31517832}}</ref> Studies have shown that [[Elastic therapeutic tape|kinesiotape]] can be used to reduce chronic low back pain.<ref>{{Cite journal |vauthors=Li Y, Yin Y, Jia G, Chen H, Yu L, Wu D |date=April 2019 |title=Effects of kinesiotape on pain and disability in individuals with chronic low back pain: a systematic review and meta-analysis of randomized controlled trials |journal=Clinical Rehabilitation |volume=33 |issue=4 |pages=596–606 |doi=10.1177/0269215518817804 |pmid=30526011 }}</ref> The [[Centers for Disease Control and Prevention|US Centers for Disease Control]] recommended that [[physical therapy]] and exercise be prescribed as [[first-line treatment]]s (rather than [[opioid]]s) for multiple causes of chronic pain in 2016 guidelines.<ref name=":0">{{Cite journal |vauthors=Dowell D, Haegerich TM, Chou R |date=March 2016 |title=CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016 |journal=MMWR. Recommendations and Reports |language=en-us |volume=65 |issue=1 |pages=1–49 |doi=10.15585/mmwr.rr6501e1 |pmc=6390846 |pmid=26987082 |doi-access=free}}</ref> Applicable disorders include chronic low back pain, [[osteoarthritis]] of the hip and knee, and [[fibromyalgia]].<ref name=":0" /> Exercise alone or with other rehabilitation disciplines (including psychotherapeutic approaches) can have a positive effects on pain.<ref name=":0" /> Besides improving the experience of pain itself, exercise can also improve individuals' well-being and general health.<ref name=":0" />

[[Manual therapy|Manipulative]] and [[Joint mobilization|mobilization]] therapies are considered safe interventions for low back pain, with manipulation potentially offering a larger therapeutic effect.<ref>{{Cite journal |vauthors=Coulter ID, Crawford C, Hurwitz EL, Vernon H, Khorsan R, Suttorp Booth M, Herman PM |date=May 2018 |title=Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis |journal=The Spine Journal |volume=18 |issue=5 |pages=866–879 |doi=10.1016/j.spinee.2018.01.013 |pmc=6020029 |pmid=29371112}}</ref>

Specifically in chronic low back pain, education about the way the brain processes pain in conjunction with routine physiotherapy interventions may provide short-term relief of disability and pain.<ref>{{cite journal |last1=Wood |first1=Lianne |last2=Hendrick |first2=Paul A. |title=A systematic review and meta-analysis of pain neuroscience education for chronic low back pain: Short-and long-term outcomes of pain and disability |journal=European Journal of Pain |date=February 2019 |volume=23 |issue=2 |pages=234–249 |doi=10.1002/ejp.1314 |pmid=30178503 |url=https://nottingham-repository.worktribe.com/output/1574403 }}</ref>

=== Exercise interventions ===
[[File:Exercise Treadmill Convey Motion.jpg|thumb|Aerobic exercise can help when it comes to pain management]]
Physical activity interventions, such as [[tai chi]], [[yoga]], and [[Pilates]], promote harmony of the mind and body through total body awareness. These practices incorporate breathing techniques, meditation, and a wide variety of movements while training the body to perform functionally by increasing strength, flexibility, and range of motion.<ref name=":1">{{Cite journal |vauthors=Geneen LJ, Moore RA, Clarke C, Martin D, Colvin LA, Smith BH |date=April 2017 |title=Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews |journal=The Cochrane Database of Systematic Reviews |volume=4 |issue=2 |article-number=CD011279 |doi=10.1002/14651858.CD011279.pub3 |pmc=5461882 |pmid=28436583 |collaboration=Cochrane Pain, Palliative and Supportive Care Group}}</ref> Physical activity can also benefit chronic sufferers by reducing inflammation and sensitivity and boosting overall energy.<ref>{{Cite web |last=University |first=Utah State |title=Exercise and Chronic Pain |url=https://extension.usu.edu/heart/research/exercise-and-chronic-pain |access-date=2024-03-02 |website=extension.usu.edu |language=en}}</ref> Physical activity and exercise may improve chronic pain (pain lasting more than 12 weeks),<ref>{{Cite web |title=Chronic Pain: Symptoms, Diagnosis, & Treatment |url=https://medlineplus.gov/magazine/issues/spring11/articles/spring11pg5-6.html |access-date=2019-03-12 |website=NIH MedlinePlus the Magazine}}</ref> and overall quality of life, while minimizing the need for pain medications.<ref name=":1" /> More specifically, walking has been effective in improving pain management in chronic low back pain.<ref>{{Cite journal |vauthors=Vanti C, Andreatta S, Borghi S, Guccione AA, Pillastrini P, Bertozzi L |date=March 2019 |title=The effectiveness of walking versus exercise on pain and function in chronic low back pain: a systematic review and meta-analysis of randomized trials |journal=Disability and Rehabilitation |volume=41 |issue=6 |pages=622–632 |doi=10.1080/09638288.2017.1410730 |pmid=29207885 }}</ref>

=== TENS ===
{{Main|Transcutaneous electrical nerve stimulation}}
Transcutaneous electrical nerve stimulation (TENS) is a self-operated portable device intended to help regulate and control chronic pain via electrical impulses.<ref name=":24">{{Cite journal |vauthors=Aboud T, Schuster NM |date=November 2019 |title=Pain Management in Multiple Sclerosis: a Review of Available Treatment Options |journal=Current Treatment Options in Neurology |volume=21 |issue=12 |article-number=62 |doi=10.1007/s11940-019-0601-2 |pmid=31773455 }}</ref> Limited research has explored the effectiveness of TENS in relation to pain management of multiple sclerosis (MS). MS is a chronic autoimmune neurological disorder, which consists of the demyelination of the nerve axons and the disruption of nerve conduction velocity and efficiency.<ref name=":24" /> In one study, electrodes were placed over the lumbar spine, and participants received treatment twice a day and at any time when they experienced a painful episode.<ref name=":24" /> This study found that TENS would benefit MS patients with localized or limited symptoms in one limb.<ref name=":24" /> The research is mixed with whether or not TENS helps manage pain in MS patients.{{cn|date=September 2024}}

[[Transcutaneous electrical nerve stimulation]] is ineffective for [[lower back pain]]. However, it might help with [[diabetic neuropathy]]<ref name="pmid20042705">{{Cite journal |vauthors=Dubinsky RM, Miyasaki J |date=January 2010 |title=Assessment: efficacy of transcutaneous electric nerve stimulation in the treatment of pain in neurologic disorders (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology |journal=Neurology |volume=74 |issue=2 |pages=173–176 |doi=10.1212/WNL.0b013e3181c918fc |pmid=20042705 |doi-access=free}}</ref> as well as other illnesses. {{citation needed|date=December 2024}}

==== tDCS ====
{{Main|Transcranial direct-current stimulation}}

Transcranial direct current stimulation (tDCS) is a non-invasive technique of brain stimulation that can modulate activity in specific brain cortex regions, and it involves the application of low-intensity (up to 2&nbsp;mA) constant direct current to the scalp through electrodes in order to modulate the excitability of large cortical areas.<ref name=":12">{{Cite journal |vauthors=Zaghi S, Thiele B, Pimentel D, Pimentel T, Fregni F |date=2011 |title=Assessment and treatment of pain with non-invasive cortical stimulation |journal=Restorative Neurology and Neuroscience |volume=29 |issue=6 |pages=439–451 |doi=10.3233/RNN-2011-0615 |pmid=22124038}}</ref> tDCS may have a role in pain assessment by contributing to efforts in distinguishing between somatic and affective aspects of pain experience.<ref name=":12" /> Zaghi and colleagues (2011) found that the motor cortex, when stimulated with tDCS, increases the threshold for both the perception of non-painful and painful stimuli.<ref name=":12" /> Although there is a greater need for research examining the mechanism of electrical stimulation in pain treatment, one theory suggests that the changes in thalamic activity may be due to the influence of motor cortex stimulation on the decrease in pain sensations.<ref name=":12" />

Concerning MS, a study found that daily tDCS sessions resulted in an individual's subjective report of pain decreased when compared to a sham condition.<ref name=":24" /> In addition, the study found a similar improvement at 1 to 3 days before and after each tDCS session.<ref name=":24" />

Fibromyalgia is a disorder in which an individual experiences dysfunctional brain activity, musculoskeletal pain, fatigue, and tenderness in localized areas.<ref name=":32">{{Cite journal |display-authors=6 |vauthors=Fregni F, Gimenes R, Valle AC, Ferreira MJ, Rocha RR, Natalle L, Bravo R, Rigonatti SP, Freedman SD, Nitsche MA, Pascual-Leone A, Boggio PS |date=December 2006 |title=A randomized, sham-controlled, proof of principle study of transcranial direct current stimulation for the treatment of pain in fibromyalgia |journal=Arthritis and Rheumatism |volume=54 |issue=12 |pages=3988–3998 |doi=10.1002/art.22195 |pmid=17133529 |doi-access=free}}</ref> Research examining tDCS for pain treatment in fibromyalgia has found initial evidence for pain decreases.<ref name=":32" /> Specifically, the stimulation of the primary motor cortex resulted in significantly greater pain improvement in comparison to the control group (e.g., sham stimulation, stimulation of the DLPFC).<ref name=":32" /> However, this effect decreased after treatment ended, but remained significant for three weeks following the extinction of treatment.<ref name=":32" />

=== Acupuncture ===
{{Main|Acupuncture}}
[[File:Tsoë-Bosi.jpg|thumb|Acupuncture can sometimes help to relieve pain]]
Acupuncture involves the insertion and manipulation of needles into specific points on the body to relieve pain or for therapeutic purposes. An analysis of the 13 highest quality studies of pain treatment with acupuncture, published in January 2009 in the ''[[British Medical Journal]]'', was unable to quantify the difference in the effect on pain of real, [[Sham surgery|sham]] and no acupuncture.<ref>{{Cite journal |vauthors=Madsen MV, Gøtzsche PC, Hróbjartsson A |date=January 2009 |title=Acupuncture treatment for pain: systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups |journal=BMJ |volume=338 |issue=jan27 2 |article-number=a3115 |doi=10.1136/bmj.a3115 |pmc=2769056 |pmid=19174438}}</ref> A systematic review in 2019 reported that acupuncture injection therapy was an effective treatment for patients with nonspecific chronic low back pain, and is widely used in Southeast Asian countries.<ref>{{Cite journal |display-authors=6 |vauthors=Liao J, Wang T, Dong W, Yang J, Zhang J, Li L, Chen J, Li J, Li D, Ma Y, Zhang X, Tang X, Jiang B, Guo Y |date=July 2019 |title=Acupoint injection for nonspecific chronic low back pain: A protocol of systematic review |journal=Medicine |volume=98 |issue=29 |article-number=e16478 |doi=10.1097/MD.0000000000016478 |pmc=6709064 |pmid=31335709}}</ref>

=== Light therapy ===
Research has found evidence that [[light therapy]] such as [[low level laser therapy]] is an effective therapy for relieving [[low back pain]].<ref name="Chou">{{Cite journal |vauthors=Chou R, Huffman LH |date=October 2007 |title=Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline |journal=Annals of Internal Medicine |volume=147 |issue=7 |pages=492–504 |doi=10.7326/0003-4819-147-7-200710020-00007 |pmid=17909210 |doi-access=free}}</ref><ref>{{Cite journal |display-authors=6 |vauthors=Yousefi-Nooraie R, Schonstein E, Heidari K, Rashidian A, Pennick V, Akbari-Kamrani M, Irani S, Shakiba B, Mortaz Hejri SA, Mortaz Hejri SO, Jonaidi A |date=April 2008 |title=Low level laser therapy for nonspecific low-back pain |journal=The Cochrane Database of Systematic Reviews |volume=2011 |issue=2 |article-number=CD005107 |doi=10.1002/14651858.CD005107.pub4 |pmc=9044120 |pmid=18425909 |veditors=Yousefi-Nooraie R}}</ref>  Instead of thermal therapy, where reactant energy is originated through heat, Low-Level Light Therapy (LLLT) utilizes photochemical reactions requiring light to function.{{citation needed|date=March 2024}}  Photochemical reactions need light in order to function. [[Photon]]s, the energy created from light, from these photochemical reactions provide the reactants with energy to embed in muscles, thus managing pain.<ref>{{Cite web |title=Photochemical Reaction: Definition, Types, Equation, Mechanisms |url=https://testbook.com/chemistry/photochemical-reaction |access-date=2024-02-02 |website=Testbook |language=en}}</ref> One study conducted by Stausholm et al. showed that at certain wavelengths, LLLT reduced pain in participants with knee osteoarthritis.<ref>{{cite journal |last1=Stausholm |first1=Martin Bjørn |last2=Naterstad |first2=Ingvill Fjell |last3=Joensen |first3=Jon |last4=Lopes-Martins |first4=Rodrigo Álvaro Brandão |last5=Sæbø |first5=Humaira |last6=Lund |first6=Hans |last7=Fersum |first7=Kjartan Vibe |last8=Bjordal |first8=Jan Magnus |title=Efficacy of low-level laser therapy on pain and disability in knee osteoarthritis: systematic review and meta-analysis of randomised placebo-controlled trials |journal=BMJ Open |date=October 2019 |volume=9 |issue=10 |article-number=e031142 |doi=10.1136/bmjopen-2019-031142 |pmid=31662383 |pmc=6830679 |hdl-access=free |hdl=1956/23441}}</ref> LLLT stimulates a variety of cell types, which in turn can help treat tendonitis, arthritis, and pain relating to muscles.{{fact|date=September 2024}}

=== Sound therapy ===
{{Main|Audioanalgesia|Music therapy}}
[[Audioanalgesia]] and [[music therapy]] are both examples of using [[auditory stimuli]] to manage pain or other distress. They are generally viewed as insufficient when used alone but also as helpful [[adjuvant therapy|adjuncts]] to other forms of [[therapy]].{{cn|date=September 2024}}

=== Interventional procedures ===
{{main|Interventional pain management}}
[[Interventional radiology]] procedures for pain control, typically used for [[back pain|chronic back pain]], include [[epidural|epidural steroid injections]], [[facet joint injection]]s, [[cordotomy|neurolytic blocks]], [[spinal cord stimulator]]s and [[intrathecal]] drug delivery system implants.

[[Pulsed radiofrequency]], [[Neuromodulation (medicine)|neuromodulation]], direct introduction of medication and nerve [[ablation]] may be used to target either the tissue structures and organ/systems responsible for persistent [[nociception]] or the [[nociceptor]]s from the structures implicated as the source of chronic pain.<ref name="Varrassi G, Paladini A">{{Cite journal |vauthors=Varrassi G, Paladini A, Marinangeli F, Racz G |date=March 2006 |title=Neural modulation by blocks and infusions |journal=Pain Practice |volume=6 |issue=1 |pages=34–38 |doi=10.1111/j.1533-2500.2006.00056.x |pmid=17309707 }}</ref><ref name="Meglio M.">{{Cite journal |vauthors=Meglio M |date=July 2004 |title=Spinal cord stimulation in chronic pain management |journal=Neurosurgery Clinics of North America |volume=15 |issue=3 |pages=297–306 |doi=10.1016/j.nec.2004.02.012 |pmid=15246338}}</ref><ref>{{Cite journal |vauthors=Rasche D, Ruppolt M, Stippich C, Unterberg A, Tronnier VM |date=March 2006 |title=Motor cortex stimulation for long-term relief of chronic neuropathic pain: a 10 year experience |journal=Pain |volume=121 |issue=1–2 |pages=43–52 |doi=10.1016/j.pain.2005.12.006 |pmid=16480828 }}</ref><ref name="Boswell MV, Trescott AM">{{cite journal |last1=Boswell |first1=Mark V. |last2=Trescot |first2=Andrea M. |last3=Datta |first3=Sukdeb |last4=Schultz |first4=David M. |last5=Hansen |first5=Hans C. |last6=Abdi |first6=Salahadin |last7=Sehgal |first7=Nalini |last8=Shah |first8=Rinoo V. |last9=Singh |first9=Vijay |last10=Benyamin |first10=Ramsin M. |last11=Patel |first11=Vikram B. |last12=Buenaventura |first12=Ricardo M. |last13=Colson |first13=James D. |last14=Cordner |first14=Harold J. |last15=Epter |first15=Richard S. |last16=Jasper |first16=Joseph F. |last17=Dunbar |first17=Elmer E. |last18=Atluri |first18=Sairam L. |last19=Bowman |first19=Richard C. |last20=Deer |first20=Timothy R. |last21=Swicegood |first21=John R. |last22=Staats |first22=Peter S. |last23=Smith |first23=Howard S. |last24=Burton |first24=Allen W. |last25=Kloth |first25=David S. |last26=Giordano |first26=James |last27=Manchikanti |first27=Laxmaiah |title=Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain |journal=Pain Physician |date=January 2007 |volume=10 |issue=1 |pages=7–111 |pmid=17256025 |url=http://www.painphysicianjournal.com/linkout?issn=1533-3159&vol=10&page=7 }}</ref><ref name="Romanelli P, Esposito V">{{Cite journal |vauthors=Romanelli P, Esposito V, Adler J |date=July 2004 |title=Ablative procedures for chronic pain |journal=Neurosurgery Clinics of North America |volume=15 |issue=3 |pages=335–342 |doi=10.1016/j.nec.2004.02.009 |pmid=15246341}}</ref> Radiofrequency treatment has been seen to improve pain in patients with facet joint low back pain. However, continuous radiofrequency is more effective in managing pain than pulsed radiofrequency.<ref>{{Cite journal |vauthors=Contreras Lopez WO, Navarro PA, Vargas MD, Alape E, Camacho Lopez PA |date=February 2019 |title=Pulsed Radiofrequency Versus Continuous Radiofrequency for Facet Joint Low Back Pain: A Systematic Review |journal=World Neurosurgery |volume=122 |pages=390–396 |doi=10.1016/j.wneu.2018.10.191 |pmid=30404055 }}</ref>

An [[intrathecal pump]] is sometimes used to deliver very small quantities of medications directly to the spinal fluid. This is similar to epidural infusions used in [[Childbirth|labour]] and postoperatively.  The major differences are that it is much more common for the drug to be delivered into the spinal fluid (intrathecal) rather than epidurally, and the pump can be fully implanted under the skin. {{medical citation needed|date=November 2018}}

A [[spinal cord stimulator]] is an implantable medical device that creates electric impulses and applies them near the dorsal surface of the spinal cord, providing a [[paresthesia]] ("tingling") sensation that alters the perception of pain by the patient.{{medical citation needed|date=November 2018}}

=== Intra-articular ozone therapy ===
Intra-articular ozone therapy has been seen to alleviate chronic pain in patients with knee osteoarthritis efficiently.<ref>{{Cite journal |vauthors=Noori-Zadeh A, Bakhtiyari S, Khooz R, Haghani K, Darabi S |date=February 2019 |title=Intra-articular ozone therapy efficiently attenuates pain in knee osteoarthritic subjects: A systematic review and meta-analysis |journal=Complementary Therapies in Medicine |volume=42 |pages=240–247 |doi=10.1016/j.ctim.2018.11.023 |pmid=30670248 }}</ref>

== Psychological approaches ==

=== Acceptance and commitment therapy ===
{{main|Acceptance and commitment therapy}}

Acceptance and commitment therapy (ACT) is a type of [[cognitive behavioral therapy]] that emphasizes [[behavior modification]] over symptom reduction, focusing on changing the context of psychological experiences and employing experiential behavior change methods.<ref name=":02">{{Cite journal |vauthors=McCracken LM, Jones R |date=July 2012 |title=Treatment for chronic pain for adults in the seventh and eighth decades of life: a preliminary study of Acceptance and Commitment Therapy (ACT) |journal=Pain Medicine |volume=13 |issue=7 |pages=860–867 |doi=10.1111/j.1526-4637.2012.01407.x |pmid=22680627 |doi-access=free}}</ref> The central process in ACT revolves around [[psychological flexibility]], which in turn includes processes of [[acceptance]]; awareness; present-oriented mindfulness in interacting with experiences; an ability to persist or change behavior; and an ability to be guided by one's values.<ref name=":02" /> ACT has robust evidence in the [[scientific literature]] for a range of health and behavior problems, including chronic pain.<ref name=":02" /> ACT facilitates the dual processes of acceptance and behavioral change, enabling patients to cultivate psychological flexibility. This approach allows for a more dynamic and adaptable focus in therapeutic interventions, enhancing overall treatment effectiveness.<ref name=":02" />

Recent research has applied ACT successfully to chronic pain in older adults due in part to its direction from individual values and being highly customizable to any stage of life.<ref name=":02" /> In line with the therapeutic model of ACT, significant increases in process variables, pain acceptance, and mindfulness were also observed in a study applying ACT to chronic pain in older adults.<ref name=":02" /> In addition, these primary results suggested that an ACT-based treatment may significantly improve levels of physical disability, psychosocial disability, and depression post-treatment and at a three-month follow-up for older adults with chronic pain.<ref name=":02" />

===Cognitive behavioral therapy===
{{main|Cognitive behavioral therapy}}

Cognitive behavioral therapy (CBT) in the setting of pain management aims to aid individuals in understanding the relationship between their pain, thoughts, emotions, and behaviors. A main goal in treatment is cognitive—thinking, reasoning, and remembering—restructuring to encourage helpful thought patterns.<ref>{{Cite news |title=What Is Cognitive Behavioral Therapy? |url=https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral |access-date=2020-07-14 |work=American Psychological Association (APA) |language=en}}</ref> This will target healthy activities such as regular exercise and pacing. Lifestyle changes are also trained to improve sleep patterns and to develop better coping skills for pain and other stressors using various techniques (e.g., relaxation, diaphragmatic breathing, and even biofeedback).{{cn|date=September 2024}}

Studies have demonstrated the usefulness of cognitive behavioral therapy in the management of chronic low back pain, producing significant decreases in physical and psychosocial disability.<ref>{{Cite journal |vauthors=Turner JA, Clancy S |date=April 1988 |title=Comparison of operant behavioral and cognitive-behavioral group treatment for chronic low back pain |journal=Journal of Consulting and Clinical Psychology |volume=56 |issue=2 |pages=261–266 |doi=10.1037/0022-006x.56.2.261 |pmid=2967314}}</ref> CBT is significantly more effective than standard care in treatment of people with body-wide pain, like fibromyalgia. Evidence for the usefulness of CBT in the management of adult chronic pain is generally poorly understood, due partly to the proliferation of techniques of doubtful quality, and the poor quality of reporting in clinical trials.{{Citation needed|date=June 2020}} The crucial content of individual interventions has not been isolated, and the important contextual elements, such as therapist training and development of treatment manuals, have not been determined. The widely varying nature of the resulting data makes useful [[systematic review]] and [[meta-analysis]] within the field very difficult.<ref name="Eccleston1">{{Cite journal |vauthors=Eccleston C |date=August 2011 |title=Can 'ehealth' technology deliver on its promise of pain management for all? |journal=Pain |volume=152 |issue=8 |pages=1701–1702 |doi=10.1016/j.pain.2011.05.004 |pmid=21612868 }}</ref>

In 2020, a [[systematic review]] of [[randomized controlled trial]]s (RCTs) evaluated the clinical effectiveness of psychological therapies for the management of adult chronic pain (excluding headaches). There is no evidence that [[behaviour therapy]] (BT) is effective for reducing this type of pain; however, BT may be useful for improving a person's mood immediately after treatment. This improvement appears to be small and is short-term in duration.<ref name=":7">{{Cite journal |vauthors=Williams AC, Fisher E, Hearn L, Eccleston C |date=August 2020 |title=Psychological therapies for the management of chronic pain (excluding headache) in adults |journal=The Cochrane Database of Systematic Reviews |volume=8 |issue=5 |article-number=CD007407 |doi=10.1002/14651858.CD007407.pub4 |pmc=7437545 |pmid=32794606}}</ref> CBT may have a small positive short-term effect on pain immediately following treatment. CBT may also have a small effect on reducing [[disability]] and potential [[Pain catastrophizing|catastrophizing]] that may be associated with adult chronic pain. These benefits do not appear to last very long following the therapy.<ref name=":7" /> CBT may contribute towards improving the mood of an adult who experiences chronic pain, which could possibility be maintained for more extended periods of time.<ref name=":7" />

For children and adolescents, a review of RCTs evaluating the effectiveness of psychological therapy for the management of chronic and recurrent pain found that psychological treatments are effective in reducing pain when people under 18 years old have headaches.<ref>{{Cite journal |vauthors=Fisher E, Law E, Dudeney J, Eccleston C, Palermo TM |date=April 2019 |title=Psychological therapies (remotely delivered) for the management of chronic and recurrent pain in children and adolescents |journal=The Cochrane Database of Systematic Reviews |volume=4 |issue=4 |article-number=CD011118 |doi=10.1002/14651858.cd011118.pub3 |pmc=6445568 |pmid=30939227}}</ref> This beneficial effect may be maintained for at least three months following the therapy.<ref name=":3">{{Cite journal |vauthors=Fisher E, Law E, Dudeney J, Palermo TM, Stewart G, Eccleston C |date=September 2018 |title=Psychological therapies for the management of chronic and recurrent pain in children and adolescents |journal=The Cochrane Database of Systematic Reviews |volume=9 |issue=10 |article-number=CD003968 |doi=10.1002/14651858.CD003968.pub5 |pmc=6257251 |pmid=30270423}}</ref> Psychological treatments may also improve pain control for children or adolescents who experience pain unrelated to headaches. It is not known if psychological therapy improves a child's or an adolescent's mood and the potential for disability related to their chronic pain.<ref name=":3" />

=== Hypnosis ===
A 2007 review of 13 studies found evidence for the efficacy of [[hypnosis]] in reducing pain in some conditions. However, the studies had limitations like small study sizes, raising issues of power to detect group differences, and lacking credible controls for placebo or expectation. The authors concluded that "although the findings provide support for the general applicability of hypnosis in the treatment of chronic pain, considerably more research will be needed to fully determine the effects of hypnosis for different chronic-pain conditions."<ref name="Elkins2007">{{Cite journal |vauthors=Elkins G, Jensen MP, Patterson DR |date=July 2007 |title=Hypnotherapy for the management of chronic pain |journal=The International Journal of Clinical and Experimental Hypnosis |volume=55 |issue=3 |pages=275–287 |doi=10.1080/00207140701338621 |pmc=2752362 |pmid=17558718}}</ref>{{rp|283}}

Hypnosis has reduced the pain of some harmful medical procedures in children and adolescents.<ref name="Accardi">{{Cite journal |vauthors=Accardi MC, Milling LS |date=August 2009 |title=The effectiveness of hypnosis for reducing procedure-related pain in children and adolescents: a comprehensive methodological review |journal=Journal of Behavioral Medicine |volume=32 |issue=4 |pages=328–339 |doi=10.1007/s10865-009-9207-6 |pmid=19255840 }}</ref> In clinical trials addressing other patient groups, it has significantly reduced pain compared to no treatment or some other non-hypnotic interventions.<ref name="APA">{{Cite web |last=American Psychological Association |date=2 July 2004 |title=Hypnosis for the relief and control of pain |url=http://www.apa.org/research/action/hypnosis.aspx |access-date=29 April 2013 |publisher=American Psychological Association}}</ref> The effects of self-hypnosis on chronic pain are roughly comparable to those of progressive muscle relaxation.<ref name="Jensen">{{Cite journal |vauthors=Jensen M, Patterson DR |date=February 2006 |title=Hypnotic treatment of chronic pain |journal=Journal of Behavioral Medicine |volume=29 |issue=1 |pages=95–124 |doi=10.1007/s10865-005-9031-6 |pmid=16404678 }}</ref>

A 2019 systematic review of 85 studies showed it to be significantly effective at reducing pain for people with high and medium suggestibility, but minimal effectiveness for people with low suggestibility. However, high-quality clinical data is needed to generalize to the whole chronic pain population.<ref>{{cite journal |last1=Thompson |first1=Trevor |last2=Terhune |first2=Devin B. |last3=Oram |first3=Charlotte |last4=Sharangparni |first4=Joseph |last5=Rouf |first5=Rommana |last6=Solmi |first6=Marco |last7=Veronese |first7=Nicola |last8=Stubbs |first8=Brendon |title=The effectiveness of hypnosis for pain relief: A systematic review and meta-analysis of 85 controlled experimental trials |journal=Neuroscience & Biobehavioral Reviews |date=April 2019 |volume=99 |pages=298–310 |doi=10.1016/j.neubiorev.2019.02.013 |pmid=30790634 |url=http://gala.gre.ac.uk/id/eprint/23018/7/23108%20THOMPSON_The_Effectiveness_of_Hypnosis_for_Pain_Relief_2019.pdf }}</ref>

=== Mindfulness meditation ===
A 2013 meta-analysis of studies that used techniques centered around the concept of [[mindfulness (psychology)|mindfulness]] concluded, "that MBIs [mindfulness-based interventions] decrease the intensity of pain for chronic pain patients."<ref>{{Cite journal |vauthors=Reiner K, Tibi L, Lipsitz JD |date=February 2013 |title=Do mindfulness-based interventions reduce pain intensity? A critical review of the literature |journal=Pain Medicine |volume=14 |issue=2 |pages=230–242 |doi=10.1111/pme.12006 |pmid=23240921 |doi-access=free}}</ref> A 2019 review of studies of brief mindfulness-based interventions (BMBI) concluded that BMBI are not recommended as a first-line treatment and could not confirm their efficacy in managing chronic or acute pain.<ref>{{Cite journal |vauthors=McClintock AS, McCarrick SM, Garland EL, Zeidan F, Zgierska AE |date=March 2019 |title=Brief Mindfulness-Based Interventions for Acute and Chronic Pain: A Systematic Review |journal=Journal of Alternative and Complementary Medicine |volume=25 |issue=3 |pages=265–278 |doi=10.1089/acm.2018.0351 |pmc=6437625 |pmid=30523705}}</ref>

=== Mindfulness-based pain management ===
[[Mindfulness-based pain management]] (MBPM) is a mindfulness-based intervention (MBI) providing specific applications for people living with chronic pain and illness.<ref name=":5">{{Cite journal |vauthors=Cusens B, Duggan GB, Thorne K, Burch V |date=2010 |title=Evaluation of the breathworks mindfulness-based pain management programme: effects on well-being and multiple measures of mindfulness |journal=Clinical Psychology & Psychotherapy |volume=17 |issue=1 |pages=63–78 |doi=10.1002/cpp.653 |pmid=19911432}}</ref><ref name=":22">{{Cite web |date=22 January 2019 |title=What is Mindfulness based Pain Management (MBPM)? |url=https://www.breathworks-mindfulness.org.uk/mbpm |access-date=2020-05-22 |website=Breathworks CIC |language=en}}</ref> Adapting the core concepts and practices of [[mindfulness-based stress reduction]] (MBSR) and [[mindfulness-based cognitive therapy]] (MBCT), MBPM includes a distinctive emphasis on the practice of '[[Maitrī|loving-kindness]]', and has been seen as sensitive to concerns about removing mindfulness teaching from its original ethical framework within [[Buddhism]].<ref name=":5" /><ref name=":8">{{Cite journal |display-authors=6 |vauthors=Pizutti LT, Carissimi A, Valdivia LJ, Ilgenfritz CA, Freitas JJ, Sopezki D, Demarzo MM, Hidalgo MP |date=June 2019 |title=Evaluation of Breathworks' Mindfulness for Stress 8-week course: Effects on depressive symptoms, psychiatric symptoms, affects, self-compassion, and mindfulness facets in Brazilian health professionals |journal=Journal of Clinical Psychology |volume=75 |issue=6 |pages=970–984 |doi=10.1002/jclp.22749 |pmid=30689206 }}</ref> It was developed by [[Vidyamala Burch]] and is delivered through the programs of [[Breathworks]].<ref name=":5" /><ref name=":22" />

== Medications ==
The [[World Health Organization]] (WHO) recommends a ''[[pain ladder]]'' for managing pain relief with pharmaceutical medicine. It was first described for use in [[cancer pain]]. However it can be used by medical professionals as a general principle when managing any type of pain.<ref>{{Cite web |title=WHO - WHO's cancer pain ladder for adults |url=https://www.who.int/cancer/palliative/painladder/en/ |website=WHO |access-date=2018-12-31 |archive-date=2003-08-07 |archive-url=https://web.archive.org/web/20030807014332/http://www.who.int/cancer/palliative/painladder/en/ }}</ref><ref name="HoMBRG">{{Cite book |url=https://archive.org/details/innovationinpain00reyn |title=Innovation in pain management: the transcript of a Witness seminar held by the Wellcome Trust Centre for the History of Medicine at UCL, London, on 12 december 2002 |date=2004 |publisher=Wellcome Trust Centre for the History of Medicine at University College London |isbn=978-0-85484-097-7 |veditors=Reynolds LA, Tansey EM |location=London}}</ref> In the treatment of chronic pain, the three-step WHO Analgesic Ladder provides guidelines for selecting the appropriate medicine. The exact medications recommended will vary by country and the individual treatment center, but the following gives an example of the WHO approach to treating chronic pain with medications. If, at any point, treatment fails to provide adequate pain relief, then the doctor and patient move onto the next step.{{cn|date=September 2024}}

{| class="wikitable sortable"
|-
! colspan="4" style="background-color: #CCEEEE;" | Common types of pain and typical drug management
|-
! Pain type
! typical initial drug treatment
! comments
|-
| [[headache]]
| paracetamol/acetaminophen, [[NSAIDs]]<ref name="BBDchronicpain">{{Citation |last=Consumer Reports Health Best Buy Drugs |title=Opioids |date=July 2012 |url=http://consumerhealthchoices.org/catalog/best-buy-drugs-opioids/ |access-date=28 October 2013 |chapter=Using Opioids to Treat: Chronic Pain - Comparing Effectiveness, Safety, and Price |chapter-url=http://consumerhealthchoices.org/wp-content/uploads/2012/08/BBD-Opioids-Full.pdf |place=[[Yonkers, New York]] |publisher=Consumer Reports |author-link=Consumer Reports}}</ref>
| doctor consultation is appropriate if headaches are severe, persistent, accompanied by fever, vomiting, or speech or balance problems;<ref name="BBDchronicpain" /> self-medication should be limited to two weeks<ref name="BBDchronicpain" />
|-
| [[migraine]]
| paracetamol, NSAIDs<ref name="BBDchronicpain" />
| [[triptans]] are used when the others do not work, or when migraines are frequent or severe<ref name="BBDchronicpain" />
|-
| [[menstrual cramps]]
| NSAIDs<ref name="BBDchronicpain" />
| some NSAIDs are marketed for cramps, but any NSAID would work<ref name="BBDchronicpain" />
|-
| minor trauma, such as a [[bruise]], [[abrasion (medical)|abrasions]], [[sprain]]
| paracetamol, NSAIDs<ref name="BBDchronicpain" />
| opioids not recommended<ref name="BBDchronicpain" />
|-
| severe trauma, such as a [[wound]], [[burn]], [[bone fracture]], or severe sprain
| opioids<ref name="BBDchronicpain" />
| more than two weeks of pain requiring opioid treatment is unusual<ref name="BBDchronicpain" />
|-
| [[strain (injury)|strain]] or pulled muscle
| NSAIDs, muscle relaxants<ref name="BBDchronicpain" />
| if inflammation is involved, NSAIDs may work better; short-term use only<ref name="BBDchronicpain" />
|-
| minor pain after surgery
| paracetamol, NSAIDs<ref name="BBDchronicpain" />
| opioids rarely needed<ref name="BBDchronicpain" />
|-
| severe pain after surgery
| opioids<ref name="BBDchronicpain" />
| combinations of opioids may be prescribed if pain is severe<ref name="BBDchronicpain" />
|-
| [[muscle ache]]
| paracetamol, NSAIDs<ref name="BBDchronicpain" />
| if inflammation involved, NSAIDs may work better.<ref name="BBDchronicpain" />
|-
| [[toothache]] or pain from dental procedures
| paracetamol, NSAIDs<ref name="BBDchronicpain" />
| this should be short term use; opioids may be necessary for severe pain<ref name="BBDchronicpain" />
|-
| [[kidney stone]] pain
| paracetamol, NSAIDs, opioids<ref name="BBDchronicpain" />
| opioids usually needed if pain is severe.<ref name="BBDchronicpain" />
|-
| pain due to [[heartburn]] or [[gastroesophageal reflux disease]]
| [[antacid]], [[H2 antagonist|H<sub>2</sub> antagonist]], [[proton-pump inhibitor]]<ref name="BBDchronicpain" />
| heartburn lasting more than a week requires medical attention; aspirin and NSAIDs should be avoided<ref name="BBDchronicpain" />
|-
| chronic back pain
| paracetamol, NSAIDs<ref name="BBDchronicpain" />
| opioids may be necessary if other drugs do not control pain and pain is persistent<ref name="BBDchronicpain" />
|-
| [[osteoarthritis]] pain
| paracetamol, NSAIDs<ref name="BBDchronicpain" />
| medical attention is recommended if pain persists.<ref name="BBDchronicpain" />
|-
| [[fibromyalgia]]
| [[antidepressant]], [[anticonvulsant]]<ref name="BBDchronicpain" />
| evidence suggests that opioids are not effective in treating fibromyalgia<ref name="BBDchronicpain" />
|-
|}

=== Mild pain ===
[[Paracetamol]] (acetaminophen), or a [[nonsteroidal anti-inflammatory drug]] (NSAID) such as [[ibuprofen]] will relieve mild pain.<ref>{{MedlinePlusEncyclopedia|002123|Over-the-counter pain relievers}}</ref>

=== Mild to moderate pain ===
Paracetamol, an NSAID or paracetamol in a combination product with a weak [[opioid]] such as [[tramadol]], may provide greater relief than their separate use.  A combination of opioid with [[Paracetamol|acetaminophen]] can be frequently used such as Percocet, [[Vicodin]], or Norco. {{Citation needed|date=June 2020}}

=== Moderate to severe pain ===
When treating moderate to severe pain, the type of the pain, acute or chronic, needs to be considered.  The type of pain can result in different medications being prescribed.  Certain medications may work better for acute pain, others for chronic pain, and some may work equally well on both.  Acute pain medication is for rapid onset of pain such as from an inflicted [[Trauma (medicine)|trauma]] or to treat [[Surgery|post-operative pain]].  [[Chronic pain]] medication is for alleviating long-lasting, ongoing pain.{{cn|date=September 2024}}

[[Morphine]] is the [[gold standard]] to which all [[narcotic]]s are compared. Semi-synthetic derivatives of morphine such as [[hydromorphone]] (Dilaudid), [[oxymorphone]] (Numorphan, Opana), [[nicomorphine]] (Vilan), [[hydromorphinol]] and others vary in such ways as duration of action, side effect profile and milligramme potency.  [[Fentanyl]] has the benefit of less [[histamine]] release and thus fewer [[side effect]]s.  It can also be administered via [[transdermal patch]] which is convenient for chronic pain management. In addition to the transdermal patch and injectable fentanyl formulations, the FDA (Food and Drug Administration) has approved various immediate release fentanyl products for breakthrough cancer pain (Actiq/OTFC/Fentora/Onsolis/Subsys/Lazanda/Abstral). [[Oxycodone]] is used across the Americas and Europe for relief of serious chronic pain. Its main slow-release formula is known as [[OxyContin]]. Short-acting tablets, capsules, syrups and [[ampule]]s which contain oxycodone are available making it suitable for acute intractable pain or [[Pain#Breakthrough pain|breakthrough pain]]. [[Diamorphine]], and [[methadone]] are used less frequently.{{Citation needed|date=January 2010}} Clinical studies have shown that transdermal [[buprenorphine]] is effective at reducing chronic pain.<ref>{{Cite journal |vauthors=Aiyer R, Gulati A, Gungor S, Bhatia A, Mehta N |date=August 2018 |title=Treatment of Chronic Pain With Various Buprenorphine Formulations: A Systematic Review of Clinical Studies |journal=Anesthesia and Analgesia |volume=127 |issue=2 |pages=529–538 |doi=10.1213/ANE.0000000000002718 |pmid=29239947 }}</ref> [[Pethidine]], known in North America as meperidine, is not recommended {{By whom|date=October 2012}} for pain management due to its low potency, short duration of action, and toxicity associated with repeated use.{{Citation needed|date=June 2020}} [[Pentazocine]], [[dextromoramide]] and [[dipipanone]] are also not recommended in new patients except for acute pain where other analgesics are not tolerated or are inappropriate, for pharmacological and misuse-related reasons.  In some countries potent synthetics such as [[piritramide]] and [[ketobemidone]] are used for severe pain. [[Tapentadol]] is a newer agent introduced in the last decade.{{cn|date=September 2024}}

For moderate pain, [[tramadol]], [[codeine]], [[dihydrocodeine]], and [[hydrocodone]] are used, with [[nicocodeine]], [[ethylmorphine]] and [[propoxyphene]] or [[dextropropoxyphene]] (less commonly).

Drugs of other types can be used to help opioids combat certain types of pain. [[Amitriptyline]] is prescribed for chronic muscular pain in the arms, legs, neck and lower back with an opiate, or sometimes without it or with an NSAID.

While [[opiate]]s are often used in the management of chronic pain, high doses are associated with an increased risk of [[opioid overdose]].<ref>{{Cite journal |display-authors=6 |vauthors=Dunn KM, Saunders KW, Rutter CM, Banta-Green CJ, Merrill JO, Sullivan MD, Weisner CM, Silverberg MJ, Campbell CI, Psaty BM, Von Korff M |date=January 2010 |title=Opioid prescriptions for chronic pain and overdose: a cohort study |journal=Annals of Internal Medicine |volume=152 |issue=2 |pages=85–92 |doi=10.7326/0003-4819-152-2-201001190-00006 |pmc=3000551 |pmid=20083827}}</ref>

In the U.S., the illegal use of opioids has led to an increasingly high threshold of prescribing analgesics to patients, and as a result minor pain killers were prescribed. Some medical analysts have criticized  that development as it might cause premature deaths among cancer patients.<ref>[https://www.nejm.org/doi/full/10.1056/NEJMra1507771 "Opioid Abuse in Chronic Pain — Misconceptions and Mitigation Strategies≥]" ''ma-assn.org''. Retrieved May 10 2025.</ref>

=== Opioids ===

In 2009, the [[Food and Drug Administration]] stated: "According to the [[National Institutes of Health]], studies have shown that properly managed medical use of opioid analgesic compounds (taken exactly as prescribed) is safe, can manage pain effectively, and rarely causes addiction."<ref>FDA.gov "A Guide to Safe Use of Pain Medicine" February 23, 2009</ref> In 2013, the FDA stated that "abuse and misuse of these products have created a serious and growing public health problem".<ref>{{Cite web |title=Abuse-deterrent opioids: evaluation and laveling guidance for industry |url=https://www.fda.gov/media/84819/download |access-date=28 March 2020 |website=Food and Drug Administration}}</ref>

[[Opioid]] medications can provide short, intermediate or long acting analgesia depending upon the specific properties of the medication and whether it is formulated as an extended release drug. Opioid medications may be administered orally, by injection, via nasal mucosa or oral mucosa, rectally, transdermally, intravenously, epidurally and intrathecally. In chronic pain conditions that are opioid responsive, a combination of a long-acting (OxyContin, MS Contin, Opana ER, Exalgo and Methadone) or [[Time release technology|extended release]] medication is often prescribed along with a shorter-acting medication (oxycodone, morphine or hydromorphone) for breakthrough pain, or exacerbations.

Most opioid treatment used by patients outside of healthcare settings is oral ([[Tablet (pharmacy)|tablet]], [[Capsule (pharmacy)|capsule]] or liquid), but [[Suppository|suppositories]] and skin patches can be prescribed. An opioid [[Injection (medicine)|injection]] is rarely needed for patients with chronic pain.

Although opioids are strong analgesics, they do not provide complete analgesia regardless of whether the pain is acute or chronic in origin. Opioids are effective analgesics in chronic malignant pain and modestly effective in nonmalignant pain management.<ref>{{Cite journal |author-link2=Howard Y. Chang |display-authors=6 |vauthors=Daubresse M, Chang HY, Yu Y, Viswanathan S, Shah ND, Stafford RS, Kruszewski SP, Alexander GC |date=October 2013 |title=Ambulatory diagnosis and treatment of nonmalignant pain in the United States, 2000-2010 |journal=Medical Care |volume=51 |issue=10 |pages=870–878 |doi=10.1097/MLR.0b013e3182a95d86 |pmc=3845222 |pmid=24025657}}</ref> However, there are associated adverse effects, especially during the commencement or change in dose. When [[opioids]] are used for prolonged periods [[drug tolerance]] will occur. Other risks can include [[chemical dependency]], [[Drug diversion|diversion]] and [[Substance use disorder|addiction]].<ref>{{Cite journal |vauthors=Carinci AJ, Mao J |date=February 2010 |title=Pain and opioid addiction: what is the connection? |journal=Current Pain and Headache Reports |volume=14 |issue=1 |pages=17–21 |doi=10.1007/s11916-009-0086-x |pmid=20425210 }}</ref><ref>{{Cite journal |vauthors=Starrels JL, Becker WC, Alford DP, Kapoor A, Williams AR, Turner BJ |date=June 2010 |title=Systematic review: treatment agreements and urine drug testing to reduce opioid misuse in patients with chronic pain |journal=Annals of Internal Medicine |volume=152 |issue=11 |pages=712–720 |doi=10.7326/0003-4819-152-11-201006010-00004 |pmid=20513829 }}</ref>

Clinical guidelines for prescribing opioids for chronic pain have been issued by the [[American Pain Society]] and the American Academy of Pain Medicine. Included in these guidelines is the importance of assessing the patient for the risk of substance abuse, misuse, or addiction. Factors correlated with an elevated risk of opioid misuse include a history of substance use disorder, younger age, major depression, and the use of psychotropic medications.<ref>Thomas R. Frieden, Harold W. Jaffe, Joanne Cono, et al. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR Recomm Rep 2016;65 Pg. 9-10</ref> Physicians who prescribe opioids should integrate this treatment with any psychotherapeutic intervention the patient may be receiving. The guidelines also recommend monitoring not only the pain but also the level of functioning and the achievement of therapeutic goals. The prescribing physician should be suspicious of abuse when a patient reports a reduction in pain but has no accompanying improvement in function or progress in achieving identified goals.<ref>{{Cite journal |vauthors=King SA |year=2010 |title=Guidelines for prescribing opioids for chronic pain |url=https://www.psychiatrictimes.com/view/guidelines-prescribing-opioids-chronic-pain |journal=Psychiatr Times |volume=27 |issue=5 |page=20}}</ref>

The list below consists of commonly used opioid analgesics which have long-acting formulations. Common brand names for the extended release formulation are in parentheses.
* [[Oxycodone]] (OxyContin)
* [[Hydromorphone]] (Exalgo, Hydromorph Contin)
* [[Morphine]] (M-Eslon, MS Contin)
* [[Oxymorphone]] (Opana ER)
* [[Fentanyl]], transdermal (Duragesic)
* [[Buprenorphine]]*, transdermal (Butrans)
* [[Tramadol]] (Ultram ER)
* [[Tapentadol]] (Nucynta ER)
* [[Methadone]]* (Metadol, Methadose)
* [[Hydrocodone]] bitartrate (Hysingla ER) and bicarbonate (Zohydro ER)
<nowiki>*</nowiki>Methadone and buprenorphine are each used both for the treatment of [[opioid use disorder|opioid addiction]] and as analgesics

=== Nonsteroidal anti-inflammatory drugs ===
The other major group of analgesics are [[nonsteroidal anti-inflammatory drug]]s (NSAID). They work by inhibiting the release of [[prostaglandin]]s, which cause inflammatory pain. [[Acetaminophen]]/paracetamol is not always included in this class of medications. However, acetaminophen may be administered as a single medication or in combination with other analgesics (both NSAIDs and opioids). The alternatively prescribed NSAIDs such as [[ketoprofen]] and [[piroxicam]] have limited benefit in chronic pain disorders and with long-term use are associated with significant [[adverse effect]]s. The use of selective NSAIDs designated as [[COX-2 inhibitor|selective COX-2 inhibitors]] have significant cardiovascular and cerebrovascular risks which have limited their utilization.<ref name="Munir MA, Enany N.">{{Cite journal |vauthors=Munir MA, Enany N, Zhang JM |date=January 2007 |title=Nonopioid analgesics |journal=The Medical Clinics of North America |volume=91 |issue=1 |pages=97–111 |doi=10.1016/j.mcna.2006.10.011 |pmid=17164106}}</ref><ref name="Ballantyne JC.">{{Cite journal |vauthors=Ballantyne JC |date=November 2006 |title=Opioids for chronic nonterminal pain |journal=Southern Medical Journal |volume=99 |issue=11 |pages=1245–1255 |doi=10.1097/01.smj.0000223946.19256.17 |pmid=17195420 }}</ref> Common NSAIDs include [[aspirin]], [[ibuprofen]], and [[naproxen]]. There are many NSAIDs such as parecoxib (selective COX-2 inhibitor) with proven effectiveness after different surgical procedures. Wide use of non-opioid analgesics can reduce opioid-induced side-effects.<ref>{{Cite journal |vauthors=Mulita F, Karpetas G, Liolis E, Vailas M, Tchabashvili L, Maroulis I |date=February 2021 |title=Comparison of analgesic efficacy of acetaminophen monotherapy versus acetaminophen combinations with either pethidine or parecoxib in patients undergoing laparoscopic cholecystectomy: a randomized prospective study |journal=Medicinski Glasnik |volume=18 |issue=1 |pages=27–32 |doi=10.17392/1245-21 |pmid=33155461 |doi-access=free}}</ref>

=== Antidepressants and antiepileptic drugs ===
Some [[antidepressant]] and [[antiepileptic]] drugs are used in chronic pain management and act primarily within the pain pathways of the central nervous system, though peripheral mechanisms have been attributed as well. They are generally used to treat nerve brain that results from injury to the nervous system. [[Neuropathy]] can be due to chronic high blood sugar levels ([[diabetic neuropathy]]). These drugs also reduce pain from viruses such as shingles, [[phantom limb pain]] and post-stroke pain.{{fact|date=April 2025}} These mechanisms vary and in general are more effective in [[neuropathy|neuropathic]] pain disorders as well as [[complex regional pain syndrome]].<ref name="Jackson KC 2nd.">{{Cite journal |vauthors=Jackson KC |date=March 2006 |title=Pharmacotherapy for neuropathic pain |journal=Pain Practice |volume=6 |issue=1 |pages=27–33 |doi=10.1111/j.1533-2500.2006.00055.x |pmid=17309706 }}</ref> A common anti-epileptic drug is [[gabapentin]], and an example of an antidepressant would be [[amitriptyline]].{{cn|date=September 2024}}

=== Cannabinoids ===

The evidence for using cannabis for pain control varies in quality, but overall there is no good evidence cannabis is effective for any type of pain management, or that it is viable as a means of reducing [[opioid]] use.<ref>{{cite journal |vauthors=Pantoja-Ruiz C, Restrepo-Jimenez P, Castañeda-Cardona C, Ferreirós A, Rosselli D |title=Cannabis and pain: a scoping review |journal=Braz J Anesthesiol |volume=72 |issue=1 |pages=142–151 |date=2022 |pmid=34280454 |pmc=9373074 |doi=10.1016/j.bjane.2021.06.018 |url=}}</ref>

=== Ketamine ===
Low-dose [[ketamine]] is sometimes used as an alternative to opioids for the treatment of acute pain in hospital [[emergency department]]s.<ref name="ACEP policy 2017">{{Cite journal |last=[[American College of Emergency Physicians]] |year=2017 |title=Optimizing the Treatment of Acute Pain in the Emergency Department |journal=Annals of Emergency Medicine |publisher=Elsevier BV |volume=70 |issue=3 |pages=446–448 |doi=10.1016/j.annemergmed.2017.06.043 |pmid=28844277 |quote=Subdissociative-dose ketamine (SDK) may be used either alone or as part of a multimodal approach to pain relief for traumatic and nontraumatic pain. |doi-access=free}}</ref><ref name="pmid33098707">{{Cite journal |vauthors=Balzer N, McLeod SL, Walsh C, Grewal K |date=April 2021 |title=Low-dose Ketamine For Acute Pain Control in the Emergency Department: A Systematic Review and Meta-analysis |journal=[[Academic Emergency Medicine]] |volume=28 |issue=4 |pages=444–454 |doi=10.1111/acem.14159 |pmid=33098707 |doi-access=free}}</ref> Ketamine probably<sup>?</sup> reduces pain more than opioids and with less nausea and vomiting.<ref name="bmjopen-2020-038134">{{cite journal |last1=Sandberg |first1=Mårten |last2=Hyldmo |first2=Per Kristian |last3=Kongstad |first3=Poul |last4=Dahl Friesgaard |first4=Kristian |last5=Raatiniemi |first5=Lasse |last6=Larsen |first6=Robert |last7=Magnusson |first7=Vidar |last8=Rognås |first8=Leif |last9=Kurola |first9=Jouni |last10=Rehn |first10=Marius |last11=Vist |first11=Gunn Elisabeth |title=Ketamine for the treatment of prehospital acute pain: a systematic review of benefit and harm |journal=BMJ Open |date=November 2020 |volume=10 |issue=11 |article-number=e038134 |doi=10.1136/bmjopen-2020-038134 |pmc=7689093 |pmid=33234621 }}</ref>

=== Other analgesics ===
Other drugs which can potentiate conventional analgesics or have analgesic properties in certain circumstances are called [[analgesic adjuvant]] medications.<ref name=":9">{{Cite journal |vauthors=Portenoy RK |date=January 2000 |title=Current pharmacotherapy of chronic pain |journal=Journal of Pain and Symptom Management |volume=19 |issue=1 Suppl |pages=S16–S20 |doi=10.1016/s0885-3924(99)00124-4 |pmid=10687334 |doi-access=free}}</ref> [[Gabapentin]], an anticonvulsant, can reduce neuropathic pain itself and can also potentiate opiates.<ref name="gabapentin">{{Cite journal |vauthors=Caraceni A, Zecca E, Martini C, De Conno F |date=June 1999 |title=Gabapentin as an adjuvant to opioid analgesia for neuropathic cancer pain |journal=Journal of Pain and Symptom Management |volume=17 |issue=6 |pages=441–445 |doi=10.1016/S0885-3924(99)00033-0 |pmid=10388250 |doi-access=free |hdl-access=free |hdl=2434/913025}}</ref>   Drugs with [[anticholinergic]] activity, such as [[orphenadrine]] and [[cyclobenzaprine]], are given in conjunction with opioids for neuropathic pain. Orphenadrine and cyclobenzaprine are also [[muscle relaxant]]s, and are useful in painful musculoskeletal conditions.  [[Clonidine]], an alpha-2 receptor agonist, is another drug that has found use as an analgesic adjuvant.<ref name=":9" /> In 2021, researchers described a novel type of pain therapy {{emdash}} a [[CRISPR activation#dCas9|CRISPR-dCas9]] [[epigenome editing]] method for repressing [[Nav1.7|Na<sub>v</sub>1.7]] [[gene expression]] which showed therapeutic potential in three mouse models of chronic pain.<ref>{{Cite news |date=11 March 2021 |title=Unique CRISPR gene therapy offers opioid-free chronic pain treatment |url=https://newatlas.com/science/crispr-gene-therapy-opioid-free-chronic-pain-relief/ |access-date=18 April 2021 |work=New Atlas}}</ref><ref>{{Cite journal |display-authors=6 |vauthors=Moreno AM, Alemán F, Catroli GF, Hunt M, Hu M, Dailamy A, Pla A, Woller SA, Palmer N, Parekh U, McDonald D, Roberts AJ, Goodwill V, Dryden I, Hevner RF, Delay L, Gonçalves Dos Santos G, Yaksh TL, Mali P |date=March 2021 |title=Long-lasting analgesia via targeted in situ repression of Na<sub>V</sub>1.7 in mice |journal=Science Translational Medicine |volume=13 |issue=584 |article-number=eaay9056 |doi=10.1126/scitranslmed.aay9056 |pmc=8830379 |pmid=33692134 }}</ref>

[[Nefopam]] may be used when common alternatives are contraindicated or ineffective, or as an add-on therapy. However it is associated with adverse drug reactions and is toxic in overdose.<ref>{{Cite web|url=https://www.sps.nhs.uk/articles/use-of-nefopam-for-chronic-pain/|title=Use of nefopam for chronic pain|date=January 5, 2024|website=SPS - Specialist Pharmacy Service}}</ref>

== Self-management ==
As of 2024, the patient is encouraged to play a major role in the management of their pain.<ref>{{Cite journal|url=https://www.bmj.com/content/384/bmj-2022-072362|title=Chronic pain: supported self-management|first1=Youngjoo|last1=Kang|first2=Louise|last2=Trewern|first3=John|last3=Jackman|first4=Anushka Irani (nee|last4=Soni)|first5=David|last5=McCartney|date=January 2, 2024|journal=BMJ|volume=384|article-number=e072362|via=www.bmj.com|doi=10.1136/bmj-2022-072362|pmid=38167273|url-access=subscription}}</ref>

Self-management of chronic pain has been described as the individual's ability to manage various aspects of their chronic pain.<ref name=":4">{{Cite journal |vauthors=Devan H, Hale L, Hempel D, Saipe B, Perry MA |date=May 2018 |title=What Works and Does Not Work in a Self-Management Intervention for People With Chronic Pain? Qualitative Systematic Review and Meta-Synthesis |journal=Physical Therapy |volume=98 |issue=5 |pages=381–397 |doi=10.1093/ptj/pzy029 |pmid=29669089 |doi-access=free}}</ref> Self-management can include building [[self-efficacy]], monitoring one's own symptoms, goal setting and action planning. It also includes patient-physician shared decision-making, among others.<ref name=":4" /> The benefits of self-management vary depending on self-management techniques used. They only have  marginal benefits in management of chronic musculoskeletal pain.<ref>{{Cite journal |vauthors=Elbers S, Wittink H, Pool JJ, Smeets RJ |date=October 2018 |title=The effectiveness of generic self-management interventions for patients with chronic musculoskeletal pain on physical function, self-efficacy, pain intensity and physical activity: A systematic review and meta-analysis |journal=European Journal of Pain |volume=22 |issue=9 |pages=1577–1596 |doi=10.1002/ejp.1253 |pmc=6175326 |pmid=29845678}}</ref> Some research has shown that self-management of pain can use different approaches. Those approaches can range from different therapies such as yoga, acupuncture, exercise and other relaxation techniques. Patients could also take a more natural approach by taking different minerals, vitamins or herbs. However, research has shown there is a difference between rural patients and non-rural patients having more access to different self-management approaches. Physicians in these areas may be readily prescribing more pain medication in these rural cities due to being less experienced with pain management. Simply put, it is sometimes easier for rural patients to get a prescription that insurance pays for instead of natural approaches that cost more money than they can afford to spend on their pain management. Self-management may be a more expensive alternative.<ref>{{Cite journal |last1=Eaton |first1=Linda H. |last2=Langford |first2=Dale J. |last3=Meins |first3=Alexa R. |last4=Rue |first4=Tessa |last5=Tauben |first5=David J. |last6=Doorenbos |first6=Ardith Z. |date=February 2018 |title=Use of Self-management Interventions for Chronic Pain Management: A Comparison between Rural and Nonrural Residents |journal=Pain Management Nursing |language=en |volume=19 |issue=1 |pages=8–13 |doi=10.1016/j.pmn.2017.09.004 |pmc=5807105 |pmid=29153296}}</ref>

==Future directions==
A 2023 review said that future chronic pain diagnosis and treatment would be more personalized and precision based.<ref>{{Cite journal|title=Clinical Diagnosis and Treatment of Chronic Pain|first1=Sadiq|last1=Rahman|first2=Ali|last2=Kidwai|first3=Emiliya|last3=Rakhamimova|first4=Murad|last4=Elias|first5=William|last5=Caldwell|first6=Sergio D.|last6=Bergese|date=December 18, 2023|journal=Diagnostics (Basel, Switzerland)|volume=13|issue=24|page=3689|doi=10.3390/diagnostics13243689|doi-access=free |pmid=38132273|pmc=10743062}}</ref>

==Society and culture==
The medical treatment of pain as practiced in [[Greece]] and [[Turkey]] is called '''algology''' (from the Greek άλγος, [[algos]], "[[pain]]"). The Hellenic Society of Algology and the Turkish Algology-Pain Society are the relevant local bodies affiliated to the [[International Association for the Study of Pain]] (IASP).<ref>{{Cite journal |vauthors=Schiller F |date=1990 |title=The history of algology, algotherapy, and the role of inhibition |journal=History and Philosophy of the Life Sciences |volume=12 |issue=1 |pages=27–49 |jstor=23330469 |pmid=2243924 }}</ref>

=== Undertreatment ===
{{main|Undertreatment of pain}}
Undertreatment of pain is the absence of pain management therapy for a person in [[pain]] when treatment is [[Indication (medicine)|indicated]].

Consensus in [[evidence-based medicine]] and the recommendations of [[medical specialty]] organizations establish guidelines to determine the treatment for pain which health care providers ought to offer.<ref name="State of Pain Treatment 2011">{{Citation |last=Human Rights Watch |title=Global State of Pain Treatment: Access to Medicines and Palliative Care |date=2 June 2011 |url=https://www.hrw.org/report/2011/06/02/global-state-pain-treatment/access-medicines-and-palliative-care |access-date=28 July 2016 |publisher=Human Rights Watch |author-link=Human Rights Watch}}</ref> For various social reasons, persons in pain may not seek or may not be able to access treatment for their pain.<ref name="State of Pain Treatment 2011" /> Health care providers may not provide the treatment which authorities recommend.<ref name="State of Pain Treatment 2011" /> Some studies  about gender biases have concluded that female pain recipients are often overlooked when it comes to the perception of their pain. Whether they appeared to be in high levels of pain didn't make a difference for their observers. The women participants in the studies were still ''perceived'' to be in less pain than they actually were. Men participants on the other hand were offered pain relief while their self reporting indicated that  their pain levels didn't necessarily warrant treatment. Biases exist when it comes to gender. Prescribers  have been seen over and under prescribing treatment to individuals based on them being male or female <ref>{{Cite journal |vauthors=Samulowitz A, Gremyr I, Eriksson E, Hensing G |date=2018 |title="Brave Men" and "Emotional Women": A Theory-Guided Literature Review on Gender Bias in Health Care and Gendered Norms towards Patients with Chronic Pain |journal=Pain Research & Management |volume=2018 |article-number=6358624 |doi=10.1155/2018/6358624 |pmc=5845507 |pmid=29682130 |doi-access=free}}</ref>'''.'''There are other prevalent reasons that undertreatment of pain occurs. Gender is a factor as well as race. When it comes to prescribers treating patients racial disparities has become a real factor. Research has shown that non-white individuals pain perception has affected their pain treatment. The [[African Americans|African-American]] community has been shown to suffer significantly when it comes to trusting the medical community to treat them. Oftentimes medication although available to be prescribed is dispensed in less quantities due to their pain being perceived on a smaller scale. The black community could be undermined by physicians thinking they are not in as much pain as they are reporting. Another occurrence may be physicians simply making the choice not to treat the patient accordingly in spite of the self-reported pain level. Racial disparity is definitely a real issue in the world of pain management.<ref>{{cite journal |last1=Hoffman |first1=Kelly M. |last2=Trawalter |first2=Sophie |last3=Axt |first3=Jordan R. |last4=Oliver |first4=M. Norman |title=Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites |journal=Proceedings of the National Academy of Sciences |date=19 April 2016 |volume=113 |issue=16 |pages=4296–4301 |doi=10.1073/pnas.1516047113 |pmc=4843483 |pmid=27044069 |doi-access=free|bibcode=2016PNAS..113.4296H }}</ref>

===In children===
{{Main|Pain management in children}}
Acute pain is common in children and adolescents as a result of injury, illness, or necessary medical procedures.<ref name="AAP.">{{Cite journal |last=American Academy of Pediatrics |date=September 2001 |title=The assessment and management of acute pain in infants, children, and adolescents |journal=Pediatrics |volume=108 |issue=3 |pages=793–797 |doi=10.1542/peds.108.3.793 |pmid=11533354 |doi-access=free}}</ref> [[Chronic pain]] is present in approximately 15–25% of children and adolescents. It may be caused by an underlying disease, such as [[sickle cell anemia]], [[cystic fibrosis]], [[rheumatoid arthritis]]. Cancer or [[functional disorder]]s such as migraines, [[fibromyalgia]], and complex regional pain could also cause chronic pain in children.<ref name="Weydert">{{Cite journal |vauthors=Weydert JA |year=2013 |title=The interdisciplinary management of pediatric pain: Time for more integration |journal=Techniques in Regional Anesthesia and Pain Management |volume=17 |issue=2013 |pages=188–94 |doi=10.1053/j.trap.2014.07.006}}</ref>

[[File:Wong-Baker scale with emoji.png|thumb|Young children can indicate their level of pain by pointing to the appropriate face on a children's [[pain scale]].]]
Pain assessment in children is often challenging due to limitations in developmental level, cognitive ability, or their previous pain experiences. Clinicians must observe physiological and behavioral cues exhibited by the child to make an assessment. Self-report, if possible, is the most accurate measure of pain. Self-report pain scales involve younger kids matching their pain intensity to photographs of other children's faces, such as the Oucher Scale, pointing to schematics of faces showing different pain levels, or pointing out the location of pain on a body outline.<ref name="AMA">{{Cite web |title=Pediatric Pain Management |url=http://www.ama-cmeonline.com/pain_mgmt/printversion/ama_painmgmt_m6.pdf |archive-url=https://web.archive.org/web/20140611163703/http://www.ama-cmeonline.com/pain_mgmt/printversion/ama_painmgmt_m6.pdf |archive-date=June 11, 2014 |access-date=March 27, 2014 |publisher=American Medical Association}}</ref> Questionnaires for older children and adolescents include the Varni-Thompson Pediatric Pain Questionnaire (PPQ) and the Children's Comprehensive Pain Questionnaire. They are often utilized for individuals with chronic or persistent pain.<ref name="AMA" />

Acetaminophen, [[nonsteroidal anti-inflammatory agents]], and [[opioid|opioid analgesics]] are commonly used to treat acute or chronic pain symptoms in children and adolescents. However a pediatrician should be consulted before administering any medication.<ref name="AMA" />

Caregivers may provide nonpharmacological treatment for children and adolescents because it carries minimal risk and is cost effective compared to pharmacological treatment. Nonpharmacologic interventions vary by age and developmental factors. Physical interventions to ease pain in infants include swaddling, rocking, or sucrose via a pacifier. For children and adolescents physical interventions include hot or cold application, [[massage]], or [[acupuncture]].<ref name="Wente.">{{Cite journal |vauthors=Wente SJ |date=March 2013 |title=Nonpharmacologic pediatric pain management in emergency departments: a systematic review of the literature |journal=Journal of Emergency Nursing |volume=39 |issue=2 |pages=140–150 |doi=10.1016/j.jen.2012.09.011 |pmid=23199786 }}</ref> [[Cognitive behavioral therapy]] (CBT) aims to reduce the emotional distress and improve the daily functioning of school-aged children and adolescents with pain by changing the relationship between their thoughts and emotions. In addition this therapy teaches them adaptive [[coping (psychology)|coping]] strategies. Integrated interventions in CBT include [[relaxation training|relaxation technique]], [[mindfulness]], [[biofeedback]], and [[acceptance]] (in the case of chronic pain).<ref name="Zagustin">{{Cite journal |vauthors=Zagustin TK |date=August 2013 |title=The role of cognitive behavioral therapy for chronic pain in adolescents |journal=PM & R |volume=5 |issue=8 |pages=697–704 |doi=10.1016/j.pmrj.2013.05.009 |pmid=23953015 }}</ref> Many therapists will hold sessions for caregivers to provide them with effective management strategies.<ref name="Weydert" />

'''In red-haired individuals'''

In recent studies, it has been noted that people who have red-hair through the MC1R receptor gene may react to opioids and perceive pain differently than the rest of the population.<ref>{{Cite web |date=2021-04-19 |title=Study finds link between red hair and pain threshold |url=https://www.nih.gov/news-events/nih-research-matters/study-finds-link-between-red-hair-pain-threshold |access-date=2024-09-21 |website=National Institutes of Health (NIH) |language=EN}}</ref> The studies on this developing topic have only become notable in the past few years with researchers looking into how red-haired individuals may experience a different threshold in pain and react to pain management differently than others. Most studies find that redheads with this gene have a higher pain tolerance and can also react more sensitively to opiates but require more anesthesia.<ref>{{Cite journal |last1=Cepeda |first1=M. Soledad |last2=Carr |first2=Daniel B. |date=November 2003 |title=Women Experience More Pain and Require More Morphine Than Men to Achieve a Similar Degree of Analgesia |journal=Anesthesia & Analgesia |volume=97 |issue=5 |pages=1464–1468 |doi=10.1213/01.ane.0000080153.36643.83 |pmid=14570666 }}</ref>

===Professional certification===
Pain management practitioners come from all fields of medicine.  In addition to medical practitioners, a pain management team may often benefit from the input of [[pharmacists]], [[physiotherapist]]s, [[clinical psychologist]]s and [[occupational therapist]]s, among others.  Together the multidisciplinary team can help create a package of care suitable to the patient.

==== Pain medicine in the United States ====
Pain physicians are often fellowship-trained [[American Board of Medical Specialties|board-certified]] [[anesthesiology|anesthesiologists]], [[neurology|neurologists]], [[physiatry|physiatrists]], [[emergency physicians]], or [[psychiatry|psychiatrists]]. [[Palliative care]] doctors are also specialists in pain management. The American Society of Interventional Pain Physicians, the [[American Board of Anesthesiology]], the [[American Osteopathic Board of Anesthesiology]] (recognized by the [[AOABOS]]), the American Board of Physical Medicine and Rehabilitation, the [[American Board of Emergency Medicine]] and the [[American Board of Psychiatry and Neurology]]<ref>{{Cite web |title=Taking a Subspecialty Exam - American Board of Psychiatry and Neurology |url=http://www.abpn.com/become-certified/taking-a-subspecialty-exam/ |access-date=2015-09-19}}</ref> each provide certification for a subspecialty in pain management following fellowship training. The fellowship training is recognized by the [[American Board of Medical Specialties]] (ABMS) or the [[American Osteopathic Association Bureau of Osteopathic Specialists]] (AOABOS). As the field of pain medicine has grown rapidly, many practitioners have entered the field, some non-ACGME board-certified.<ref name="pmid23953018">{{Cite journal |vauthors=Mayer EK, Ihm JM, Sibell DM, Press JM, Kennedy DJ |date=August 2013 |title=ACGME sports, ACGME pain, or non-ACGME sports and spine: which is the ideal fellowship training for PM&R physicians interested in musculoskeletal medicine? |journal=PM & R |volume=5 |issue=8 |pages=718–23; discussion 723–5 |doi=10.1016/j.pmrj.2013.07.004 |pmid=23953018 }}</ref>

== See also ==
{{col div|colwidth=30em}}
* [[Equianalgesic]]
* [[List of investigational analgesics]]
* [[Opioid comparison]], an example of an [[equianalgesic]] chart
* [[Pain Catastrophizing Scale]]
* [[Pain ladder]]
* [[Pain management during childbirth]]
* [[Pain psychology]]
{{colend}}

== References ==
{{Reflist|30em}}

== Further reading ==
{{refbegin|30em}}
* {{cite book |last1=Staats |first1=Peter |last2=Diwan |first2=Sudhir |title=Atlas of Pain Medicine Procedures |date=2014 |publisher=McGraw-Hill Education |isbn=978-0-07-173876-7 }}
* {{cite book |last1=Staats |first1=Peter |last2=Wallace |first2=Mark S. |title=Pain Medicine and Management: Just the Facts |date=2015 |publisher=McGraw-Hill Education |isbn=978-0-07-181745-5 }}
* {{Cite book |title=Manual of pain management |vauthors=Fausett HJ, Warfield CA |publisher=Lippincott Williams & Wilkins |year=2002 |isbn=978-0-7817-2313-8 |location=Hagerstwon, MD}}
* {{Cite book |title=Principles and practice of pain medicine |vauthors=Bajwa ZH, Warfield CA |publisher=McGraw-Hill, Medical Publishing Division |year=2004 |isbn=978-0-07-144349-4 |location=New York}}
* {{Cite book |title=Pain Management |vauthors=Waldman SD |publisher=Saunders |year=2006 |isbn=978-0-7216-0334-6 |location=Philadelphia}}
* {{Cite journal |display-authors=6 |vauthors=Daubresse M, Chang HY, Yu Y, Viswanathan S, Shah ND, Stafford RS, Kruszewski SP, Alexander GC |date=October 2013 |title=Ambulatory diagnosis and treatment of nonmalignant pain in the United States, 2000-2010 |journal=Medical Care |volume=51 |issue=10 |pages=870–878 |doi=10.1097/MLR.0b013e3182a95d86 |pmc=3845222 |pmid=24025657}}
* {{cite book |last1=Graham |first1=S. Scott |title=The Politics of Pain Medicine: A Rhetorical-Ontological Inquiry |date=2015 |publisher=University of Chicago Press |isbn=978-0-226-26405-9 }}
* {{Cite book |title=Innovation in pain management: the transcript of a witness seminar held by the Wellcome Trust Centre for the History of Medicine at UCL, London, on 12 December 2002 |vauthors=Reynolds LA, Tansey EM |author-link2=Tilli Tansey |date=2004 |publisher=Wellcome Trust Centre for the History of Medicine at UCL |isbn=978-0-85484-097-7}} <!-- {{cite Q|Q29581683}} -->
* {{cite book |last1=Wailoo |first1=Keith |title=Pain: A Political History |date=2014 |publisher=JHU Press |id={{Project MUSE|30085|type=book}} |isbn=978-1-4214-1365-5 }}
{{refend}}

==External links==
{{Commons category}}
* [https://web.archive.org/web/20130327044726/http://www.who.int/medicines/areas/quality_safety/guide_on_pain/en/ World Health Organization (WHO) Treatment Guidelines on Pain]

{{Pain}}
{{medicine}}
{{Authority control}}

{{DEFAULTSORT:Pain Management}}
[[Category:Pain management| ]]
[[Category:Acute pain]]
[[Category:Palliative care]]