{"id":300,"date":"2021-03-22T17:08:26","date_gmt":"2021-03-22T17:08:26","guid":{"rendered":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/?post_type=chapter&#038;p=300"},"modified":"2021-03-22T17:08:26","modified_gmt":"2021-03-22T17:08:26","slug":"pain-management","status":"publish","type":"chapter","link":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/chapter\/pain-management\/","title":{"raw":"Pain management","rendered":"Pain management"},"content":{"raw":"<b>Pain management<\/b>,\u00a0<b>pain killer<\/b>,\u00a0<b>pain medicine<\/b>,\u00a0<b>pain control<\/b>\u00a0or\u00a0<b>algiatry<\/b>, is a branch of\u00a0<a title=\"Medicine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Medicine\">medicine<\/a>\u00a0that uses an interdisciplinary approach for easing the suffering and improving the\u00a0<a title=\"Quality of life\" href=\"https:\/\/en.wikipedia.org\/wiki\/Quality_of_life\">quality of life<\/a>\u00a0of those living with\u00a0<a title=\"Chronic pain\" href=\"https:\/\/en.wikipedia.org\/wiki\/Chronic_pain\">chronic pain<\/a>.<sup id=\"cite_ref-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-1\">[1]<\/a><\/sup>\u00a0The typical pain management team includes\u00a0<a class=\"mw-redirect\" title=\"Medical practitioner\" href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_practitioner\">medical practitioners<\/a>,\u00a0<a title=\"Pharmacist\" href=\"https:\/\/en.wikipedia.org\/wiki\/Pharmacist\">pharmacists<\/a>,\u00a0<a class=\"mw-redirect\" title=\"Clinical psychologist\" href=\"https:\/\/en.wikipedia.org\/wiki\/Clinical_psychologist\">clinical psychologists<\/a>,\u00a0<a class=\"mw-redirect\" title=\"Physiotherapist\" href=\"https:\/\/en.wikipedia.org\/wiki\/Physiotherapist\">physiotherapists<\/a>,\u00a0<a title=\"Occupational therapist\" href=\"https:\/\/en.wikipedia.org\/wiki\/Occupational_therapist\">occupational therapists<\/a>,\u00a0<a class=\"mw-redirect\" title=\"Physician assistants\" href=\"https:\/\/en.wikipedia.org\/wiki\/Physician_assistants\">physician assistants<\/a>,\u00a0<a class=\"mw-redirect\" title=\"Nurse\" href=\"https:\/\/en.wikipedia.org\/wiki\/Nurse\">nurses<\/a>, and\u00a0<a title=\"Dentist\" href=\"https:\/\/en.wikipedia.org\/wiki\/Dentist\">dentists<\/a>.<sup id=\"cite_ref-2\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-2\">[2]<\/a><\/sup>\u00a0The team may also include other\u00a0<a title=\"Mental health\" href=\"https:\/\/en.wikipedia.org\/wiki\/Mental_health\">mental health<\/a>\u00a0specialists and\u00a0<a class=\"mw-redirect\" title=\"Massage therapist\" href=\"https:\/\/en.wikipedia.org\/wiki\/Massage_therapist\">massage therapists<\/a>. Pain sometimes resolves quickly once the underlying\u00a0<a class=\"mw-redirect\" title=\"Trauma (medicine)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Trauma_(medicine)\">trauma<\/a>\u00a0or\u00a0<a title=\"Pathology\" href=\"https:\/\/en.wikipedia.org\/wiki\/Pathology\">pathology<\/a>\u00a0has healed, and is treated by one practitioner, with drugs such as\u00a0<a title=\"Analgesic\" href=\"https:\/\/en.wikipedia.org\/wiki\/Analgesic\">analgesics<\/a>\u00a0and (occasionally)\u00a0<a class=\"mw-redirect\" title=\"Anxiolytics\" href=\"https:\/\/en.wikipedia.org\/wiki\/Anxiolytics\">anxiolytics<\/a>. Effective management of\u00a0<a title=\"Chronic pain\" href=\"https:\/\/en.wikipedia.org\/wiki\/Chronic_pain\">chronic (long-term) pain<\/a>, however, frequently requires the coordinated efforts of the pain management team.<sup id=\"cite_ref-3\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-3\">[3]<\/a><\/sup>\u00a0Effective pain management does not mean total eradication of all pain.\r\n\r\nMedicine treats\u00a0<a title=\"Injury\" href=\"https:\/\/en.wikipedia.org\/wiki\/Injury\">injuries<\/a>\u00a0and diseases to support and speed healing. It treats distressing symptoms such as pain to relieve\u00a0<a title=\"Suffering\" href=\"https:\/\/en.wikipedia.org\/wiki\/Suffering\">suffering<\/a>\u00a0during treatment, healing, and\u00a0<a class=\"mw-redirect\" title=\"Dying\" href=\"https:\/\/en.wikipedia.org\/wiki\/Dying\">dying<\/a>. The task of medicine is to relieve suffering under three circumstances. The first being 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\u00a0<a title=\"Pharmacology\" href=\"https:\/\/en.wikipedia.org\/wiki\/Pharmacology\">pharmacological<\/a>\u00a0measures, such as\u00a0<a class=\"mw-redirect\" title=\"Analgesics\" href=\"https:\/\/en.wikipedia.org\/wiki\/Analgesics\">analgesics<\/a>,\u00a0<a title=\"Antidepressant\" href=\"https:\/\/en.wikipedia.org\/wiki\/Antidepressant\">antidepressants<\/a>\u00a0and\u00a0<a title=\"Anticonvulsant\" href=\"https:\/\/en.wikipedia.org\/wiki\/Anticonvulsant\">anticonvulsants<\/a>, interventional procedures, physical therapy,\u00a0<a class=\"mw-redirect\" title=\"Physical exercise\" href=\"https:\/\/en.wikipedia.org\/wiki\/Physical_exercise\">physical exercise<\/a>, application of ice or heat, and\u00a0<a class=\"mw-redirect\" title=\"Psychological\" href=\"https:\/\/en.wikipedia.org\/wiki\/Psychological\">psychological<\/a>\u00a0measures, such as\u00a0<a title=\"Biofeedback\" href=\"https:\/\/en.wikipedia.org\/wiki\/Biofeedback\">biofeedback<\/a>\u00a0and\u00a0<a title=\"Cognitive behavioral therapy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Cognitive_behavioral_therapy\">cognitive behavioral therapy<\/a>.\r\n<h2><span id=\"Defining_pain\" class=\"mw-headline\">Defining pain<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Defining pain\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=1\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h2>\r\nIn 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\".<sup id=\"cite_ref-4\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-4\">[4]<\/a><\/sup>\r\n\r\nPain management includes patient communication about the pain problem.<sup id=\"cite_ref-Consumer_Reports_pain_relief_April_2016_5-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Consumer_Reports_pain_relief_April_2016-5\">[5]<\/a><\/sup>\u00a0To define the pain problem, a health care provider will likely ask questions such as:<sup id=\"cite_ref-Consumer_Reports_pain_relief_April_2016_5-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Consumer_Reports_pain_relief_April_2016-5\">[5]<\/a><\/sup>\r\n<ul>\r\n \t<li>How intense is the pain?<\/li>\r\n \t<li>How does the pain feel?<\/li>\r\n \t<li>Where is the pain?<\/li>\r\n \t<li>What, if anything, makes the pain lessen?<\/li>\r\n \t<li>What, if anything, makes the pain increase?<\/li>\r\n \t<li>When did the pain start?<\/li>\r\n<\/ul>\r\nAfter asking such questions, the health care provider will have a description of the pain.<sup id=\"cite_ref-Consumer_Reports_pain_relief_April_2016_5-2\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Consumer_Reports_pain_relief_April_2016-5\">[5]<\/a><\/sup>\u00a0Pain management will then be used to address that pain.<sup id=\"cite_ref-Consumer_Reports_pain_relief_April_2016_5-3\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Consumer_Reports_pain_relief_April_2016-5\">[5]<\/a><\/sup>\r\n<h2><span id=\"Adverse_effects\" class=\"mw-headline\">Adverse effects<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Adverse effects\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=2\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h2>\r\nThere are many types of pain management. Each have their own benefits, drawbacks, and limits.<sup id=\"cite_ref-Consumer_Reports_pain_relief_April_2016_5-4\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Consumer_Reports_pain_relief_April_2016-5\">[5]<\/a><\/sup>\r\n\r\nA common challenge in pain management is communication between the health care provider and the person experiencing pain.<sup id=\"cite_ref-Consumer_Reports_pain_relief_April_2016_5-5\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Consumer_Reports_pain_relief_April_2016-5\">[5]<\/a><\/sup>\u00a0People experiencing pain may have difficulty recognizing or describing what they feel and how intense it is.<sup id=\"cite_ref-Consumer_Reports_pain_relief_April_2016_5-6\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Consumer_Reports_pain_relief_April_2016-5\">[5]<\/a><\/sup>\u00a0Health care providers and patients may have difficulty communicating with each other about how pain responds to treatments.<sup id=\"cite_ref-Consumer_Reports_pain_relief_April_2016_5-7\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Consumer_Reports_pain_relief_April_2016-5\">[5]<\/a><\/sup>\u00a0There 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.<sup id=\"cite_ref-Consumer_Reports_pain_relief_April_2016_5-8\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Consumer_Reports_pain_relief_April_2016-5\">[5]<\/a><\/sup>\u00a0Some treatments for pain can be harmful if overused.<sup id=\"cite_ref-Consumer_Reports_pain_relief_April_2016_5-9\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Consumer_Reports_pain_relief_April_2016-5\">[5]<\/a><\/sup>\u00a0A 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.<sup id=\"cite_ref-Consumer_Reports_pain_relief_April_2016_5-10\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Consumer_Reports_pain_relief_April_2016-5\">[5]<\/a><\/sup>\r\n\r\nAnother problem with pain management is that pain is the body's natural way of communicating a problem.<sup id=\"cite_ref-Consumer_Reports_pain_relief_April_2016_5-11\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Consumer_Reports_pain_relief_April_2016-5\">[5]<\/a><\/sup>\u00a0Pain is supposed to resolve as the body heals itself with time and pain management.<sup id=\"cite_ref-Consumer_Reports_pain_relief_April_2016_5-12\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Consumer_Reports_pain_relief_April_2016-5\">[5]<\/a><\/sup>\u00a0Sometimes pain management covers a problem, and the patient might be less aware that they need treatment for a deeper problem.<sup id=\"cite_ref-Consumer_Reports_pain_relief_April_2016_5-13\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Consumer_Reports_pain_relief_April_2016-5\">[5]<\/a><\/sup>\r\n<h2><span id=\"Physical_approach\" class=\"mw-headline\">Physical approach<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Physical approach\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=3\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h2>\r\n<h3><span id=\"Physical_medicine_and_rehabilitation\" class=\"mw-headline\">Physical medicine and rehabilitation<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Physical medicine and rehabilitation\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=4\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\r\n<a title=\"Physical medicine and rehabilitation\" href=\"https:\/\/en.wikipedia.org\/wiki\/Physical_medicine_and_rehabilitation\">Physical medicine and rehabilitation<\/a>\u00a0uses a range of physical techniques such as heat and\u00a0<a title=\"Electrotherapy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Electrotherapy\">electrotherapy<\/a>, as well as therapeutic exercises and behavioral therapy. These techniques are usually part of an interdisciplinary or multidisciplinary program that might also include pharmaceutical medicines.<sup id=\"cite_ref-Geertzen_JH,_Van_Wilgen_CP._6-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Geertzen_JH,_Van_Wilgen_CP.-6\">[6]<\/a><\/sup>\u00a0Spa therapy has showed positive effects in reducing pain among patients with chronic low back pain. However there are limited studies looking at this approach.<sup id=\"cite_ref-7\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-7\">[7]<\/a><\/sup>\u00a0Studies have shown that\u00a0<a title=\"Elastic therapeutic tape\" href=\"https:\/\/en.wikipedia.org\/wiki\/Elastic_therapeutic_tape\">kinesiotape<\/a>\u00a0could be used on individuals with chronic low back pain to reduce pain.<sup id=\"cite_ref-8\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-8\">[8]<\/a><\/sup>\u00a0The Center for Disease Control recommends that physical therapy and exercise can be prescribed as a positive alternative to\u00a0<a title=\"Opioid\" href=\"https:\/\/en.wikipedia.org\/wiki\/Opioid\">opioids<\/a>\u00a0for decreasing one's pain in multiple injuries, illnesses, or diseases.<sup id=\"cite_ref-:0_9-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:0-9\">[9]<\/a><\/sup>\u00a0This can include chronic low back pain, osteoarthritis of the hip and knee, or fibromyalgia.<sup id=\"cite_ref-:0_9-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:0-9\">[9]<\/a><\/sup>\u00a0Exercise alone or with other rehabilitation disciplines (such as psychologically based approaches) can have a positive effect on reducing pain.<sup id=\"cite_ref-:0_9-2\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:0-9\">[9]<\/a><\/sup>\u00a0In addition to improving pain, exercise also can improve one's well-being and general health.<sup id=\"cite_ref-:0_9-3\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:0-9\">[9]<\/a><\/sup>\r\n\r\n<a title=\"Manual therapy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Manual_therapy\">Manipulative<\/a>\u00a0and\u00a0<a title=\"Joint mobilization\" href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_mobilization\">mobilization<\/a>\u00a0therapy are safe interventions that likely reduce pain for patients with chronic low back pain. However, manipulation produces a larger effect than mobilization.<sup id=\"cite_ref-10\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-10\">[10]<\/a><\/sup>\r\n\r\nSpecifically 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.<sup id=\"cite_ref-11\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-11\">[11]<\/a><\/sup>\r\n<h3><span id=\"Exercise_interventions\" class=\"mw-headline\">Exercise interventions<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Exercise interventions\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=5\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\r\nPhysical 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.<sup id=\"cite_ref-:1_12-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:1-12\">[12]<\/a><\/sup>\u00a0Physical activity and exercise may improve chronic pain (pain lasting more than 12 weeks),<sup id=\"cite_ref-13\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-13\">[13]<\/a><\/sup>\u00a0and overall quality of life, while minimizing the need for pain medications.<sup id=\"cite_ref-:1_12-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:1-12\">[12]<\/a><\/sup>\u00a0More specifically, walking has been effective in improving pain management in chronic low back pain.<sup id=\"cite_ref-14\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-14\">[14]<\/a><\/sup>\r\n<h3><span id=\"TENS\" class=\"mw-headline\">TENS<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: TENS\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=6\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\r\nTranscutaneous electrical nerve stimulation (TENS) is a self-operated portable device intended to help regulate and create chronic pain via electrical impulses.<sup id=\"cite_ref-:23_15-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:23-15\">[15]<\/a><\/sup>\u00a0Limited 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 disruption of nerve conduction velocity and efficiency.<sup id=\"cite_ref-:23_15-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:23-15\">[15]<\/a><\/sup>\u00a0In one study, electrodes were placed over the lumbar spins and participants received treatment twice a day and at any time when they experienced a painful episode.<sup id=\"cite_ref-:23_15-2\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:23-15\">[15]<\/a><\/sup>\u00a0This study found that TENS would be beneficial to MS patients who reported localized or limited symptoms to one limp.<sup id=\"cite_ref-:23_15-3\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:23-15\">[15]<\/a><\/sup>\u00a0The research is mixed with whether or not TENS helps manage pain in MS patients.\r\n\r\n<a title=\"Transcutaneous electrical nerve stimulation\" href=\"https:\/\/en.wikipedia.org\/wiki\/Transcutaneous_electrical_nerve_stimulation\">Transcutaneous electrical nerve stimulation<\/a>\u00a0has been found to be ineffective for\u00a0<a class=\"mw-redirect\" title=\"Lower back pain\" href=\"https:\/\/en.wikipedia.org\/wiki\/Lower_back_pain\">lower back pain<\/a>. However, it might help with\u00a0<a title=\"Diabetic neuropathy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Diabetic_neuropathy\">diabetic neuropathy<\/a><sup id=\"cite_ref-pmid20042705_16-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-pmid20042705-16\">[16]<\/a><\/sup>\u00a0as well as other illnesses.\r\n<h4><span id=\"tDCS\" class=\"mw-headline\">tDCS<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: tDCS\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=7\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h4>\r\nTranscranial 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 mA) constant direct current to the scalp through electrodes in order to modulate excitability of large cortical areas.<sup id=\"cite_ref-:12_17-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:12-17\">[17]<\/a><\/sup>\u00a0tDCS may have a role in pain assessment by contributing to efforts in distinguishing between somatic and affective aspects of pain experience.<sup id=\"cite_ref-:12_17-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:12-17\">[17]<\/a><\/sup>\u00a0Zaghi 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.<sup id=\"cite_ref-:12_17-2\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:12-17\">[17]<\/a><\/sup>\u00a0Although there is a greater need for research examining the mechanism of electrical stimulation in relation to pain treatment, one theory suggests that the changes in thalamic activity may be due the influence of motor cortex stimulation on the decrease in pain sensations.<sup id=\"cite_ref-:12_17-3\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:12-17\">[17]<\/a><\/sup>\r\n\r\nIn relation to MS, a study found that after daily tDCS sessions resulted in an individual's subjective report of pain to decrease when compared to a sham condition.<sup id=\"cite_ref-:24_18-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:24-18\">[18]<\/a><\/sup>\u00a0In addition, the study found a similar improvement at 1 to 3 days before and after each tDCS session.<sup id=\"cite_ref-:24_18-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:24-18\">[18]<\/a><\/sup>\r\n\r\nFibromyalgia is a disorder in which an individual experiences dysfunctional brain activity, musculoskeletal pain, fatigue, and tenderness in localized areas.<sup id=\"cite_ref-:32_19-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:32-19\">[19]<\/a><\/sup>\u00a0Research examining tDCS for pain treatment in Fibromyalgia has found initial evidence for pain decreases.<sup id=\"cite_ref-:32_19-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:32-19\">[19]<\/a><\/sup>\u00a0Specifically, 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).<sup id=\"cite_ref-:32_19-2\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:32-19\">[19]<\/a><\/sup>\u00a0However, this effect decreased after treatment ended, but remained significant for three weeks following the extinction of treatment.<sup id=\"cite_ref-:32_19-3\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:32-19\">[19]<\/a><\/sup>\r\n<h3><span id=\"Acupuncture\" class=\"mw-headline\">Acupuncture<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Acupuncture\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=8\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\r\n<a title=\"Acupuncture\" href=\"https:\/\/en.wikipedia.org\/wiki\/Acupuncture\">Acupuncture<\/a>\u00a0involves 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\u00a0<i><a class=\"mw-redirect\" title=\"British Medical Journal\" href=\"https:\/\/en.wikipedia.org\/wiki\/British_Medical_Journal\">British Medical Journal<\/a><\/i>, was unable to quantify the difference in the effect on pain of real,\u00a0<a title=\"Sham surgery\" href=\"https:\/\/en.wikipedia.org\/wiki\/Sham_surgery\">sham<\/a>\u00a0and no acupuncture.<sup id=\"cite_ref-20\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-20\">[20]<\/a><\/sup>\u00a0A 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.<sup id=\"cite_ref-21\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-21\">[21]<\/a><\/sup>\r\n<h3><span id=\"Light_therapy\" class=\"mw-headline\">Light therapy<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Light therapy\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=9\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\r\nResearch has not found evidence that\u00a0<a title=\"Light therapy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Light_therapy\">light therapy<\/a>\u00a0such as\u00a0<a class=\"mw-redirect\" title=\"Low level laser therapy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Low_level_laser_therapy\">low level laser therapy<\/a>\u00a0is an effective therapy for relieving\u00a0<a title=\"Low back pain\" href=\"https:\/\/en.wikipedia.org\/wiki\/Low_back_pain\">low back pain<\/a>.<sup id=\"cite_ref-Chou_22-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Chou-22\">[22]<\/a><\/sup><sup id=\"cite_ref-23\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-23\">[23]<\/a><\/sup>\r\n<h3><span id=\"Interventional_procedures\" class=\"mw-headline\">Interventional procedures<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Interventional procedures\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=10\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\r\n<div class=\"hatnote navigation-not-searchable\" role=\"note\">Main article:\u00a0<a title=\"Interventional pain management\" href=\"https:\/\/en.wikipedia.org\/wiki\/Interventional_pain_management\">Interventional pain management<\/a><\/div>\r\nInterventional procedures - typically used for\u00a0<a title=\"Back pain\" href=\"https:\/\/en.wikipedia.org\/wiki\/Back_pain\">chronic back pain<\/a>\u00a0- include\u00a0<a class=\"mw-redirect\" title=\"Epidural\" href=\"https:\/\/en.wikipedia.org\/wiki\/Epidural\">epidural steroid injections<\/a>,\u00a0<a title=\"Facet joint injection\" href=\"https:\/\/en.wikipedia.org\/wiki\/Facet_joint_injection\">facet joint injections<\/a>,\u00a0<a title=\"Cordotomy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Cordotomy\">neurolytic blocks<\/a>,\u00a0<a title=\"Spinal cord stimulator\" href=\"https:\/\/en.wikipedia.org\/wiki\/Spinal_cord_stimulator\">spinal cord stimulators<\/a>\u00a0and\u00a0<a class=\"mw-redirect\" title=\"Intrathecal\" href=\"https:\/\/en.wikipedia.org\/wiki\/Intrathecal\">intrathecal<\/a>\u00a0drug delivery system implants.\r\n\r\n<a title=\"Pulsed radiofrequency\" href=\"https:\/\/en.wikipedia.org\/wiki\/Pulsed_radiofrequency\">Pulsed radiofrequency<\/a>,\u00a0<a title=\"Neuromodulation (medicine)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Neuromodulation_(medicine)\">neuromodulation<\/a>, direct introduction of medication and nerve\u00a0<a title=\"Ablation\" href=\"https:\/\/en.wikipedia.org\/wiki\/Ablation\">ablation<\/a>\u00a0may be used to target either the tissue structures and organ\/systems responsible for persistent\u00a0<a title=\"Nociception\" href=\"https:\/\/en.wikipedia.org\/wiki\/Nociception\">nociception<\/a>\u00a0or the\u00a0<a title=\"Nociceptor\" href=\"https:\/\/en.wikipedia.org\/wiki\/Nociceptor\">nociceptors<\/a>\u00a0from the structures implicated as the source of chronic pain.<sup id=\"cite_ref-Varrassi_G,_Paladini_A_24-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Varrassi_G,_Paladini_A-24\">[24]<\/a><\/sup><sup id=\"cite_ref-Meglio_M._25-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Meglio_M.-25\">[25]<\/a><\/sup><sup id=\"cite_ref-26\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-26\">[26]<\/a><\/sup><sup id=\"cite_ref-Boswell_MV,_Trescott_AM_27-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Boswell_MV,_Trescott_AM-27\">[27]<\/a><\/sup><sup id=\"cite_ref-Romanelli_P,_Esposito_V_28-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Romanelli_P,_Esposito_V-28\">[28]<\/a><\/sup>\u00a0Radiofrequency treatment has been seen to improve pain in patients for facet joint low back pain. However, continuous radiofrequency is more effective in managing pain than pulsed radiofrequency.<sup id=\"cite_ref-29\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-29\">[29]<\/a><\/sup>\r\n\r\nAn\u00a0<a title=\"Intrathecal pump\" href=\"https:\/\/en.wikipedia.org\/wiki\/Intrathecal_pump\">intrathecal pump<\/a>\u00a0used to deliver very small quantities of medications directly to the spinal fluid. This is similar to epidural infusions used in\u00a0<a title=\"Childbirth\" href=\"https:\/\/en.wikipedia.org\/wiki\/Childbirth\">labour<\/a>\u00a0and 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.<sup class=\"noprint Inline-Template Template-Fact\">[<i><a title=\"Wikipedia:Identifying reliable sources (medicine)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Identifying_reliable_sources_(medicine)\"><span title=\"Material near this tag needs references to reliable medical sources. (November 2018)\">medical citation needed<\/span><\/a><\/i>]<\/sup>\r\n\r\nA\u00a0<a title=\"Spinal cord stimulator\" href=\"https:\/\/en.wikipedia.org\/wiki\/Spinal_cord_stimulator\">spinal cord stimulator<\/a>\u00a0is an implantable medical device that creates electric impulses and applies them near the dorsal surface of the spinal cord provides a\u00a0<a title=\"Paresthesia\" href=\"https:\/\/en.wikipedia.org\/wiki\/Paresthesia\">paresthesia<\/a>\u00a0(\"tingling\") sensation that alters the perception of pain by the patient.<sup class=\"noprint Inline-Template Template-Fact\">[<i><a title=\"Wikipedia:Identifying reliable sources (medicine)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Identifying_reliable_sources_(medicine)\"><span title=\"Material near this tag needs references to reliable medical sources. (November 2018)\">medical citation needed<\/span><\/a><\/i>]<\/sup>\r\n<h3><span id=\"Intra-articular_ozone_therapy\" class=\"mw-headline\">Intra-articular ozone therapy<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Intra-articular ozone therapy\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=11\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\r\nIntra-articular ozone therapy has been seen to efficiently alleviate chronic pain in patients with knee osteoarthritis.<sup id=\"cite_ref-30\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-30\">[30]<\/a><\/sup>\r\n<h2><span id=\"Psychological_approach\" class=\"mw-headline\">Psychological approach<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Psychological approach\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=12\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h2>\r\n<h3><span id=\"Acceptance_and_Commitment_Therapy\" class=\"mw-headline\">Acceptance and Commitment Therapy<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Acceptance and Commitment Therapy\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=13\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\r\nAcceptance and Commitment Therapy (ACT) is a form of cognitive behavioral therapy that focuses on behavior change rather than symptom change, includes methods designed to alter the context around psychological experiences rather than to alter the makeup of the experiences, and emphasizes the use of experiential behavior change methods.<sup id=\"cite_ref-:02_31-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:02-31\">[31]<\/a><\/sup>\u00a0The central process in ACT revolves around psychological flexibility, which in turn includes processes of acceptance, awareness, a present-oriented quality in interacting with experiences, an ability to persist or change behavior, and an ability to be guided by one's values.<sup id=\"cite_ref-:02_31-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:02-31\">[31]<\/a><\/sup>\u00a0ACT has an increased evidence base for range of health and behavior problems, including chronic pain.<sup id=\"cite_ref-:02_31-2\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:02-31\">[31]<\/a><\/sup>\u00a0ACT influences patients to adopt a tandem process to acceptance and change, which allows for a greater flexibility in the focus of treatment.<sup id=\"cite_ref-:02_31-3\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:02-31\">[31]<\/a><\/sup>\r\n\r\nRecent research has applied ACT successfully to chronic pain in older adults due to in part of its direction from individual values and being highly customizable to any stage of life.<sup id=\"cite_ref-:02_31-4\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:02-31\">[31]<\/a><\/sup>\u00a0In 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.<sup id=\"cite_ref-:02_31-5\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:02-31\">[31]<\/a><\/sup>\u00a0In 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.<sup id=\"cite_ref-:02_31-6\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:02-31\">[31]<\/a><\/sup>\r\n<h3><span id=\"Cognitive_behavioral_therapy\" class=\"mw-headline\">Cognitive behavioral therapy<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Cognitive behavioral therapy\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=14\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\r\n<a title=\"Cognitive behavioral therapy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Cognitive_behavioral_therapy\">Cognitive behavioral therapy<\/a>\u00a0(CBT) helps patients with pain to understand the relationship between their pain, thoughts, emotions, and behaviors. A main goal in treatment is cognitive (thinking, reasoning or remembering) restructuring to encourage helpful thought patterns.<sup id=\"cite_ref-32\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-32\">[32]<\/a><\/sup>\u00a0This 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).\r\n\r\nStudies have demonstrated the usefulness of cognitive behavioral therapy in the management of chronic low back pain, producing significant decreases in physical and psychosocial disability.<sup id=\"cite_ref-33\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-33\">[33]<\/a><\/sup>\u00a0CBT 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.<sup class=\"noprint Inline-Template Template-Fact\">[<i><a title=\"Wikipedia:Citation needed\" href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\"><span title=\"This claim needs references to reliable sources. (June 2020)\">citation needed<\/span><\/a><\/i>]<\/sup>\u00a0The 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\u00a0<a title=\"Systematic review\" href=\"https:\/\/en.wikipedia.org\/wiki\/Systematic_review\">systematic review<\/a>\u00a0and\u00a0<a title=\"Meta-analysis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Meta-analysis\">meta-analysis<\/a>\u00a0within the field very difficult.<sup id=\"cite_ref-Eccleston1_34-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Eccleston1-34\">[34]<\/a><\/sup>\r\n\r\nIn 2020, a\u00a0<a title=\"Systematic review\" href=\"https:\/\/en.wikipedia.org\/wiki\/Systematic_review\">systematic review<\/a>\u00a0of\u00a0<a title=\"Randomized controlled trial\" href=\"https:\/\/en.wikipedia.org\/wiki\/Randomized_controlled_trial\">randomized controlled trials<\/a>\u00a0(RCTs) evaluated the clinical effectiveness of psychological therapies for the management of adult chronic pain (excluding headaches). There is no evidence that\u00a0<a title=\"Behaviour therapy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Behaviour_therapy\">behaviour therapy<\/a>\u00a0(BT) is effective for reducing this type of pain, however BT may be useful for improving a persons mood immediately after treatment. This improvement appears to be small, and is short term in duration.<sup id=\"cite_ref-:7_35-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:7-35\">[35]<\/a><\/sup>\u00a0CBT may have a small positive short-term effect on pain immediately following treatment. CBT may also have a small effect on reducing\u00a0<a title=\"Disability\" href=\"https:\/\/en.wikipedia.org\/wiki\/Disability\">disability<\/a>\u00a0and potential\u00a0<a title=\"Pain catastrophizing\" href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_catastrophizing\">catastrophizing<\/a>\u00a0that may be associated with adult chronic pain. These benefits do not appear to last very long following the therapy.<sup id=\"cite_ref-:7_35-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:7-35\">[35]<\/a><\/sup>\u00a0CBT may contribute towards improving the mood of an adult who experiences chronic pain, which could possibility be maintained for longer periods of time.<sup id=\"cite_ref-:7_35-2\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:7-35\">[35]<\/a><\/sup>\r\n\r\nFor 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.<sup id=\"cite_ref-36\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-36\">[36]<\/a><\/sup>\u00a0This beneficial effect may be maintained for at least three months following the therapy.<sup id=\"cite_ref-:3_37-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:3-37\">[37]<\/a><\/sup>\u00a0Psychological treatments may also improve pain control for children or adolescents who experience pain not related to headaches. It is not known if psychological therapy improves a child or adolescents mood and the potential for disability related to their chronic pain.<sup id=\"cite_ref-:3_37-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:3-37\">[37]<\/a><\/sup>\r\n<h3><span id=\"Hypnosis\" class=\"mw-headline\">Hypnosis<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Hypnosis\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=15\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\r\nA 2007 review of 13 studies found evidence for the efficacy of\u00a0<a title=\"Hypnosis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Hypnosis\">hypnosis<\/a>\u00a0in the reduction of pain in some conditions. However the studies had some limitations like small study sizes, bringing up 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.\"<sup id=\"cite_ref-Elkins2007_38-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Elkins2007-38\">[38]<\/a><\/sup><sup class=\"reference\">:283<\/sup>\r\n\r\nHypnosis has reduced the pain of some harmful medical procedures in children and adolescents.<sup id=\"cite_ref-Accardi_39-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Accardi-39\">[39]<\/a><\/sup>\u00a0In clinical trials addressing other patient groups, it has significantly reduced pain compared to no treatment or some other non-hypnotic interventions.<sup id=\"cite_ref-APA_40-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-APA-40\">[40]<\/a><\/sup>\u00a0The effects of self hypnosis on chronic pain are roughly comparable to those of progressive muscle relaxation.<sup id=\"cite_ref-Jensen_41-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Jensen-41\">[41]<\/a><\/sup>\r\n\r\nHypnosis with analgesic (painkiller) has been seen to relieve chronic pain for most people and may be a safe and effective alternative to medications. However, high quality clinical data is needed to generalize to the whole chronic pain population.<sup id=\"cite_ref-42\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-42\">[42]<\/a><\/sup>\r\n<h3><span id=\"Mindfulness_meditation\" class=\"mw-headline\">Mindfulness meditation<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Mindfulness meditation\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=16\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\r\nA 2013 meta-analysis of studies that used techniques centered around the concept of\u00a0<a class=\"mw-redirect\" title=\"Mindfulness (psychology)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Mindfulness_(psychology)\">mindfulness<\/a>, concluded, \"that MBIs [mindfulness-based interventions] decrease the intensity of pain for chronic pain patients.\"<sup id=\"cite_ref-43\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-43\">[43]<\/a><\/sup>\u00a0A 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.<sup id=\"cite_ref-44\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-44\">[44]<\/a><\/sup>\r\n<h3><span id=\"Mindfulness-based_pain_management\" class=\"mw-headline\">Mindfulness-based pain management<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Mindfulness-based pain management\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=17\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\r\n<a title=\"Mindfulness-based pain management\" href=\"https:\/\/en.wikipedia.org\/wiki\/Mindfulness-based_pain_management\">Mindfulness-based pain management<\/a>\u00a0(MBPM) is a mindfulness-based intervention (MBI) providing specific applications for people living with chronic pain and illness.<sup id=\"cite_ref-:5_45-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:5-45\">[45]<\/a><\/sup><sup id=\"cite_ref-:22_46-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:22-46\">[46]<\/a><\/sup>\u00a0Adapting the core concepts and practices of\u00a0<a title=\"Mindfulness-based stress reduction\" href=\"https:\/\/en.wikipedia.org\/wiki\/Mindfulness-based_stress_reduction\">mindfulness-based stress reduction<\/a>\u00a0(MBSR) and\u00a0<a title=\"Mindfulness-based cognitive therapy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Mindfulness-based_cognitive_therapy\">mindfulness-based cognitive therapy<\/a>\u00a0(MBCT), MBPM includes a distinctive emphasis on the practice of '<a title=\"Maitr\u012b\" href=\"https:\/\/en.wikipedia.org\/wiki\/Maitr%C4%AB\">loving-kindness<\/a>', and has been seen as sensitive to concerns about removing mindfulness teaching from its original ethical framework within\u00a0<a title=\"Buddhism\" href=\"https:\/\/en.wikipedia.org\/wiki\/Buddhism\">Buddhism<\/a>.<sup id=\"cite_ref-:5_45-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:5-45\">[45]<\/a><\/sup><sup id=\"cite_ref-:8_47-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:8-47\">[47]<\/a><\/sup>\u00a0It was developed by\u00a0<a title=\"Vidyamala Burch\" href=\"https:\/\/en.wikipedia.org\/wiki\/Vidyamala_Burch\">Vidyamala Burch<\/a>\u00a0and is delivered through the programs of\u00a0<a title=\"Breathworks\" href=\"https:\/\/en.wikipedia.org\/wiki\/Breathworks\">Breathworks<\/a>.<sup id=\"cite_ref-:5_45-2\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:5-45\">[45]<\/a><\/sup><sup id=\"cite_ref-:22_46-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:22-46\">[46]<\/a><\/sup>\u00a0It has been subject to a range of clinical studies demonstrating its effectiveness.<sup id=\"cite_ref-:6_48-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:6-48\">[48]<\/a><\/sup><sup id=\"cite_ref-:16_49-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:16-49\">[49]<\/a><\/sup><sup id=\"cite_ref-:17_50-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:17-50\">[50]<\/a><\/sup><sup id=\"cite_ref-:13_51-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:13-51\">[51]<\/a><\/sup><sup id=\"cite_ref-:14_52-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:14-52\">[52]<\/a><\/sup><sup id=\"cite_ref-:15_53-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:15-53\">[53]<\/a><\/sup><sup id=\"cite_ref-:42_54-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:42-54\">[54]<\/a><\/sup><sup id=\"cite_ref-:5_45-3\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:5-45\">[45]<\/a><\/sup>\r\n<h2><span id=\"Medications\" class=\"mw-headline\">Medications<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Medications\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=18\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h2>\r\nThe\u00a0<a title=\"World Health Organization\" href=\"https:\/\/en.wikipedia.org\/wiki\/World_Health_Organization\">World Health Organization<\/a>\u00a0(WHO) recommends a\u00a0<i><a title=\"Pain ladder\" href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_ladder\">pain ladder<\/a><\/i>\u00a0for managing pain relief with pharmaceutical medicine. It was first described for use in\u00a0<a title=\"Cancer pain\" href=\"https:\/\/en.wikipedia.org\/wiki\/Cancer_pain\">cancer pain<\/a>. However it can be used by medical professionals as a general principle when managing any type of pain.<sup id=\"cite_ref-55\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-55\">[55]<\/a><\/sup><sup id=\"cite_ref-HoMBRG_56-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-HoMBRG-56\">[56]<\/a><\/sup>\u00a0In 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.\r\n<table class=\"wikitable sortable jquery-tablesorter\">\r\n<thead>\r\n<tr>\r\n<th colspan=\"4\">Common types of pain and typical drug management<\/th>\r\n<\/tr>\r\n<tr>\r\n<th class=\"headerSort\" title=\"Sort ascending\" role=\"columnheader button\">Pain type<\/th>\r\n<th class=\"headerSort\" title=\"Sort ascending\" role=\"columnheader button\">typical initial drug treatment<\/th>\r\n<th class=\"headerSort\" title=\"Sort ascending\" role=\"columnheader button\">comments<\/th>\r\n<\/tr>\r\n<\/thead>\r\n<tbody>\r\n<tr>\r\n<td><a title=\"Headache\" href=\"https:\/\/en.wikipedia.org\/wiki\/Headache\">headache<\/a><\/td>\r\n<td>paracetamol\u00a0<a class=\"external autonumber\" href=\"http:\/\/aeknil.com\/\" rel=\"nofollow\">[1]<\/a>\/acetaminophen,\u00a0<a class=\"mw-redirect\" title=\"NSAIDs\" href=\"https:\/\/en.wikipedia.org\/wiki\/NSAIDs\">NSAIDs<\/a><sup id=\"cite_ref-BBDchronicpain_57-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\r\n<td>doctor consultation is appropriate if headaches are severe, persistent, accompanied by fever, vomiting, or speech or balance problems;<sup id=\"cite_ref-BBDchronicpain_57-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup>\u00a0self-medication should be limited to two weeks<sup id=\"cite_ref-BBDchronicpain_57-2\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\r\n<\/tr>\r\n<tr>\r\n<td><a title=\"Migraine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Migraine\">migraine<\/a><\/td>\r\n<td>paracetamol, NSAIDs<sup id=\"cite_ref-BBDchronicpain_57-3\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\r\n<td><a class=\"mw-redirect\" title=\"Triptans\" href=\"https:\/\/en.wikipedia.org\/wiki\/Triptans\">triptans<\/a>\u00a0are used when the others do not work, or when migraines are frequent or severe<sup id=\"cite_ref-BBDchronicpain_57-4\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\r\n<\/tr>\r\n<tr>\r\n<td><a class=\"mw-redirect\" title=\"Menstrual cramps\" href=\"https:\/\/en.wikipedia.org\/wiki\/Menstrual_cramps\">menstrual cramps<\/a><\/td>\r\n<td>NSAIDs<sup id=\"cite_ref-BBDchronicpain_57-5\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\r\n<td>some NSAIDs are marketed for cramps, but any NSAID would work<sup id=\"cite_ref-BBDchronicpain_57-6\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\r\n<\/tr>\r\n<tr>\r\n<td>minor trauma, such as a\u00a0<a title=\"Bruise\" href=\"https:\/\/en.wikipedia.org\/wiki\/Bruise\">bruise<\/a>,\u00a0<a title=\"Abrasion (medical)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Abrasion_(medical)\">abrasions<\/a>,\u00a0<a title=\"Sprain\" href=\"https:\/\/en.wikipedia.org\/wiki\/Sprain\">sprain<\/a><\/td>\r\n<td>paracetamol, NSAIDs<sup id=\"cite_ref-BBDchronicpain_57-7\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\r\n<td>opioids not recommended<sup id=\"cite_ref-BBDchronicpain_57-8\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\r\n<\/tr>\r\n<tr>\r\n<td>severe trauma, such as a\u00a0<a title=\"Wound\" href=\"https:\/\/en.wikipedia.org\/wiki\/Wound\">wound<\/a>,\u00a0<a title=\"Burn\" href=\"https:\/\/en.wikipedia.org\/wiki\/Burn\">burn<\/a>,\u00a0<a title=\"Bone fracture\" href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_fracture\">bone fracture<\/a>, or severe sprain<\/td>\r\n<td>opioids<sup id=\"cite_ref-BBDchronicpain_57-9\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\r\n<td>more than two weeks of pain requiring opioid treatment is unusual<sup id=\"cite_ref-BBDchronicpain_57-10\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\r\n<\/tr>\r\n<tr>\r\n<td><a title=\"Strain (injury)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Strain_(injury)\">strain<\/a>\u00a0or pulled muscle<\/td>\r\n<td>NSAIDs, muscle relaxants<sup id=\"cite_ref-BBDchronicpain_57-11\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\r\n<td>if inflammation is involved, NSAIDs may work better; short-term use only<sup id=\"cite_ref-BBDchronicpain_57-12\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\r\n<\/tr>\r\n<tr>\r\n<td>minor pain after surgery<\/td>\r\n<td>paracetamol, NSAIDs<sup id=\"cite_ref-BBDchronicpain_57-13\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\r\n<td>opioids rarely needed<sup id=\"cite_ref-BBDchronicpain_57-14\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\r\n<\/tr>\r\n<tr>\r\n<td>severe pain after surgery<\/td>\r\n<td>opioids<sup id=\"cite_ref-BBDchronicpain_57-15\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\r\n<td>combinations of opioids may be prescribed if pain is severe<sup id=\"cite_ref-BBDchronicpain_57-16\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\r\n<\/tr>\r\n<tr>\r\n<td><a class=\"mw-redirect\" title=\"Muscle ache\" href=\"https:\/\/en.wikipedia.org\/wiki\/Muscle_ache\">muscle ache<\/a><\/td>\r\n<td>paracetamol, NSAIDs<sup id=\"cite_ref-BBDchronicpain_57-17\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\r\n<td>if inflammation involved, NSAIDs may work better.<sup id=\"cite_ref-BBDchronicpain_57-18\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\r\n<\/tr>\r\n<tr>\r\n<td><a title=\"Toothache\" href=\"https:\/\/en.wikipedia.org\/wiki\/Toothache\">toothache<\/a>\u00a0or pain from dental procedures<\/td>\r\n<td>paracetamol, NSAIDs<sup id=\"cite_ref-BBDchronicpain_57-19\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\r\n<td>this should be short term use; opioids may be necessary for severe pain<sup id=\"cite_ref-BBDchronicpain_57-20\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\r\n<\/tr>\r\n<tr>\r\n<td><a class=\"mw-redirect\" title=\"Kidney stone\" href=\"https:\/\/en.wikipedia.org\/wiki\/Kidney_stone\">kidney stone<\/a>\u00a0pain<\/td>\r\n<td>paracetamol, NSAIDs, opioids<sup id=\"cite_ref-BBDchronicpain_57-21\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\r\n<td>opioids usually needed if pain is severe.<sup id=\"cite_ref-BBDchronicpain_57-22\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\r\n<\/tr>\r\n<tr>\r\n<td>pain due to\u00a0<a title=\"Heartburn\" href=\"https:\/\/en.wikipedia.org\/wiki\/Heartburn\">heartburn<\/a>\u00a0or\u00a0<a title=\"Gastroesophageal reflux disease\" href=\"https:\/\/en.wikipedia.org\/wiki\/Gastroesophageal_reflux_disease\">gastroesophageal reflux disease<\/a><\/td>\r\n<td><a title=\"Antacid\" href=\"https:\/\/en.wikipedia.org\/wiki\/Antacid\">antacid<\/a>,\u00a0<a title=\"H2 antagonist\" href=\"https:\/\/en.wikipedia.org\/wiki\/H2_antagonist\">H2 antagonist<\/a>,\u00a0<a title=\"Proton-pump inhibitor\" href=\"https:\/\/en.wikipedia.org\/wiki\/Proton-pump_inhibitor\">proton-pump inhibitor<\/a><sup id=\"cite_ref-BBDchronicpain_57-23\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\r\n<td>heartburn lasting more than a week requires medical attention; aspirin and NSAIDs should be avoided<sup id=\"cite_ref-BBDchronicpain_57-24\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\r\n<\/tr>\r\n<tr>\r\n<td>chronic back pain<\/td>\r\n<td>paracetamol, NSAIDs<sup id=\"cite_ref-BBDchronicpain_57-25\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\r\n<td>opioids may be necessary if other drugs do not control pain and pain is persistent<sup id=\"cite_ref-BBDchronicpain_57-26\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\r\n<\/tr>\r\n<tr>\r\n<td><a title=\"Osteoarthritis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Osteoarthritis\">osteoarthritis<\/a>\u00a0pain<\/td>\r\n<td>paracetamol, NSAIDs<sup id=\"cite_ref-BBDchronicpain_57-27\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\r\n<td>medical attention is recommended if pain persists.<sup id=\"cite_ref-BBDchronicpain_57-28\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\r\n<\/tr>\r\n<tr>\r\n<td><a title=\"Fibromyalgia\" href=\"https:\/\/en.wikipedia.org\/wiki\/Fibromyalgia\">fibromyalgia<\/a><\/td>\r\n<td><a title=\"Antidepressant\" href=\"https:\/\/en.wikipedia.org\/wiki\/Antidepressant\">antidepressant<\/a>,\u00a0<a title=\"Anticonvulsant\" href=\"https:\/\/en.wikipedia.org\/wiki\/Anticonvulsant\">anticonvulsant<\/a><sup id=\"cite_ref-BBDchronicpain_57-29\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\r\n<td>evidence suggests that opioids are not effective in treating fibromyalgia<sup id=\"cite_ref-BBDchronicpain_57-30\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<tfoot><\/tfoot>\r\n<\/table>\r\n<h3><span id=\"Mild_pain\" class=\"mw-headline\">Mild pain<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Mild pain\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=19\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\r\n<a title=\"Paracetamol\" href=\"https:\/\/en.wikipedia.org\/wiki\/Paracetamol\">Paracetamol<\/a>\u00a0(acetaminophen), or a\u00a0<a title=\"Nonsteroidal anti-inflammatory drug\" href=\"https:\/\/en.wikipedia.org\/wiki\/Nonsteroidal_anti-inflammatory_drug\">nonsteroidal anti-inflammatory drug<\/a>\u00a0(NSAID) such as\u00a0<a title=\"Ibuprofen\" href=\"https:\/\/en.wikipedia.org\/wiki\/Ibuprofen\">ibuprofen<\/a>\u00a0will relieve mild pain.<sup id=\"cite_ref-58\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-58\">[58]<\/a><\/sup><sup class=\"noprint Inline-Template Template-Fact\">[<i><a title=\"Wikipedia:Citation needed\" href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\"><span title=\"This claim needs references to reliable sources. (June 2020)\">citation needed<\/span><\/a><\/i>]<\/sup>\r\n<h3><span id=\"Mild_to_moderate_pain\" class=\"mw-headline\">Mild to moderate pain<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Mild to moderate pain\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=20\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\r\nParacetamol, an NSAID or paracetamol in a combination product with a weak\u00a0<a title=\"Opioid\" href=\"https:\/\/en.wikipedia.org\/wiki\/Opioid\">opioid<\/a>\u00a0such as\u00a0<a title=\"Tramadol\" href=\"https:\/\/en.wikipedia.org\/wiki\/Tramadol\">tramadol<\/a>, may provide greater relief than their separate use. A combination of opioid with\u00a0<a title=\"Paracetamol\" href=\"https:\/\/en.wikipedia.org\/wiki\/Paracetamol\">acetaminophen<\/a>\u00a0can be frequently used such as Percocet,\u00a0<a class=\"mw-redirect\" title=\"Vicodin\" href=\"https:\/\/en.wikipedia.org\/wiki\/Vicodin\">Vicodin<\/a>, or Norco.<sup class=\"noprint Inline-Template Template-Fact\">[<i><a title=\"Wikipedia:Citation needed\" href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\"><span title=\"This claim needs references to reliable sources. (June 2020)\">citation needed<\/span><\/a><\/i>]<\/sup>\r\n<h3><span id=\"Moderate_to_severe_pain\" class=\"mw-headline\">Moderate to severe pain<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Moderate to severe pain\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=21\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\r\nWhen 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\u00a0<a class=\"mw-redirect\" title=\"Trauma (medicine)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Trauma_(medicine)\">trauma<\/a>\u00a0or to treat\u00a0<a title=\"Surgery\" href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\">post-operative pain<\/a>.\u00a0<a title=\"Chronic pain\" href=\"https:\/\/en.wikipedia.org\/wiki\/Chronic_pain\">Chronic pain<\/a>\u00a0medication is for alleviating long-lasting, ongoing pain.\r\n\r\n<a title=\"Morphine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Morphine\">Morphine<\/a>\u00a0is the\u00a0<a title=\"Gold standard\" href=\"https:\/\/en.wikipedia.org\/wiki\/Gold_standard\">gold standard<\/a>\u00a0to which all\u00a0<a title=\"Narcotic\" href=\"https:\/\/en.wikipedia.org\/wiki\/Narcotic\">narcotics<\/a>\u00a0are compared. Semi-synthetic derivatives of morphine such as\u00a0<a title=\"Hydromorphone\" href=\"https:\/\/en.wikipedia.org\/wiki\/Hydromorphone\">hydromorphone<\/a>\u00a0(Dilaudid),\u00a0<a title=\"Oxymorphone\" href=\"https:\/\/en.wikipedia.org\/wiki\/Oxymorphone\">oxymorphone<\/a>\u00a0(Numorphan, Opana),\u00a0<a title=\"Nicomorphine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Nicomorphine\">nicomorphine<\/a>\u00a0(Vilan),\u00a0<a title=\"Hydromorphinol\" href=\"https:\/\/en.wikipedia.org\/wiki\/Hydromorphinol\">hydromorphinol<\/a>\u00a0and others vary in such ways as duration of action, side effect profile and milligramme potency.\u00a0<a title=\"Fentanyl\" href=\"https:\/\/en.wikipedia.org\/wiki\/Fentanyl\">Fentanyl<\/a>\u00a0has the benefit of less\u00a0<a title=\"Histamine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Histamine\">histamine<\/a>\u00a0release and thus fewer\u00a0<a title=\"Side effect\" href=\"https:\/\/en.wikipedia.org\/wiki\/Side_effect\">side effects<\/a>. It can also be administered via\u00a0<a title=\"Transdermal patch\" href=\"https:\/\/en.wikipedia.org\/wiki\/Transdermal_patch\">transdermal patch<\/a>\u00a0which is convenient for chronic pain management. In addition to the intrathecal 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).\u00a0<a title=\"Oxycodone\" href=\"https:\/\/en.wikipedia.org\/wiki\/Oxycodone\">Oxycodone<\/a>\u00a0is used across the Americas and Europe for relief of serious chronic pain. Its main slow-release formula is known as\u00a0<a class=\"mw-redirect\" title=\"OxyContin\" href=\"https:\/\/en.wikipedia.org\/wiki\/OxyContin\">OxyContin<\/a>. Short-acting tablets, capsules, syrups and\u00a0<a class=\"mw-redirect\" title=\"Ampule\" href=\"https:\/\/en.wikipedia.org\/wiki\/Ampule\">ampules<\/a>\u00a0which contain OxyContin are available making it suitable for acute intractable pain or\u00a0<a title=\"Pain\" href=\"https:\/\/en.wikipedia.org\/wiki\/Pain#Breakthrough_pain\">breakthrough pain<\/a>.\u00a0<a class=\"mw-redirect\" title=\"Diamorphine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Diamorphine\">Diamorphine<\/a>, and\u00a0<a title=\"Methadone\" href=\"https:\/\/en.wikipedia.org\/wiki\/Methadone\">methadone<\/a>\u00a0are used less frequently.<sup class=\"noprint Inline-Template Template-Fact\">[<i><a title=\"Wikipedia:Citation needed\" href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\"><span title=\"This claim needs references to reliable sources. (January 2010)\">citation needed<\/span><\/a><\/i>]<\/sup>\u00a0Clinical studies have shown that transdermal\u00a0<a title=\"Buprenorphine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Buprenorphine\">Buprenorphine<\/a>\u00a0is effective at reducing chronic pain.<sup id=\"cite_ref-59\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-59\">[59]<\/a><\/sup>\u00a0<a title=\"Pethidine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Pethidine\">Pethidine<\/a>, known in North America as meperidine, is not recommended<sup class=\"noprint Inline-Template\">[<i><a title=\"Wikipedia:Manual of Style\/Words to watch\" href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Manual_of_Style\/Words_to_watch#Unsupported_attributions\"><span title=\"The material near this tag may use weasel words or too-vague attribution. (October 2012)\">by whom?<\/span><\/a><\/i>]<\/sup>\u00a0for pain management due to its low potency, short duration of action, and toxicity associated with repeated use.<sup class=\"noprint Inline-Template Template-Fact\">[<i><a title=\"Wikipedia:Citation needed\" href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\"><span title=\"This claim needs references to reliable sources. (June 2020)\">citation needed<\/span><\/a><\/i>]<\/sup>\u00a0<a title=\"Pentazocine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Pentazocine\">Pentazocine<\/a>,\u00a0<a title=\"Dextromoramide\" href=\"https:\/\/en.wikipedia.org\/wiki\/Dextromoramide\">dextromoramide<\/a>\u00a0and\u00a0<a title=\"Dipipanone\" href=\"https:\/\/en.wikipedia.org\/wiki\/Dipipanone\">dipipanone<\/a>\u00a0are 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\u00a0<a title=\"Piritramide\" href=\"https:\/\/en.wikipedia.org\/wiki\/Piritramide\">piritramide<\/a>\u00a0and\u00a0<a title=\"Ketobemidone\" href=\"https:\/\/en.wikipedia.org\/wiki\/Ketobemidone\">ketobemidone<\/a>\u00a0are used for severe pain.\u00a0<a title=\"Tapentadol\" href=\"https:\/\/en.wikipedia.org\/wiki\/Tapentadol\">Tapentadol<\/a>\u00a0is a newer agent introduced in the last decade.\r\n\r\nFor moderate pain,\u00a0<a title=\"Tramadol\" href=\"https:\/\/en.wikipedia.org\/wiki\/Tramadol\">tramadol<\/a>,\u00a0<a title=\"Codeine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Codeine\">codeine<\/a>,\u00a0<a title=\"Dihydrocodeine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Dihydrocodeine\">dihydrocodeine<\/a>, and\u00a0<a title=\"Hydrocodone\" href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrocodone\">hydrocodone<\/a>\u00a0are used, with\u00a0<a title=\"Nicocodeine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Nicocodeine\">nicocodeine<\/a>,\u00a0<a title=\"Ethylmorphine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Ethylmorphine\">ethylmorphine<\/a>\u00a0and\u00a0<a class=\"mw-redirect\" title=\"Propoxyphene\" href=\"https:\/\/en.wikipedia.org\/wiki\/Propoxyphene\">propoxyphene<\/a>\u00a0or\u00a0<a title=\"Dextropropoxyphene\" href=\"https:\/\/en.wikipedia.org\/wiki\/Dextropropoxyphene\">dextropropoxyphene<\/a>\u00a0(less commonly).\r\n\r\nDrugs of other types can be used to help opioids combat certain types of pain.\u00a0<a title=\"Amitriptyline\" href=\"https:\/\/en.wikipedia.org\/wiki\/Amitriptyline\">Amitriptyline<\/a>\u00a0is prescribed for chronic muscular pain in the arms, legs, neck and lower back with an opiate, or sometimes without it or with an NSAID.\r\n\r\nWhile\u00a0<a title=\"Opiate\" href=\"https:\/\/en.wikipedia.org\/wiki\/Opiate\">opiates<\/a>\u00a0are often used in the management of chronic pain, high doses are associated with an increased risk of\u00a0<a title=\"Opioid overdose\" href=\"https:\/\/en.wikipedia.org\/wiki\/Opioid_overdose\">opioid overdose<\/a>.<sup id=\"cite_ref-60\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-60\">[60]<\/a><\/sup>\r\n<h3><span id=\"Opioids\" class=\"mw-headline\">Opioids<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Opioids\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=22\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\r\nIn 2009, the\u00a0<a title=\"Food and Drug Administration\" href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration\">Food and Drug Administration<\/a>\u00a0stated: \"According to the\u00a0<a title=\"National Institutes of Health\" href=\"https:\/\/en.wikipedia.org\/wiki\/National_Institutes_of_Health\">National Institutes of Health<\/a>, 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.\"<sup id=\"cite_ref-61\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-61\">[61]<\/a><\/sup>\u00a0In 2013, the FDA stated that \"abuse and misuse of these products have created a serious and growing public health problem\".<sup id=\"cite_ref-62\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-62\">[62]<\/a><\/sup>\r\n\r\n<a title=\"Opioid\" href=\"https:\/\/en.wikipedia.org\/wiki\/Opioid\">Opioid<\/a>\u00a0medications 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\u00a0<a class=\"mw-redirect\" title=\"Time release technology\" href=\"https:\/\/en.wikipedia.org\/wiki\/Time_release_technology\">extended release<\/a>\u00a0medication is often prescribed along with a shorter-acting medication (oxycodone, morphine or hydromorphone) for breakthrough pain, or exacerbations.\r\n\r\nMost opioid treatment used by patients outside of healthcare settings is oral (<a title=\"Tablet (pharmacy)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Tablet_(pharmacy)\">tablet<\/a>,\u00a0<a title=\"Capsule (pharmacy)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Capsule_(pharmacy)\">capsule<\/a>\u00a0or liquid), but\u00a0<a title=\"Suppository\" href=\"https:\/\/en.wikipedia.org\/wiki\/Suppository\">suppositories<\/a>\u00a0and skin patches can be prescribed. An opioid\u00a0<a title=\"Injection (medicine)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Injection_(medicine)\">injection<\/a>\u00a0is rarely needed for patients with chronic pain.\r\n\r\nAlthough 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.<sup id=\"cite_ref-63\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-63\">[63]<\/a><\/sup>\u00a0However, there are associated adverse effects, especially during the commencement or change in dose. When\u00a0<a class=\"mw-redirect\" title=\"Opioids\" href=\"https:\/\/en.wikipedia.org\/wiki\/Opioids\">opioids<\/a>\u00a0are used for prolonged periods\u00a0<a title=\"Drug tolerance\" href=\"https:\/\/en.wikipedia.org\/wiki\/Drug_tolerance\">drug tolerance<\/a>,\u00a0<a class=\"mw-redirect\" title=\"Chemical dependency\" href=\"https:\/\/en.wikipedia.org\/wiki\/Chemical_dependency\">chemical dependency<\/a>,\u00a0<a title=\"Drug diversion\" href=\"https:\/\/en.wikipedia.org\/wiki\/Drug_diversion\">diversion<\/a>\u00a0and\u00a0<a title=\"Substance use disorder\" href=\"https:\/\/en.wikipedia.org\/wiki\/Substance_use_disorder\">addiction<\/a>\u00a0may occur.<sup id=\"cite_ref-64\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-64\">[64]<\/a><\/sup><sup id=\"cite_ref-65\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-65\">[65]<\/a><\/sup>\r\n\r\nClinical guidelines for prescribing opioids for chronic pain have been issued by the\u00a0<a title=\"American Pain Society\" href=\"https:\/\/en.wikipedia.org\/wiki\/American_Pain_Society\">American Pain Society<\/a>\u00a0and 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.<sup id=\"cite_ref-66\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-66\">[66]<\/a><\/sup>\u00a0Physicians 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.<sup id=\"cite_ref-67\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-67\">[67]<\/a><\/sup>\r\n\r\nThe list below consists of commonly used opioid analgesics which have long-acting formulations. Common brand names for the extended release formulation are in parentheses.\r\n<ul>\r\n \t<li><a title=\"Oxycodone\" href=\"https:\/\/en.wikipedia.org\/wiki\/Oxycodone\">Oxycodone<\/a>\u00a0(OxyContin)<\/li>\r\n \t<li><a title=\"Hydromorphone\" href=\"https:\/\/en.wikipedia.org\/wiki\/Hydromorphone\">Hydromorphone<\/a>\u00a0(Exalgo, Hydromorph Contin,)<\/li>\r\n \t<li><a title=\"Morphine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Morphine\">Morphine<\/a>\u00a0(M-Eslon,MS Contin)<\/li>\r\n \t<li><a title=\"Oxymorphone\" href=\"https:\/\/en.wikipedia.org\/wiki\/Oxymorphone\">Oxymorphone<\/a>\u00a0(Opana ER)<\/li>\r\n \t<li><a title=\"Fentanyl\" href=\"https:\/\/en.wikipedia.org\/wiki\/Fentanyl\">Fentanyl<\/a>, transdermal (Duragesic)<\/li>\r\n \t<li><a title=\"Buprenorphine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Buprenorphine\">Buprenorphine<\/a>*, transdermal (Butrans)<\/li>\r\n \t<li><a title=\"Tramadol\" href=\"https:\/\/en.wikipedia.org\/wiki\/Tramadol\">Tramadol<\/a>\u00a0(Ultram ER)<\/li>\r\n \t<li><a title=\"Tapentadol\" href=\"https:\/\/en.wikipedia.org\/wiki\/Tapentadol\">Tapentadol<\/a>\u00a0(Nucynta ER)<\/li>\r\n \t<li><a title=\"Methadone\" href=\"https:\/\/en.wikipedia.org\/wiki\/Methadone\">Methadone<\/a>* (Metadol, Methadose)<\/li>\r\n \t<li><a title=\"Hydrocodone\" href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrocodone\">Hydrocodone<\/a>\u00a0bitartrate (Hysingla ER) and bicarbonate (Zohydro ER)<\/li>\r\n<\/ul>\r\n*Methadone and buprenorphine are each used both for the treatment of\u00a0<a title=\"Opioid use disorder\" href=\"https:\/\/en.wikipedia.org\/wiki\/Opioid_use_disorder\">opioid addiction<\/a>\u00a0and as analgesics\r\n<h3><span id=\"Nonsteroidal_anti-inflammatory_drugs\" class=\"mw-headline\">Nonsteroidal anti-inflammatory drugs<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Nonsteroidal anti-inflammatory drugs\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=23\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\r\nThe other major group of analgesics are\u00a0<a title=\"Nonsteroidal anti-inflammatory drug\" href=\"https:\/\/en.wikipedia.org\/wiki\/Nonsteroidal_anti-inflammatory_drug\">nonsteroidal anti-inflammatory drugs<\/a>\u00a0(NSAID). They work by inhibiting the release of\u00a0<a title=\"Prostaglandin\" href=\"https:\/\/en.wikipedia.org\/wiki\/Prostaglandin\">prostaglandins<\/a>, which cause inflammatory pain.\u00a0<a class=\"mw-redirect\" title=\"Acetaminophen\" href=\"https:\/\/en.wikipedia.org\/wiki\/Acetaminophen\">Acetaminophen<\/a>\/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\u00a0<a title=\"Ketoprofen\" href=\"https:\/\/en.wikipedia.org\/wiki\/Ketoprofen\">ketoprofen<\/a>\u00a0and\u00a0<a title=\"Piroxicam\" href=\"https:\/\/en.wikipedia.org\/wiki\/Piroxicam\">piroxicam<\/a>\u00a0have limited benefit in chronic pain disorders and with long-term use are associated with significant\u00a0<a title=\"Adverse effect\" href=\"https:\/\/en.wikipedia.org\/wiki\/Adverse_effect\">adverse effects<\/a>. The use of selective NSAIDs designated as\u00a0<a title=\"COX-2 inhibitor\" href=\"https:\/\/en.wikipedia.org\/wiki\/COX-2_inhibitor\">selective COX-2 inhibitors<\/a>\u00a0have significant cardiovascular and cerebrovascular risks which have limited their utilization.<sup id=\"cite_ref-Munir_MA,_Enany_N._68-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Munir_MA,_Enany_N.-68\">[68]<\/a><\/sup><sup id=\"cite_ref-Ballantyne_JC._69-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Ballantyne_JC.-69\">[69]<\/a><\/sup>\u00a0Common NSAIDs include\u00a0<a title=\"Aspirin\" href=\"https:\/\/en.wikipedia.org\/wiki\/Aspirin\">aspirin<\/a>,\u00a0<a title=\"Ibuprofen\" href=\"https:\/\/en.wikipedia.org\/wiki\/Ibuprofen\">ibuprofen<\/a>, and\u00a0<a title=\"Naproxen\" href=\"https:\/\/en.wikipedia.org\/wiki\/Naproxen\">naproxen<\/a>. 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.<sup id=\"cite_ref-70\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-70\">[70]<\/a><\/sup>\r\n<h3><span id=\"Antidepressants_and_antiepileptic_drugs\" class=\"mw-headline\">Antidepressants and antiepileptic drugs<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Antidepressants and antiepileptic drugs\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=24\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\r\nSome\u00a0<a title=\"Antidepressant\" href=\"https:\/\/en.wikipedia.org\/wiki\/Antidepressant\">antidepressant<\/a>\u00a0and\u00a0<a class=\"mw-redirect\" title=\"Antiepileptic\" href=\"https:\/\/en.wikipedia.org\/wiki\/Antiepileptic\">antiepileptic<\/a>\u00a0drugs 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.\u00a0<a class=\"mw-redirect\" title=\"Neuropathy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Neuropathy\">Neuropathy<\/a>\u00a0can be due to chronic high blood sugar levels (<a title=\"Diabetic neuropathy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Diabetic_neuropathy\">diabetic neuropathy<\/a>). These drugs also reduce pain from viruses such as shingles,\u00a0<a class=\"mw-redirect\" title=\"Phantom limb pain\" href=\"https:\/\/en.wikipedia.org\/wiki\/Phantom_limb_pain\">phantom limb pain<\/a>\u00a0and post-stroke pain.<sup id=\"cite_ref-71\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-71\">[71]<\/a><\/sup>\u00a0These mechanisms vary and in general are more effective in\u00a0<a class=\"mw-redirect\" title=\"Neuropathy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Neuropathy\">neuropathic<\/a>\u00a0pain disorders as well as\u00a0<a title=\"Complex regional pain syndrome\" href=\"https:\/\/en.wikipedia.org\/wiki\/Complex_regional_pain_syndrome\">complex regional pain syndrome<\/a>.<sup id=\"cite_ref-Jackson_KC_2nd._72-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Jackson_KC_2nd.-72\">[72]<\/a><\/sup>\u00a0A common anti-epileptic drug is\u00a0<a title=\"Gabapentin\" href=\"https:\/\/en.wikipedia.org\/wiki\/Gabapentin\">gabapentin<\/a>, and an example of an antidepressant would be\u00a0<a title=\"Amitriptyline\" href=\"https:\/\/en.wikipedia.org\/wiki\/Amitriptyline\">amitriptyline<\/a>.\r\n<h3><span id=\"Cannabinoids\" class=\"mw-headline\">Cannabinoids<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Cannabinoids\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=25\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\r\nEvidence of medical marijuana's effect on reducing pain is generally conclusive. Detailed in a 1999 report by the\u00a0<a class=\"mw-redirect\" title=\"Institute of Medicine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Institute_of_Medicine\">Institute of Medicine<\/a>, \"the available evidence from animal and human studies indicates that cannabinoids can have a substantial analgesic effect\".<sup id=\"cite_ref-73\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-73\">[73]<\/a><\/sup>\u00a0In a 2013 review study published in\u00a0<i>Fundamental &amp; Clinical Pharmacology<\/i>, various studies were cited in demonstrating that cannabinoids exhibit comparable effectiveness to opioids in models of acute pain and even greater effectiveness in models of chronic pain.<sup id=\"cite_ref-74\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-74\">[74]<\/a><\/sup>\r\n<h3><span id=\"Other_analgesics\" class=\"mw-headline\">Other analgesics<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Other analgesics\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=26\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\r\nOther drugs which can potentiate conventional analgesics or have analgesic properties in certain circumstances are called\u00a0<a title=\"Analgesic adjuvant\" href=\"https:\/\/en.wikipedia.org\/wiki\/Analgesic_adjuvant\">analgesic adjuvant<\/a>\u00a0medications.<sup id=\"cite_ref-:9_75-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:9-75\">[75]<\/a><\/sup>\u00a0<a title=\"Gabapentin\" href=\"https:\/\/en.wikipedia.org\/wiki\/Gabapentin\">Gabapentin<\/a>, an anticonvulsant, can reduce neuropathic pain itself and can also potentiate opiates.<sup id=\"cite_ref-gabapentin_76-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-gabapentin-76\">[76]<\/a><\/sup>\u00a0Drugs with\u00a0<a title=\"Anticholinergic\" href=\"https:\/\/en.wikipedia.org\/wiki\/Anticholinergic\">anticholinergic<\/a>\u00a0activity, such as\u00a0<a title=\"Orphenadrine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Orphenadrine\">orphenadrine<\/a>,\u00a0<a title=\"Cyclobenzaprine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Cyclobenzaprine\">cyclobenzaprine<\/a>, and\u00a0<a title=\"Trazodone\" href=\"https:\/\/en.wikipedia.org\/wiki\/Trazodone\">trazodone<\/a>, are given in conjunction with opioids for neuropathic pain. Orphenadrine and cyclobenzaprine are also\u00a0<a title=\"Muscle relaxant\" href=\"https:\/\/en.wikipedia.org\/wiki\/Muscle_relaxant\">muscle relaxants<\/a>, and are useful in painful musculoskeletal conditions.\u00a0<a title=\"Clonidine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Clonidine\">Clonidine<\/a>, an alpha-2 receptor agonist, is another drug that has found use as an analgesic adjuvant.<sup id=\"cite_ref-:9_75-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:9-75\">[75]<\/a><\/sup>\r\n<h2><span id=\"Self-management\" class=\"mw-headline\">Self-management<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Self-management\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=27\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h2>\r\nSelf-management of chronic pain has been described as the individual's ability to manage various aspects of their chronic pain.<sup id=\"cite_ref-:4_77-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:4-77\">[77]<\/a><\/sup>\u00a0Self-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.<sup id=\"cite_ref-:4_77-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:4-77\">[77]<\/a><\/sup>\u00a0The benefits of self-management vary depending on self-management techniques used. They only have marginal benefits in management of chronic musculoskeletal pain.<sup id=\"cite_ref-78\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-78\">[78]<\/a><\/sup>\r\n<h2><span id=\"Society_and_culture\" class=\"mw-headline\">Society and culture<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Society and culture\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=28\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h2>\r\nThe medical treatment of pain as practiced in\u00a0<a title=\"Greece\" href=\"https:\/\/en.wikipedia.org\/wiki\/Greece\">Greece<\/a>\u00a0and\u00a0<a title=\"Turkey\" href=\"https:\/\/en.wikipedia.org\/wiki\/Turkey\">Turkey<\/a>\u00a0is called\u00a0<b>algology<\/b>\u00a0(from the Greek \u03ac\u03bb\u03b3\u03bf\u03c2,\u00a0<a title=\"Algos\" href=\"https:\/\/en.wikipedia.org\/wiki\/Algos\">algos<\/a>, \"<a title=\"Pain\" href=\"https:\/\/en.wikipedia.org\/wiki\/Pain\">pain<\/a>\"). The Hellenic Society of Algology<sup id=\"cite_ref-79\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-79\">[79]<\/a><\/sup>\u00a0and the Turkish Algology-Pain Society<sup id=\"cite_ref-80\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-80\">[80]<\/a><\/sup>\u00a0are the relevant local bodies affiliated to the\u00a0<a title=\"International Association for the Study of Pain\" href=\"https:\/\/en.wikipedia.org\/wiki\/International_Association_for_the_Study_of_Pain\">International Association for the Study of Pain<\/a>\u00a0(IASP).<sup id=\"cite_ref-81\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-81\">[81]<\/a><\/sup>\r\n<h3><span id=\"Undertreatment\" class=\"mw-headline\">Undertreatment<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Undertreatment\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=29\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\r\n<div class=\"hatnote navigation-not-searchable\" role=\"note\">Main article:\u00a0<a title=\"Undertreatment of pain\" href=\"https:\/\/en.wikipedia.org\/wiki\/Undertreatment_of_pain\">Undertreatment of pain<\/a><\/div>\r\nUndertreatment of pain is the absence of pain management therapy for a person in\u00a0<a title=\"Pain\" href=\"https:\/\/en.wikipedia.org\/wiki\/Pain\">pain<\/a>\u00a0when treatment is\u00a0<a title=\"Indication (medicine)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Indication_(medicine)\">indicated<\/a>.\r\n\r\nConsensus in\u00a0<a title=\"Evidence-based medicine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Evidence-based_medicine\">evidence-based medicine<\/a>\u00a0and the recommendations of\u00a0<a title=\"Medical specialty\" href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_specialty\">medical specialty<\/a>\u00a0organizations establish guidelines to determine the treatment for pain which health care providers ought to offer.<sup id=\"cite_ref-State_of_Pain_Treatment_2011_82-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-State_of_Pain_Treatment_2011-82\">[82]<\/a><\/sup>\u00a0For various social reasons, persons in pain may not seek or may not be able to access treatment for their pain.<sup id=\"cite_ref-State_of_Pain_Treatment_2011_82-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-State_of_Pain_Treatment_2011-82\">[82]<\/a><\/sup>\u00a0The Joint Commission, which has long recognized nonpharmacological approaches to pain, emphasizes the importance of strategies needed to facilitate both access and coverage to nonpharmacological therapies. Users of nonpharmacological therapy for pain management generally have lower insurance expenditures than those who did not use them.<sup id=\"cite_ref-:2_83-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:2-83\">[83]<\/a><\/sup>\u00a0At the same time, health care providers may not provide the treatment which authorities recommend.<sup id=\"cite_ref-State_of_Pain_Treatment_2011_82-2\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-State_of_Pain_Treatment_2011-82\">[82]<\/a><\/sup>\u00a0The need for an informed strategy including all evidence-based comprehensive pain care is demonstrated to be in the patients' best interest. Healthcare providers' failure to educate patients and recommend nonpharmacologic care should be considered unethical.<sup id=\"cite_ref-:2_83-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:2-83\">[83]<\/a><\/sup>\r\n<h3><span id=\"In_children\" class=\"mw-headline\">In children<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: In children\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=30\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\r\n<div class=\"hatnote navigation-not-searchable\" role=\"note\">Main article:\u00a0<a title=\"Pain management in children\" href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management_in_children\">Pain management in children<\/a><\/div>\r\nAcute pain is common in children and adolescents as a result of injury, illness, or necessary medical procedures.<sup id=\"cite_ref-AAP._84-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-AAP.-84\">[84]<\/a><\/sup>\u00a0<a title=\"Chronic pain\" href=\"https:\/\/en.wikipedia.org\/wiki\/Chronic_pain\">Chronic pain<\/a>\u00a0is present in approximately 15\u201325% of children and adolescents. It may be caused by an underlying disease, such as\u00a0<a class=\"mw-redirect\" title=\"Sickle cell anemia\" href=\"https:\/\/en.wikipedia.org\/wiki\/Sickle_cell_anemia\">sickle cell anemia<\/a>,\u00a0<a title=\"Cystic fibrosis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Cystic_fibrosis\">cystic fibrosis<\/a>,\u00a0<a title=\"Rheumatoid arthritis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Rheumatoid_arthritis\">rheumatoid arthritis<\/a>. Cancer or\u00a0<a title=\"Functional disorder\" href=\"https:\/\/en.wikipedia.org\/wiki\/Functional_disorder\">functional disorders<\/a>\u00a0such as migraines,\u00a0<a title=\"Fibromyalgia\" href=\"https:\/\/en.wikipedia.org\/wiki\/Fibromyalgia\">fibromyalgia<\/a>, and complex regional pain could also cause chronic pain in children.<sup id=\"cite_ref-Weydert_85-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Weydert-85\">[85]<\/a><\/sup>\r\n<dl>\r\n \t<dt>Assessment<\/dt>\r\n<\/dl>\r\n<div class=\"thumb tright\">\r\n<div class=\"thumbinner\"><a class=\"image\" href=\"https:\/\/en.wikipedia.org\/wiki\/File:Children%27s_pain_scale.JPG\"><img class=\"thumbimage aligncenter\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a7\/Children%27s_pain_scale.JPG\/400px-Children%27s_pain_scale.JPG\" alt=\"\" width=\"400\" height=\"155\" \/><\/a>\r\n<div class=\"thumbcaption\">\r\n<div class=\"magnify\" style=\"text-align: center\"><\/div>\r\nYoung children can indicate their level of pain by pointing to the appropriate face on a children's pain scale.<sup id=\"cite_ref-86\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-86\">[86]<\/a><\/sup><\/div>\r\n<\/div>\r\n<\/div>\r\nPain 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.<sup id=\"cite_ref-AMA_87-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-AMA-87\">[87]<\/a><\/sup>\u00a0Questionnaires for older children and adolescents include the Varni-Thompson Pediatric Pain Questionnaire (PPQ) and the Children\u2019s Comprehensive Pain Questionnaire. They are often utilized for individuals with chronic or persistent pain.<sup id=\"cite_ref-AMA_87-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-AMA-87\">[87]<\/a><\/sup>\r\n<dl>\r\n \t<dt>Nonpharmacologic<\/dt>\r\n<\/dl>\r\nCaregivers 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,\u00a0<a title=\"Massage\" href=\"https:\/\/en.wikipedia.org\/wiki\/Massage\">massage<\/a>, or\u00a0<a title=\"Acupuncture\" href=\"https:\/\/en.wikipedia.org\/wiki\/Acupuncture\">acupuncture<\/a>.<sup id=\"cite_ref-Wente._88-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Wente.-88\">[88]<\/a><\/sup>\u00a0<a title=\"Cognitive behavioral therapy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Cognitive_behavioral_therapy\">Cognitive behavioral therapy<\/a>\u00a0(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\u00a0<a class=\"mw-redirect\" title=\"Coping (psychology)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Coping_(psychology)\">coping<\/a>\u00a0strategies. Integrated interventions in CBT include\u00a0<a class=\"mw-redirect\" title=\"Relaxation training\" href=\"https:\/\/en.wikipedia.org\/wiki\/Relaxation_training\">relaxation technique<\/a>,\u00a0<a title=\"Mindfulness\" href=\"https:\/\/en.wikipedia.org\/wiki\/Mindfulness\">mindfulness<\/a>,\u00a0<a title=\"Biofeedback\" href=\"https:\/\/en.wikipedia.org\/wiki\/Biofeedback\">biofeedback<\/a>, and\u00a0<a title=\"Acceptance\" href=\"https:\/\/en.wikipedia.org\/wiki\/Acceptance\">acceptance<\/a>\u00a0(in the case of chronic pain).<sup id=\"cite_ref-Zagustin_89-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Zagustin-89\">[89]<\/a><\/sup>\u00a0Many therapists will hold sessions for caregivers to provide them with effective management strategies.<sup id=\"cite_ref-Weydert_85-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Weydert-85\">[85]<\/a><\/sup>\r\n<dl>\r\n \t<dt>Pharmacologic<\/dt>\r\n<\/dl>\r\nAcetaminophen,\u00a0<a class=\"mw-redirect\" title=\"Nonsteroidal anti-inflammatory agents\" href=\"https:\/\/en.wikipedia.org\/wiki\/Nonsteroidal_anti-inflammatory_agents\">nonsteroidal anti-inflammatory agents<\/a>, and\u00a0<a title=\"Opioid\" href=\"https:\/\/en.wikipedia.org\/wiki\/Opioid\">opioid analgesics<\/a>\u00a0are commonly used to treat acute or chronic pain symptoms in children and adolescents. However a pediatrician should be consulted before administering any medication.<sup id=\"cite_ref-AMA_87-2\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-AMA-87\">[87]<\/a><\/sup>","rendered":"<p><b>Pain management<\/b>,\u00a0<b>pain killer<\/b>,\u00a0<b>pain medicine<\/b>,\u00a0<b>pain control<\/b>\u00a0or\u00a0<b>algiatry<\/b>, is a branch of\u00a0<a title=\"Medicine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Medicine\">medicine<\/a>\u00a0that uses an interdisciplinary approach for easing the suffering and improving the\u00a0<a title=\"Quality of life\" href=\"https:\/\/en.wikipedia.org\/wiki\/Quality_of_life\">quality of life<\/a>\u00a0of those living with\u00a0<a title=\"Chronic pain\" href=\"https:\/\/en.wikipedia.org\/wiki\/Chronic_pain\">chronic pain<\/a>.<sup id=\"cite_ref-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-1\">[1]<\/a><\/sup>\u00a0The typical pain management team includes\u00a0<a class=\"mw-redirect\" title=\"Medical practitioner\" href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_practitioner\">medical practitioners<\/a>,\u00a0<a title=\"Pharmacist\" href=\"https:\/\/en.wikipedia.org\/wiki\/Pharmacist\">pharmacists<\/a>,\u00a0<a class=\"mw-redirect\" title=\"Clinical psychologist\" href=\"https:\/\/en.wikipedia.org\/wiki\/Clinical_psychologist\">clinical psychologists<\/a>,\u00a0<a class=\"mw-redirect\" title=\"Physiotherapist\" href=\"https:\/\/en.wikipedia.org\/wiki\/Physiotherapist\">physiotherapists<\/a>,\u00a0<a title=\"Occupational therapist\" href=\"https:\/\/en.wikipedia.org\/wiki\/Occupational_therapist\">occupational therapists<\/a>,\u00a0<a class=\"mw-redirect\" title=\"Physician assistants\" href=\"https:\/\/en.wikipedia.org\/wiki\/Physician_assistants\">physician assistants<\/a>,\u00a0<a class=\"mw-redirect\" title=\"Nurse\" href=\"https:\/\/en.wikipedia.org\/wiki\/Nurse\">nurses<\/a>, and\u00a0<a title=\"Dentist\" href=\"https:\/\/en.wikipedia.org\/wiki\/Dentist\">dentists<\/a>.<sup id=\"cite_ref-2\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-2\">[2]<\/a><\/sup>\u00a0The team may also include other\u00a0<a title=\"Mental health\" href=\"https:\/\/en.wikipedia.org\/wiki\/Mental_health\">mental health<\/a>\u00a0specialists and\u00a0<a class=\"mw-redirect\" title=\"Massage therapist\" href=\"https:\/\/en.wikipedia.org\/wiki\/Massage_therapist\">massage therapists<\/a>. Pain sometimes resolves quickly once the underlying\u00a0<a class=\"mw-redirect\" title=\"Trauma (medicine)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Trauma_(medicine)\">trauma<\/a>\u00a0or\u00a0<a title=\"Pathology\" href=\"https:\/\/en.wikipedia.org\/wiki\/Pathology\">pathology<\/a>\u00a0has healed, and is treated by one practitioner, with drugs such as\u00a0<a title=\"Analgesic\" href=\"https:\/\/en.wikipedia.org\/wiki\/Analgesic\">analgesics<\/a>\u00a0and (occasionally)\u00a0<a class=\"mw-redirect\" title=\"Anxiolytics\" href=\"https:\/\/en.wikipedia.org\/wiki\/Anxiolytics\">anxiolytics<\/a>. Effective management of\u00a0<a title=\"Chronic pain\" href=\"https:\/\/en.wikipedia.org\/wiki\/Chronic_pain\">chronic (long-term) pain<\/a>, however, frequently requires the coordinated efforts of the pain management team.<sup id=\"cite_ref-3\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-3\">[3]<\/a><\/sup>\u00a0Effective pain management does not mean total eradication of all pain.<\/p>\n<p>Medicine treats\u00a0<a title=\"Injury\" href=\"https:\/\/en.wikipedia.org\/wiki\/Injury\">injuries<\/a>\u00a0and diseases to support and speed healing. It treats distressing symptoms such as pain to relieve\u00a0<a title=\"Suffering\" href=\"https:\/\/en.wikipedia.org\/wiki\/Suffering\">suffering<\/a>\u00a0during treatment, healing, and\u00a0<a class=\"mw-redirect\" title=\"Dying\" href=\"https:\/\/en.wikipedia.org\/wiki\/Dying\">dying<\/a>. The task of medicine is to relieve suffering under three circumstances. The first being 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\u00a0<a title=\"Pharmacology\" href=\"https:\/\/en.wikipedia.org\/wiki\/Pharmacology\">pharmacological<\/a>\u00a0measures, such as\u00a0<a class=\"mw-redirect\" title=\"Analgesics\" href=\"https:\/\/en.wikipedia.org\/wiki\/Analgesics\">analgesics<\/a>,\u00a0<a title=\"Antidepressant\" href=\"https:\/\/en.wikipedia.org\/wiki\/Antidepressant\">antidepressants<\/a>\u00a0and\u00a0<a title=\"Anticonvulsant\" href=\"https:\/\/en.wikipedia.org\/wiki\/Anticonvulsant\">anticonvulsants<\/a>, interventional procedures, physical therapy,\u00a0<a class=\"mw-redirect\" title=\"Physical exercise\" href=\"https:\/\/en.wikipedia.org\/wiki\/Physical_exercise\">physical exercise<\/a>, application of ice or heat, and\u00a0<a class=\"mw-redirect\" title=\"Psychological\" href=\"https:\/\/en.wikipedia.org\/wiki\/Psychological\">psychological<\/a>\u00a0measures, such as\u00a0<a title=\"Biofeedback\" href=\"https:\/\/en.wikipedia.org\/wiki\/Biofeedback\">biofeedback<\/a>\u00a0and\u00a0<a title=\"Cognitive behavioral therapy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Cognitive_behavioral_therapy\">cognitive behavioral therapy<\/a>.<\/p>\n<h2><span id=\"Defining_pain\" class=\"mw-headline\">Defining pain<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Defining pain\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=1\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h2>\n<p>In the nursing profession, one common definition of pain is any problem that is &#8220;whatever the experiencing person says it is, existing whenever the experiencing person says it does&#8221;.<sup id=\"cite_ref-4\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-4\">[4]<\/a><\/sup><\/p>\n<p>Pain management includes patient communication about the pain problem.<sup id=\"cite_ref-Consumer_Reports_pain_relief_April_2016_5-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Consumer_Reports_pain_relief_April_2016-5\">[5]<\/a><\/sup>\u00a0To define the pain problem, a health care provider will likely ask questions such as:<sup id=\"cite_ref-Consumer_Reports_pain_relief_April_2016_5-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Consumer_Reports_pain_relief_April_2016-5\">[5]<\/a><\/sup><\/p>\n<ul>\n<li>How intense is the pain?<\/li>\n<li>How does the pain feel?<\/li>\n<li>Where is the pain?<\/li>\n<li>What, if anything, makes the pain lessen?<\/li>\n<li>What, if anything, makes the pain increase?<\/li>\n<li>When did the pain start?<\/li>\n<\/ul>\n<p>After asking such questions, the health care provider will have a description of the pain.<sup id=\"cite_ref-Consumer_Reports_pain_relief_April_2016_5-2\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Consumer_Reports_pain_relief_April_2016-5\">[5]<\/a><\/sup>\u00a0Pain management will then be used to address that pain.<sup id=\"cite_ref-Consumer_Reports_pain_relief_April_2016_5-3\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Consumer_Reports_pain_relief_April_2016-5\">[5]<\/a><\/sup><\/p>\n<h2><span id=\"Adverse_effects\" class=\"mw-headline\">Adverse effects<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Adverse effects\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=2\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h2>\n<p>There are many types of pain management. Each have their own benefits, drawbacks, and limits.<sup id=\"cite_ref-Consumer_Reports_pain_relief_April_2016_5-4\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Consumer_Reports_pain_relief_April_2016-5\">[5]<\/a><\/sup><\/p>\n<p>A common challenge in pain management is communication between the health care provider and the person experiencing pain.<sup id=\"cite_ref-Consumer_Reports_pain_relief_April_2016_5-5\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Consumer_Reports_pain_relief_April_2016-5\">[5]<\/a><\/sup>\u00a0People experiencing pain may have difficulty recognizing or describing what they feel and how intense it is.<sup id=\"cite_ref-Consumer_Reports_pain_relief_April_2016_5-6\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Consumer_Reports_pain_relief_April_2016-5\">[5]<\/a><\/sup>\u00a0Health care providers and patients may have difficulty communicating with each other about how pain responds to treatments.<sup id=\"cite_ref-Consumer_Reports_pain_relief_April_2016_5-7\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Consumer_Reports_pain_relief_April_2016-5\">[5]<\/a><\/sup>\u00a0There 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.<sup id=\"cite_ref-Consumer_Reports_pain_relief_April_2016_5-8\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Consumer_Reports_pain_relief_April_2016-5\">[5]<\/a><\/sup>\u00a0Some treatments for pain can be harmful if overused.<sup id=\"cite_ref-Consumer_Reports_pain_relief_April_2016_5-9\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Consumer_Reports_pain_relief_April_2016-5\">[5]<\/a><\/sup>\u00a0A 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.<sup id=\"cite_ref-Consumer_Reports_pain_relief_April_2016_5-10\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Consumer_Reports_pain_relief_April_2016-5\">[5]<\/a><\/sup><\/p>\n<p>Another problem with pain management is that pain is the body&#8217;s natural way of communicating a problem.<sup id=\"cite_ref-Consumer_Reports_pain_relief_April_2016_5-11\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Consumer_Reports_pain_relief_April_2016-5\">[5]<\/a><\/sup>\u00a0Pain is supposed to resolve as the body heals itself with time and pain management.<sup id=\"cite_ref-Consumer_Reports_pain_relief_April_2016_5-12\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Consumer_Reports_pain_relief_April_2016-5\">[5]<\/a><\/sup>\u00a0Sometimes pain management covers a problem, and the patient might be less aware that they need treatment for a deeper problem.<sup id=\"cite_ref-Consumer_Reports_pain_relief_April_2016_5-13\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Consumer_Reports_pain_relief_April_2016-5\">[5]<\/a><\/sup><\/p>\n<h2><span id=\"Physical_approach\" class=\"mw-headline\">Physical approach<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Physical approach\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=3\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h2>\n<h3><span id=\"Physical_medicine_and_rehabilitation\" class=\"mw-headline\">Physical medicine and rehabilitation<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Physical medicine and rehabilitation\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=4\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\n<p><a title=\"Physical medicine and rehabilitation\" href=\"https:\/\/en.wikipedia.org\/wiki\/Physical_medicine_and_rehabilitation\">Physical medicine and rehabilitation<\/a>\u00a0uses a range of physical techniques such as heat and\u00a0<a title=\"Electrotherapy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Electrotherapy\">electrotherapy<\/a>, as well as therapeutic exercises and behavioral therapy. These techniques are usually part of an interdisciplinary or multidisciplinary program that might also include pharmaceutical medicines.<sup id=\"cite_ref-Geertzen_JH,_Van_Wilgen_CP._6-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Geertzen_JH,_Van_Wilgen_CP.-6\">[6]<\/a><\/sup>\u00a0Spa therapy has showed positive effects in reducing pain among patients with chronic low back pain. However there are limited studies looking at this approach.<sup id=\"cite_ref-7\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-7\">[7]<\/a><\/sup>\u00a0Studies have shown that\u00a0<a title=\"Elastic therapeutic tape\" href=\"https:\/\/en.wikipedia.org\/wiki\/Elastic_therapeutic_tape\">kinesiotape<\/a>\u00a0could be used on individuals with chronic low back pain to reduce pain.<sup id=\"cite_ref-8\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-8\">[8]<\/a><\/sup>\u00a0The Center for Disease Control recommends that physical therapy and exercise can be prescribed as a positive alternative to\u00a0<a title=\"Opioid\" href=\"https:\/\/en.wikipedia.org\/wiki\/Opioid\">opioids<\/a>\u00a0for decreasing one&#8217;s pain in multiple injuries, illnesses, or diseases.<sup id=\"cite_ref-:0_9-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:0-9\">[9]<\/a><\/sup>\u00a0This can include chronic low back pain, osteoarthritis of the hip and knee, or fibromyalgia.<sup id=\"cite_ref-:0_9-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:0-9\">[9]<\/a><\/sup>\u00a0Exercise alone or with other rehabilitation disciplines (such as psychologically based approaches) can have a positive effect on reducing pain.<sup id=\"cite_ref-:0_9-2\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:0-9\">[9]<\/a><\/sup>\u00a0In addition to improving pain, exercise also can improve one&#8217;s well-being and general health.<sup id=\"cite_ref-:0_9-3\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:0-9\">[9]<\/a><\/sup><\/p>\n<p><a title=\"Manual therapy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Manual_therapy\">Manipulative<\/a>\u00a0and\u00a0<a title=\"Joint mobilization\" href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_mobilization\">mobilization<\/a>\u00a0therapy are safe interventions that likely reduce pain for patients with chronic low back pain. However, manipulation produces a larger effect than mobilization.<sup id=\"cite_ref-10\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-10\">[10]<\/a><\/sup><\/p>\n<p>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.<sup id=\"cite_ref-11\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-11\">[11]<\/a><\/sup><\/p>\n<h3><span id=\"Exercise_interventions\" class=\"mw-headline\">Exercise interventions<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Exercise interventions\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=5\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\n<p>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.<sup id=\"cite_ref-:1_12-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:1-12\">[12]<\/a><\/sup>\u00a0Physical activity and exercise may improve chronic pain (pain lasting more than 12 weeks),<sup id=\"cite_ref-13\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-13\">[13]<\/a><\/sup>\u00a0and overall quality of life, while minimizing the need for pain medications.<sup id=\"cite_ref-:1_12-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:1-12\">[12]<\/a><\/sup>\u00a0More specifically, walking has been effective in improving pain management in chronic low back pain.<sup id=\"cite_ref-14\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-14\">[14]<\/a><\/sup><\/p>\n<h3><span id=\"TENS\" class=\"mw-headline\">TENS<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: TENS\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=6\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\n<p>Transcutaneous electrical nerve stimulation (TENS) is a self-operated portable device intended to help regulate and create chronic pain via electrical impulses.<sup id=\"cite_ref-:23_15-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:23-15\">[15]<\/a><\/sup>\u00a0Limited 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 disruption of nerve conduction velocity and efficiency.<sup id=\"cite_ref-:23_15-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:23-15\">[15]<\/a><\/sup>\u00a0In one study, electrodes were placed over the lumbar spins and participants received treatment twice a day and at any time when they experienced a painful episode.<sup id=\"cite_ref-:23_15-2\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:23-15\">[15]<\/a><\/sup>\u00a0This study found that TENS would be beneficial to MS patients who reported localized or limited symptoms to one limp.<sup id=\"cite_ref-:23_15-3\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:23-15\">[15]<\/a><\/sup>\u00a0The research is mixed with whether or not TENS helps manage pain in MS patients.<\/p>\n<p><a title=\"Transcutaneous electrical nerve stimulation\" href=\"https:\/\/en.wikipedia.org\/wiki\/Transcutaneous_electrical_nerve_stimulation\">Transcutaneous electrical nerve stimulation<\/a>\u00a0has been found to be ineffective for\u00a0<a class=\"mw-redirect\" title=\"Lower back pain\" href=\"https:\/\/en.wikipedia.org\/wiki\/Lower_back_pain\">lower back pain<\/a>. However, it might help with\u00a0<a title=\"Diabetic neuropathy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Diabetic_neuropathy\">diabetic neuropathy<\/a><sup id=\"cite_ref-pmid20042705_16-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-pmid20042705-16\">[16]<\/a><\/sup>\u00a0as well as other illnesses.<\/p>\n<h4><span id=\"tDCS\" class=\"mw-headline\">tDCS<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: tDCS\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=7\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h4>\n<p>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 mA) constant direct current to the scalp through electrodes in order to modulate excitability of large cortical areas.<sup id=\"cite_ref-:12_17-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:12-17\">[17]<\/a><\/sup>\u00a0tDCS may have a role in pain assessment by contributing to efforts in distinguishing between somatic and affective aspects of pain experience.<sup id=\"cite_ref-:12_17-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:12-17\">[17]<\/a><\/sup>\u00a0Zaghi 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.<sup id=\"cite_ref-:12_17-2\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:12-17\">[17]<\/a><\/sup>\u00a0Although there is a greater need for research examining the mechanism of electrical stimulation in relation to pain treatment, one theory suggests that the changes in thalamic activity may be due the influence of motor cortex stimulation on the decrease in pain sensations.<sup id=\"cite_ref-:12_17-3\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:12-17\">[17]<\/a><\/sup><\/p>\n<p>In relation to MS, a study found that after daily tDCS sessions resulted in an individual&#8217;s subjective report of pain to decrease when compared to a sham condition.<sup id=\"cite_ref-:24_18-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:24-18\">[18]<\/a><\/sup>\u00a0In addition, the study found a similar improvement at 1 to 3 days before and after each tDCS session.<sup id=\"cite_ref-:24_18-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:24-18\">[18]<\/a><\/sup><\/p>\n<p>Fibromyalgia is a disorder in which an individual experiences dysfunctional brain activity, musculoskeletal pain, fatigue, and tenderness in localized areas.<sup id=\"cite_ref-:32_19-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:32-19\">[19]<\/a><\/sup>\u00a0Research examining tDCS for pain treatment in Fibromyalgia has found initial evidence for pain decreases.<sup id=\"cite_ref-:32_19-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:32-19\">[19]<\/a><\/sup>\u00a0Specifically, 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).<sup id=\"cite_ref-:32_19-2\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:32-19\">[19]<\/a><\/sup>\u00a0However, this effect decreased after treatment ended, but remained significant for three weeks following the extinction of treatment.<sup id=\"cite_ref-:32_19-3\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:32-19\">[19]<\/a><\/sup><\/p>\n<h3><span id=\"Acupuncture\" class=\"mw-headline\">Acupuncture<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Acupuncture\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=8\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\n<p><a title=\"Acupuncture\" href=\"https:\/\/en.wikipedia.org\/wiki\/Acupuncture\">Acupuncture<\/a>\u00a0involves 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\u00a0<i><a class=\"mw-redirect\" title=\"British Medical Journal\" href=\"https:\/\/en.wikipedia.org\/wiki\/British_Medical_Journal\">British Medical Journal<\/a><\/i>, was unable to quantify the difference in the effect on pain of real,\u00a0<a title=\"Sham surgery\" href=\"https:\/\/en.wikipedia.org\/wiki\/Sham_surgery\">sham<\/a>\u00a0and no acupuncture.<sup id=\"cite_ref-20\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-20\">[20]<\/a><\/sup>\u00a0A 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.<sup id=\"cite_ref-21\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-21\">[21]<\/a><\/sup><\/p>\n<h3><span id=\"Light_therapy\" class=\"mw-headline\">Light therapy<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Light therapy\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=9\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\n<p>Research has not found evidence that\u00a0<a title=\"Light therapy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Light_therapy\">light therapy<\/a>\u00a0such as\u00a0<a class=\"mw-redirect\" title=\"Low level laser therapy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Low_level_laser_therapy\">low level laser therapy<\/a>\u00a0is an effective therapy for relieving\u00a0<a title=\"Low back pain\" href=\"https:\/\/en.wikipedia.org\/wiki\/Low_back_pain\">low back pain<\/a>.<sup id=\"cite_ref-Chou_22-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Chou-22\">[22]<\/a><\/sup><sup id=\"cite_ref-23\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-23\">[23]<\/a><\/sup><\/p>\n<h3><span id=\"Interventional_procedures\" class=\"mw-headline\">Interventional procedures<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Interventional procedures\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=10\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\n<div class=\"hatnote navigation-not-searchable\" role=\"note\">Main article:\u00a0<a title=\"Interventional pain management\" href=\"https:\/\/en.wikipedia.org\/wiki\/Interventional_pain_management\">Interventional pain management<\/a><\/div>\n<p>Interventional procedures &#8211; typically used for\u00a0<a title=\"Back pain\" href=\"https:\/\/en.wikipedia.org\/wiki\/Back_pain\">chronic back pain<\/a>\u00a0&#8211; include\u00a0<a class=\"mw-redirect\" title=\"Epidural\" href=\"https:\/\/en.wikipedia.org\/wiki\/Epidural\">epidural steroid injections<\/a>,\u00a0<a title=\"Facet joint injection\" href=\"https:\/\/en.wikipedia.org\/wiki\/Facet_joint_injection\">facet joint injections<\/a>,\u00a0<a title=\"Cordotomy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Cordotomy\">neurolytic blocks<\/a>,\u00a0<a title=\"Spinal cord stimulator\" href=\"https:\/\/en.wikipedia.org\/wiki\/Spinal_cord_stimulator\">spinal cord stimulators<\/a>\u00a0and\u00a0<a class=\"mw-redirect\" title=\"Intrathecal\" href=\"https:\/\/en.wikipedia.org\/wiki\/Intrathecal\">intrathecal<\/a>\u00a0drug delivery system implants.<\/p>\n<p><a title=\"Pulsed radiofrequency\" href=\"https:\/\/en.wikipedia.org\/wiki\/Pulsed_radiofrequency\">Pulsed radiofrequency<\/a>,\u00a0<a title=\"Neuromodulation (medicine)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Neuromodulation_(medicine)\">neuromodulation<\/a>, direct introduction of medication and nerve\u00a0<a title=\"Ablation\" href=\"https:\/\/en.wikipedia.org\/wiki\/Ablation\">ablation<\/a>\u00a0may be used to target either the tissue structures and organ\/systems responsible for persistent\u00a0<a title=\"Nociception\" href=\"https:\/\/en.wikipedia.org\/wiki\/Nociception\">nociception<\/a>\u00a0or the\u00a0<a title=\"Nociceptor\" href=\"https:\/\/en.wikipedia.org\/wiki\/Nociceptor\">nociceptors<\/a>\u00a0from the structures implicated as the source of chronic pain.<sup id=\"cite_ref-Varrassi_G,_Paladini_A_24-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Varrassi_G,_Paladini_A-24\">[24]<\/a><\/sup><sup id=\"cite_ref-Meglio_M._25-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Meglio_M.-25\">[25]<\/a><\/sup><sup id=\"cite_ref-26\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-26\">[26]<\/a><\/sup><sup id=\"cite_ref-Boswell_MV,_Trescott_AM_27-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Boswell_MV,_Trescott_AM-27\">[27]<\/a><\/sup><sup id=\"cite_ref-Romanelli_P,_Esposito_V_28-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Romanelli_P,_Esposito_V-28\">[28]<\/a><\/sup>\u00a0Radiofrequency treatment has been seen to improve pain in patients for facet joint low back pain. However, continuous radiofrequency is more effective in managing pain than pulsed radiofrequency.<sup id=\"cite_ref-29\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-29\">[29]<\/a><\/sup><\/p>\n<p>An\u00a0<a title=\"Intrathecal pump\" href=\"https:\/\/en.wikipedia.org\/wiki\/Intrathecal_pump\">intrathecal pump<\/a>\u00a0used to deliver very small quantities of medications directly to the spinal fluid. This is similar to epidural infusions used in\u00a0<a title=\"Childbirth\" href=\"https:\/\/en.wikipedia.org\/wiki\/Childbirth\">labour<\/a>\u00a0and 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.<sup class=\"noprint Inline-Template Template-Fact\">[<i><a title=\"Wikipedia:Identifying reliable sources (medicine)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Identifying_reliable_sources_(medicine)\"><span title=\"Material near this tag needs references to reliable medical sources. (November 2018)\">medical citation needed<\/span><\/a><\/i>]<\/sup><\/p>\n<p>A\u00a0<a title=\"Spinal cord stimulator\" href=\"https:\/\/en.wikipedia.org\/wiki\/Spinal_cord_stimulator\">spinal cord stimulator<\/a>\u00a0is an implantable medical device that creates electric impulses and applies them near the dorsal surface of the spinal cord provides a\u00a0<a title=\"Paresthesia\" href=\"https:\/\/en.wikipedia.org\/wiki\/Paresthesia\">paresthesia<\/a>\u00a0(&#8220;tingling&#8221;) sensation that alters the perception of pain by the patient.<sup class=\"noprint Inline-Template Template-Fact\">[<i><a title=\"Wikipedia:Identifying reliable sources (medicine)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Identifying_reliable_sources_(medicine)\"><span title=\"Material near this tag needs references to reliable medical sources. (November 2018)\">medical citation needed<\/span><\/a><\/i>]<\/sup><\/p>\n<h3><span id=\"Intra-articular_ozone_therapy\" class=\"mw-headline\">Intra-articular ozone therapy<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Intra-articular ozone therapy\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=11\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\n<p>Intra-articular ozone therapy has been seen to efficiently alleviate chronic pain in patients with knee osteoarthritis.<sup id=\"cite_ref-30\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-30\">[30]<\/a><\/sup><\/p>\n<h2><span id=\"Psychological_approach\" class=\"mw-headline\">Psychological approach<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Psychological approach\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=12\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h2>\n<h3><span id=\"Acceptance_and_Commitment_Therapy\" class=\"mw-headline\">Acceptance and Commitment Therapy<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Acceptance and Commitment Therapy\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=13\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\n<p>Acceptance and Commitment Therapy (ACT) is a form of cognitive behavioral therapy that focuses on behavior change rather than symptom change, includes methods designed to alter the context around psychological experiences rather than to alter the makeup of the experiences, and emphasizes the use of experiential behavior change methods.<sup id=\"cite_ref-:02_31-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:02-31\">[31]<\/a><\/sup>\u00a0The central process in ACT revolves around psychological flexibility, which in turn includes processes of acceptance, awareness, a present-oriented quality in interacting with experiences, an ability to persist or change behavior, and an ability to be guided by one&#8217;s values.<sup id=\"cite_ref-:02_31-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:02-31\">[31]<\/a><\/sup>\u00a0ACT has an increased evidence base for range of health and behavior problems, including chronic pain.<sup id=\"cite_ref-:02_31-2\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:02-31\">[31]<\/a><\/sup>\u00a0ACT influences patients to adopt a tandem process to acceptance and change, which allows for a greater flexibility in the focus of treatment.<sup id=\"cite_ref-:02_31-3\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:02-31\">[31]<\/a><\/sup><\/p>\n<p>Recent research has applied ACT successfully to chronic pain in older adults due to in part of its direction from individual values and being highly customizable to any stage of life.<sup id=\"cite_ref-:02_31-4\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:02-31\">[31]<\/a><\/sup>\u00a0In 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.<sup id=\"cite_ref-:02_31-5\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:02-31\">[31]<\/a><\/sup>\u00a0In 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.<sup id=\"cite_ref-:02_31-6\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:02-31\">[31]<\/a><\/sup><\/p>\n<h3><span id=\"Cognitive_behavioral_therapy\" class=\"mw-headline\">Cognitive behavioral therapy<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Cognitive behavioral therapy\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=14\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\n<p><a title=\"Cognitive behavioral therapy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Cognitive_behavioral_therapy\">Cognitive behavioral therapy<\/a>\u00a0(CBT) helps patients with pain to understand the relationship between their pain, thoughts, emotions, and behaviors. A main goal in treatment is cognitive (thinking, reasoning or remembering) restructuring to encourage helpful thought patterns.<sup id=\"cite_ref-32\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-32\">[32]<\/a><\/sup>\u00a0This 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).<\/p>\n<p>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.<sup id=\"cite_ref-33\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-33\">[33]<\/a><\/sup>\u00a0CBT 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.<sup class=\"noprint Inline-Template Template-Fact\">[<i><a title=\"Wikipedia:Citation needed\" href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\"><span title=\"This claim needs references to reliable sources. (June 2020)\">citation needed<\/span><\/a><\/i>]<\/sup>\u00a0The 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\u00a0<a title=\"Systematic review\" href=\"https:\/\/en.wikipedia.org\/wiki\/Systematic_review\">systematic review<\/a>\u00a0and\u00a0<a title=\"Meta-analysis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Meta-analysis\">meta-analysis<\/a>\u00a0within the field very difficult.<sup id=\"cite_ref-Eccleston1_34-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Eccleston1-34\">[34]<\/a><\/sup><\/p>\n<p>In 2020, a\u00a0<a title=\"Systematic review\" href=\"https:\/\/en.wikipedia.org\/wiki\/Systematic_review\">systematic review<\/a>\u00a0of\u00a0<a title=\"Randomized controlled trial\" href=\"https:\/\/en.wikipedia.org\/wiki\/Randomized_controlled_trial\">randomized controlled trials<\/a>\u00a0(RCTs) evaluated the clinical effectiveness of psychological therapies for the management of adult chronic pain (excluding headaches). There is no evidence that\u00a0<a title=\"Behaviour therapy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Behaviour_therapy\">behaviour therapy<\/a>\u00a0(BT) is effective for reducing this type of pain, however BT may be useful for improving a persons mood immediately after treatment. This improvement appears to be small, and is short term in duration.<sup id=\"cite_ref-:7_35-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:7-35\">[35]<\/a><\/sup>\u00a0CBT may have a small positive short-term effect on pain immediately following treatment. CBT may also have a small effect on reducing\u00a0<a title=\"Disability\" href=\"https:\/\/en.wikipedia.org\/wiki\/Disability\">disability<\/a>\u00a0and potential\u00a0<a title=\"Pain catastrophizing\" href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_catastrophizing\">catastrophizing<\/a>\u00a0that may be associated with adult chronic pain. These benefits do not appear to last very long following the therapy.<sup id=\"cite_ref-:7_35-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:7-35\">[35]<\/a><\/sup>\u00a0CBT may contribute towards improving the mood of an adult who experiences chronic pain, which could possibility be maintained for longer periods of time.<sup id=\"cite_ref-:7_35-2\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:7-35\">[35]<\/a><\/sup><\/p>\n<p>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.<sup id=\"cite_ref-36\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-36\">[36]<\/a><\/sup>\u00a0This beneficial effect may be maintained for at least three months following the therapy.<sup id=\"cite_ref-:3_37-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:3-37\">[37]<\/a><\/sup>\u00a0Psychological treatments may also improve pain control for children or adolescents who experience pain not related to headaches. It is not known if psychological therapy improves a child or adolescents mood and the potential for disability related to their chronic pain.<sup id=\"cite_ref-:3_37-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:3-37\">[37]<\/a><\/sup><\/p>\n<h3><span id=\"Hypnosis\" class=\"mw-headline\">Hypnosis<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Hypnosis\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=15\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\n<p>A 2007 review of 13 studies found evidence for the efficacy of\u00a0<a title=\"Hypnosis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Hypnosis\">hypnosis<\/a>\u00a0in the reduction of pain in some conditions. However the studies had some limitations like small study sizes, bringing up issues of power to detect group differences, and lacking credible controls for placebo or expectation. The authors concluded that &#8220;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.&#8221;<sup id=\"cite_ref-Elkins2007_38-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Elkins2007-38\">[38]<\/a><\/sup><sup class=\"reference\">:283<\/sup><\/p>\n<p>Hypnosis has reduced the pain of some harmful medical procedures in children and adolescents.<sup id=\"cite_ref-Accardi_39-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Accardi-39\">[39]<\/a><\/sup>\u00a0In clinical trials addressing other patient groups, it has significantly reduced pain compared to no treatment or some other non-hypnotic interventions.<sup id=\"cite_ref-APA_40-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-APA-40\">[40]<\/a><\/sup>\u00a0The effects of self hypnosis on chronic pain are roughly comparable to those of progressive muscle relaxation.<sup id=\"cite_ref-Jensen_41-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Jensen-41\">[41]<\/a><\/sup><\/p>\n<p>Hypnosis with analgesic (painkiller) has been seen to relieve chronic pain for most people and may be a safe and effective alternative to medications. However, high quality clinical data is needed to generalize to the whole chronic pain population.<sup id=\"cite_ref-42\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-42\">[42]<\/a><\/sup><\/p>\n<h3><span id=\"Mindfulness_meditation\" class=\"mw-headline\">Mindfulness meditation<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Mindfulness meditation\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=16\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\n<p>A 2013 meta-analysis of studies that used techniques centered around the concept of\u00a0<a class=\"mw-redirect\" title=\"Mindfulness (psychology)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Mindfulness_(psychology)\">mindfulness<\/a>, concluded, &#8220;that MBIs [mindfulness-based interventions] decrease the intensity of pain for chronic pain patients.&#8221;<sup id=\"cite_ref-43\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-43\">[43]<\/a><\/sup>\u00a0A 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.<sup id=\"cite_ref-44\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-44\">[44]<\/a><\/sup><\/p>\n<h3><span id=\"Mindfulness-based_pain_management\" class=\"mw-headline\">Mindfulness-based pain management<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Mindfulness-based pain management\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=17\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\n<p><a title=\"Mindfulness-based pain management\" href=\"https:\/\/en.wikipedia.org\/wiki\/Mindfulness-based_pain_management\">Mindfulness-based pain management<\/a>\u00a0(MBPM) is a mindfulness-based intervention (MBI) providing specific applications for people living with chronic pain and illness.<sup id=\"cite_ref-:5_45-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:5-45\">[45]<\/a><\/sup><sup id=\"cite_ref-:22_46-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:22-46\">[46]<\/a><\/sup>\u00a0Adapting the core concepts and practices of\u00a0<a title=\"Mindfulness-based stress reduction\" href=\"https:\/\/en.wikipedia.org\/wiki\/Mindfulness-based_stress_reduction\">mindfulness-based stress reduction<\/a>\u00a0(MBSR) and\u00a0<a title=\"Mindfulness-based cognitive therapy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Mindfulness-based_cognitive_therapy\">mindfulness-based cognitive therapy<\/a>\u00a0(MBCT), MBPM includes a distinctive emphasis on the practice of &#8216;<a title=\"Maitr\u012b\" href=\"https:\/\/en.wikipedia.org\/wiki\/Maitr%C4%AB\">loving-kindness<\/a>&#8216;, and has been seen as sensitive to concerns about removing mindfulness teaching from its original ethical framework within\u00a0<a title=\"Buddhism\" href=\"https:\/\/en.wikipedia.org\/wiki\/Buddhism\">Buddhism<\/a>.<sup id=\"cite_ref-:5_45-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:5-45\">[45]<\/a><\/sup><sup id=\"cite_ref-:8_47-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:8-47\">[47]<\/a><\/sup>\u00a0It was developed by\u00a0<a title=\"Vidyamala Burch\" href=\"https:\/\/en.wikipedia.org\/wiki\/Vidyamala_Burch\">Vidyamala Burch<\/a>\u00a0and is delivered through the programs of\u00a0<a title=\"Breathworks\" href=\"https:\/\/en.wikipedia.org\/wiki\/Breathworks\">Breathworks<\/a>.<sup id=\"cite_ref-:5_45-2\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:5-45\">[45]<\/a><\/sup><sup id=\"cite_ref-:22_46-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:22-46\">[46]<\/a><\/sup>\u00a0It has been subject to a range of clinical studies demonstrating its effectiveness.<sup id=\"cite_ref-:6_48-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:6-48\">[48]<\/a><\/sup><sup id=\"cite_ref-:16_49-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:16-49\">[49]<\/a><\/sup><sup id=\"cite_ref-:17_50-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:17-50\">[50]<\/a><\/sup><sup id=\"cite_ref-:13_51-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:13-51\">[51]<\/a><\/sup><sup id=\"cite_ref-:14_52-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:14-52\">[52]<\/a><\/sup><sup id=\"cite_ref-:15_53-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:15-53\">[53]<\/a><\/sup><sup id=\"cite_ref-:42_54-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:42-54\">[54]<\/a><\/sup><sup id=\"cite_ref-:5_45-3\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:5-45\">[45]<\/a><\/sup><\/p>\n<h2><span id=\"Medications\" class=\"mw-headline\">Medications<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Medications\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=18\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h2>\n<p>The\u00a0<a title=\"World Health Organization\" href=\"https:\/\/en.wikipedia.org\/wiki\/World_Health_Organization\">World Health Organization<\/a>\u00a0(WHO) recommends a\u00a0<i><a title=\"Pain ladder\" href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_ladder\">pain ladder<\/a><\/i>\u00a0for managing pain relief with pharmaceutical medicine. It was first described for use in\u00a0<a title=\"Cancer pain\" href=\"https:\/\/en.wikipedia.org\/wiki\/Cancer_pain\">cancer pain<\/a>. However it can be used by medical professionals as a general principle when managing any type of pain.<sup id=\"cite_ref-55\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-55\">[55]<\/a><\/sup><sup id=\"cite_ref-HoMBRG_56-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-HoMBRG-56\">[56]<\/a><\/sup>\u00a0In 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.<\/p>\n<table class=\"wikitable sortable jquery-tablesorter\">\n<thead>\n<tr>\n<th colspan=\"4\">Common types of pain and typical drug management<\/th>\n<\/tr>\n<tr>\n<th class=\"headerSort\" title=\"Sort ascending\" role=\"columnheader button\">Pain type<\/th>\n<th class=\"headerSort\" title=\"Sort ascending\" role=\"columnheader button\">typical initial drug treatment<\/th>\n<th class=\"headerSort\" title=\"Sort ascending\" role=\"columnheader button\">comments<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td><a title=\"Headache\" href=\"https:\/\/en.wikipedia.org\/wiki\/Headache\">headache<\/a><\/td>\n<td>paracetamol\u00a0<a class=\"external autonumber\" href=\"http:\/\/aeknil.com\/\" rel=\"nofollow\">[1]<\/a>\/acetaminophen,\u00a0<a class=\"mw-redirect\" title=\"NSAIDs\" href=\"https:\/\/en.wikipedia.org\/wiki\/NSAIDs\">NSAIDs<\/a><sup id=\"cite_ref-BBDchronicpain_57-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\n<td>doctor consultation is appropriate if headaches are severe, persistent, accompanied by fever, vomiting, or speech or balance problems;<sup id=\"cite_ref-BBDchronicpain_57-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup>\u00a0self-medication should be limited to two weeks<sup id=\"cite_ref-BBDchronicpain_57-2\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\n<\/tr>\n<tr>\n<td><a title=\"Migraine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Migraine\">migraine<\/a><\/td>\n<td>paracetamol, NSAIDs<sup id=\"cite_ref-BBDchronicpain_57-3\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\n<td><a class=\"mw-redirect\" title=\"Triptans\" href=\"https:\/\/en.wikipedia.org\/wiki\/Triptans\">triptans<\/a>\u00a0are used when the others do not work, or when migraines are frequent or severe<sup id=\"cite_ref-BBDchronicpain_57-4\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\n<\/tr>\n<tr>\n<td><a class=\"mw-redirect\" title=\"Menstrual cramps\" href=\"https:\/\/en.wikipedia.org\/wiki\/Menstrual_cramps\">menstrual cramps<\/a><\/td>\n<td>NSAIDs<sup id=\"cite_ref-BBDchronicpain_57-5\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\n<td>some NSAIDs are marketed for cramps, but any NSAID would work<sup id=\"cite_ref-BBDchronicpain_57-6\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\n<\/tr>\n<tr>\n<td>minor trauma, such as a\u00a0<a title=\"Bruise\" href=\"https:\/\/en.wikipedia.org\/wiki\/Bruise\">bruise<\/a>,\u00a0<a title=\"Abrasion (medical)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Abrasion_(medical)\">abrasions<\/a>,\u00a0<a title=\"Sprain\" href=\"https:\/\/en.wikipedia.org\/wiki\/Sprain\">sprain<\/a><\/td>\n<td>paracetamol, NSAIDs<sup id=\"cite_ref-BBDchronicpain_57-7\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\n<td>opioids not recommended<sup id=\"cite_ref-BBDchronicpain_57-8\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\n<\/tr>\n<tr>\n<td>severe trauma, such as a\u00a0<a title=\"Wound\" href=\"https:\/\/en.wikipedia.org\/wiki\/Wound\">wound<\/a>,\u00a0<a title=\"Burn\" href=\"https:\/\/en.wikipedia.org\/wiki\/Burn\">burn<\/a>,\u00a0<a title=\"Bone fracture\" href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_fracture\">bone fracture<\/a>, or severe sprain<\/td>\n<td>opioids<sup id=\"cite_ref-BBDchronicpain_57-9\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\n<td>more than two weeks of pain requiring opioid treatment is unusual<sup id=\"cite_ref-BBDchronicpain_57-10\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\n<\/tr>\n<tr>\n<td><a title=\"Strain (injury)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Strain_(injury)\">strain<\/a>\u00a0or pulled muscle<\/td>\n<td>NSAIDs, muscle relaxants<sup id=\"cite_ref-BBDchronicpain_57-11\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\n<td>if inflammation is involved, NSAIDs may work better; short-term use only<sup id=\"cite_ref-BBDchronicpain_57-12\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\n<\/tr>\n<tr>\n<td>minor pain after surgery<\/td>\n<td>paracetamol, NSAIDs<sup id=\"cite_ref-BBDchronicpain_57-13\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\n<td>opioids rarely needed<sup id=\"cite_ref-BBDchronicpain_57-14\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\n<\/tr>\n<tr>\n<td>severe pain after surgery<\/td>\n<td>opioids<sup id=\"cite_ref-BBDchronicpain_57-15\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\n<td>combinations of opioids may be prescribed if pain is severe<sup id=\"cite_ref-BBDchronicpain_57-16\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\n<\/tr>\n<tr>\n<td><a class=\"mw-redirect\" title=\"Muscle ache\" href=\"https:\/\/en.wikipedia.org\/wiki\/Muscle_ache\">muscle ache<\/a><\/td>\n<td>paracetamol, NSAIDs<sup id=\"cite_ref-BBDchronicpain_57-17\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\n<td>if inflammation involved, NSAIDs may work better.<sup id=\"cite_ref-BBDchronicpain_57-18\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\n<\/tr>\n<tr>\n<td><a title=\"Toothache\" href=\"https:\/\/en.wikipedia.org\/wiki\/Toothache\">toothache<\/a>\u00a0or pain from dental procedures<\/td>\n<td>paracetamol, NSAIDs<sup id=\"cite_ref-BBDchronicpain_57-19\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\n<td>this should be short term use; opioids may be necessary for severe pain<sup id=\"cite_ref-BBDchronicpain_57-20\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\n<\/tr>\n<tr>\n<td><a class=\"mw-redirect\" title=\"Kidney stone\" href=\"https:\/\/en.wikipedia.org\/wiki\/Kidney_stone\">kidney stone<\/a>\u00a0pain<\/td>\n<td>paracetamol, NSAIDs, opioids<sup id=\"cite_ref-BBDchronicpain_57-21\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\n<td>opioids usually needed if pain is severe.<sup id=\"cite_ref-BBDchronicpain_57-22\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\n<\/tr>\n<tr>\n<td>pain due to\u00a0<a title=\"Heartburn\" href=\"https:\/\/en.wikipedia.org\/wiki\/Heartburn\">heartburn<\/a>\u00a0or\u00a0<a title=\"Gastroesophageal reflux disease\" href=\"https:\/\/en.wikipedia.org\/wiki\/Gastroesophageal_reflux_disease\">gastroesophageal reflux disease<\/a><\/td>\n<td><a title=\"Antacid\" href=\"https:\/\/en.wikipedia.org\/wiki\/Antacid\">antacid<\/a>,\u00a0<a title=\"H2 antagonist\" href=\"https:\/\/en.wikipedia.org\/wiki\/H2_antagonist\">H2 antagonist<\/a>,\u00a0<a title=\"Proton-pump inhibitor\" href=\"https:\/\/en.wikipedia.org\/wiki\/Proton-pump_inhibitor\">proton-pump inhibitor<\/a><sup id=\"cite_ref-BBDchronicpain_57-23\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\n<td>heartburn lasting more than a week requires medical attention; aspirin and NSAIDs should be avoided<sup id=\"cite_ref-BBDchronicpain_57-24\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\n<\/tr>\n<tr>\n<td>chronic back pain<\/td>\n<td>paracetamol, NSAIDs<sup id=\"cite_ref-BBDchronicpain_57-25\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\n<td>opioids may be necessary if other drugs do not control pain and pain is persistent<sup id=\"cite_ref-BBDchronicpain_57-26\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\n<\/tr>\n<tr>\n<td><a title=\"Osteoarthritis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Osteoarthritis\">osteoarthritis<\/a>\u00a0pain<\/td>\n<td>paracetamol, NSAIDs<sup id=\"cite_ref-BBDchronicpain_57-27\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\n<td>medical attention is recommended if pain persists.<sup id=\"cite_ref-BBDchronicpain_57-28\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\n<\/tr>\n<tr>\n<td><a title=\"Fibromyalgia\" href=\"https:\/\/en.wikipedia.org\/wiki\/Fibromyalgia\">fibromyalgia<\/a><\/td>\n<td><a title=\"Antidepressant\" href=\"https:\/\/en.wikipedia.org\/wiki\/Antidepressant\">antidepressant<\/a>,\u00a0<a title=\"Anticonvulsant\" href=\"https:\/\/en.wikipedia.org\/wiki\/Anticonvulsant\">anticonvulsant<\/a><sup id=\"cite_ref-BBDchronicpain_57-29\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\n<td>evidence suggests that opioids are not effective in treating fibromyalgia<sup id=\"cite_ref-BBDchronicpain_57-30\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-BBDchronicpain-57\">[57]<\/a><\/sup><\/td>\n<\/tr>\n<\/tbody>\n<tfoot><\/tfoot>\n<\/table>\n<h3><span id=\"Mild_pain\" class=\"mw-headline\">Mild pain<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Mild pain\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=19\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\n<p><a title=\"Paracetamol\" href=\"https:\/\/en.wikipedia.org\/wiki\/Paracetamol\">Paracetamol<\/a>\u00a0(acetaminophen), or a\u00a0<a title=\"Nonsteroidal anti-inflammatory drug\" href=\"https:\/\/en.wikipedia.org\/wiki\/Nonsteroidal_anti-inflammatory_drug\">nonsteroidal anti-inflammatory drug<\/a>\u00a0(NSAID) such as\u00a0<a title=\"Ibuprofen\" href=\"https:\/\/en.wikipedia.org\/wiki\/Ibuprofen\">ibuprofen<\/a>\u00a0will relieve mild pain.<sup id=\"cite_ref-58\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-58\">[58]<\/a><\/sup><sup class=\"noprint Inline-Template Template-Fact\">[<i><a title=\"Wikipedia:Citation needed\" href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\"><span title=\"This claim needs references to reliable sources. (June 2020)\">citation needed<\/span><\/a><\/i>]<\/sup><\/p>\n<h3><span id=\"Mild_to_moderate_pain\" class=\"mw-headline\">Mild to moderate pain<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Mild to moderate pain\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=20\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\n<p>Paracetamol, an NSAID or paracetamol in a combination product with a weak\u00a0<a title=\"Opioid\" href=\"https:\/\/en.wikipedia.org\/wiki\/Opioid\">opioid<\/a>\u00a0such as\u00a0<a title=\"Tramadol\" href=\"https:\/\/en.wikipedia.org\/wiki\/Tramadol\">tramadol<\/a>, may provide greater relief than their separate use. A combination of opioid with\u00a0<a title=\"Paracetamol\" href=\"https:\/\/en.wikipedia.org\/wiki\/Paracetamol\">acetaminophen<\/a>\u00a0can be frequently used such as Percocet,\u00a0<a class=\"mw-redirect\" title=\"Vicodin\" href=\"https:\/\/en.wikipedia.org\/wiki\/Vicodin\">Vicodin<\/a>, or Norco.<sup class=\"noprint Inline-Template Template-Fact\">[<i><a title=\"Wikipedia:Citation needed\" href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\"><span title=\"This claim needs references to reliable sources. (June 2020)\">citation needed<\/span><\/a><\/i>]<\/sup><\/p>\n<h3><span id=\"Moderate_to_severe_pain\" class=\"mw-headline\">Moderate to severe pain<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Moderate to severe pain\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=21\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\n<p>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\u00a0<a class=\"mw-redirect\" title=\"Trauma (medicine)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Trauma_(medicine)\">trauma<\/a>\u00a0or to treat\u00a0<a title=\"Surgery\" href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\">post-operative pain<\/a>.\u00a0<a title=\"Chronic pain\" href=\"https:\/\/en.wikipedia.org\/wiki\/Chronic_pain\">Chronic pain<\/a>\u00a0medication is for alleviating long-lasting, ongoing pain.<\/p>\n<p><a title=\"Morphine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Morphine\">Morphine<\/a>\u00a0is the\u00a0<a title=\"Gold standard\" href=\"https:\/\/en.wikipedia.org\/wiki\/Gold_standard\">gold standard<\/a>\u00a0to which all\u00a0<a title=\"Narcotic\" href=\"https:\/\/en.wikipedia.org\/wiki\/Narcotic\">narcotics<\/a>\u00a0are compared. Semi-synthetic derivatives of morphine such as\u00a0<a title=\"Hydromorphone\" href=\"https:\/\/en.wikipedia.org\/wiki\/Hydromorphone\">hydromorphone<\/a>\u00a0(Dilaudid),\u00a0<a title=\"Oxymorphone\" href=\"https:\/\/en.wikipedia.org\/wiki\/Oxymorphone\">oxymorphone<\/a>\u00a0(Numorphan, Opana),\u00a0<a title=\"Nicomorphine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Nicomorphine\">nicomorphine<\/a>\u00a0(Vilan),\u00a0<a title=\"Hydromorphinol\" href=\"https:\/\/en.wikipedia.org\/wiki\/Hydromorphinol\">hydromorphinol<\/a>\u00a0and others vary in such ways as duration of action, side effect profile and milligramme potency.\u00a0<a title=\"Fentanyl\" href=\"https:\/\/en.wikipedia.org\/wiki\/Fentanyl\">Fentanyl<\/a>\u00a0has the benefit of less\u00a0<a title=\"Histamine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Histamine\">histamine<\/a>\u00a0release and thus fewer\u00a0<a title=\"Side effect\" href=\"https:\/\/en.wikipedia.org\/wiki\/Side_effect\">side effects<\/a>. It can also be administered via\u00a0<a title=\"Transdermal patch\" href=\"https:\/\/en.wikipedia.org\/wiki\/Transdermal_patch\">transdermal patch<\/a>\u00a0which is convenient for chronic pain management. In addition to the intrathecal 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).\u00a0<a title=\"Oxycodone\" href=\"https:\/\/en.wikipedia.org\/wiki\/Oxycodone\">Oxycodone<\/a>\u00a0is used across the Americas and Europe for relief of serious chronic pain. Its main slow-release formula is known as\u00a0<a class=\"mw-redirect\" title=\"OxyContin\" href=\"https:\/\/en.wikipedia.org\/wiki\/OxyContin\">OxyContin<\/a>. Short-acting tablets, capsules, syrups and\u00a0<a class=\"mw-redirect\" title=\"Ampule\" href=\"https:\/\/en.wikipedia.org\/wiki\/Ampule\">ampules<\/a>\u00a0which contain OxyContin are available making it suitable for acute intractable pain or\u00a0<a title=\"Pain\" href=\"https:\/\/en.wikipedia.org\/wiki\/Pain#Breakthrough_pain\">breakthrough pain<\/a>.\u00a0<a class=\"mw-redirect\" title=\"Diamorphine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Diamorphine\">Diamorphine<\/a>, and\u00a0<a title=\"Methadone\" href=\"https:\/\/en.wikipedia.org\/wiki\/Methadone\">methadone<\/a>\u00a0are used less frequently.<sup class=\"noprint Inline-Template Template-Fact\">[<i><a title=\"Wikipedia:Citation needed\" href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\"><span title=\"This claim needs references to reliable sources. (January 2010)\">citation needed<\/span><\/a><\/i>]<\/sup>\u00a0Clinical studies have shown that transdermal\u00a0<a title=\"Buprenorphine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Buprenorphine\">Buprenorphine<\/a>\u00a0is effective at reducing chronic pain.<sup id=\"cite_ref-59\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-59\">[59]<\/a><\/sup>\u00a0<a title=\"Pethidine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Pethidine\">Pethidine<\/a>, known in North America as meperidine, is not recommended<sup class=\"noprint Inline-Template\">[<i><a title=\"Wikipedia:Manual of Style\/Words to watch\" href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Manual_of_Style\/Words_to_watch#Unsupported_attributions\"><span title=\"The material near this tag may use weasel words or too-vague attribution. (October 2012)\">by whom?<\/span><\/a><\/i>]<\/sup>\u00a0for pain management due to its low potency, short duration of action, and toxicity associated with repeated use.<sup class=\"noprint Inline-Template Template-Fact\">[<i><a title=\"Wikipedia:Citation needed\" href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\"><span title=\"This claim needs references to reliable sources. (June 2020)\">citation needed<\/span><\/a><\/i>]<\/sup>\u00a0<a title=\"Pentazocine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Pentazocine\">Pentazocine<\/a>,\u00a0<a title=\"Dextromoramide\" href=\"https:\/\/en.wikipedia.org\/wiki\/Dextromoramide\">dextromoramide<\/a>\u00a0and\u00a0<a title=\"Dipipanone\" href=\"https:\/\/en.wikipedia.org\/wiki\/Dipipanone\">dipipanone<\/a>\u00a0are 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\u00a0<a title=\"Piritramide\" href=\"https:\/\/en.wikipedia.org\/wiki\/Piritramide\">piritramide<\/a>\u00a0and\u00a0<a title=\"Ketobemidone\" href=\"https:\/\/en.wikipedia.org\/wiki\/Ketobemidone\">ketobemidone<\/a>\u00a0are used for severe pain.\u00a0<a title=\"Tapentadol\" href=\"https:\/\/en.wikipedia.org\/wiki\/Tapentadol\">Tapentadol<\/a>\u00a0is a newer agent introduced in the last decade.<\/p>\n<p>For moderate pain,\u00a0<a title=\"Tramadol\" href=\"https:\/\/en.wikipedia.org\/wiki\/Tramadol\">tramadol<\/a>,\u00a0<a title=\"Codeine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Codeine\">codeine<\/a>,\u00a0<a title=\"Dihydrocodeine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Dihydrocodeine\">dihydrocodeine<\/a>, and\u00a0<a title=\"Hydrocodone\" href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrocodone\">hydrocodone<\/a>\u00a0are used, with\u00a0<a title=\"Nicocodeine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Nicocodeine\">nicocodeine<\/a>,\u00a0<a title=\"Ethylmorphine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Ethylmorphine\">ethylmorphine<\/a>\u00a0and\u00a0<a class=\"mw-redirect\" title=\"Propoxyphene\" href=\"https:\/\/en.wikipedia.org\/wiki\/Propoxyphene\">propoxyphene<\/a>\u00a0or\u00a0<a title=\"Dextropropoxyphene\" href=\"https:\/\/en.wikipedia.org\/wiki\/Dextropropoxyphene\">dextropropoxyphene<\/a>\u00a0(less commonly).<\/p>\n<p>Drugs of other types can be used to help opioids combat certain types of pain.\u00a0<a title=\"Amitriptyline\" href=\"https:\/\/en.wikipedia.org\/wiki\/Amitriptyline\">Amitriptyline<\/a>\u00a0is prescribed for chronic muscular pain in the arms, legs, neck and lower back with an opiate, or sometimes without it or with an NSAID.<\/p>\n<p>While\u00a0<a title=\"Opiate\" href=\"https:\/\/en.wikipedia.org\/wiki\/Opiate\">opiates<\/a>\u00a0are often used in the management of chronic pain, high doses are associated with an increased risk of\u00a0<a title=\"Opioid overdose\" href=\"https:\/\/en.wikipedia.org\/wiki\/Opioid_overdose\">opioid overdose<\/a>.<sup id=\"cite_ref-60\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-60\">[60]<\/a><\/sup><\/p>\n<h3><span id=\"Opioids\" class=\"mw-headline\">Opioids<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Opioids\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=22\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\n<p>In 2009, the\u00a0<a title=\"Food and Drug Administration\" href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration\">Food and Drug Administration<\/a>\u00a0stated: &#8220;According to the\u00a0<a title=\"National Institutes of Health\" href=\"https:\/\/en.wikipedia.org\/wiki\/National_Institutes_of_Health\">National Institutes of Health<\/a>, 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.&#8221;<sup id=\"cite_ref-61\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-61\">[61]<\/a><\/sup>\u00a0In 2013, the FDA stated that &#8220;abuse and misuse of these products have created a serious and growing public health problem&#8221;.<sup id=\"cite_ref-62\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-62\">[62]<\/a><\/sup><\/p>\n<p><a title=\"Opioid\" href=\"https:\/\/en.wikipedia.org\/wiki\/Opioid\">Opioid<\/a>\u00a0medications 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\u00a0<a class=\"mw-redirect\" title=\"Time release technology\" href=\"https:\/\/en.wikipedia.org\/wiki\/Time_release_technology\">extended release<\/a>\u00a0medication is often prescribed along with a shorter-acting medication (oxycodone, morphine or hydromorphone) for breakthrough pain, or exacerbations.<\/p>\n<p>Most opioid treatment used by patients outside of healthcare settings is oral (<a title=\"Tablet (pharmacy)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Tablet_(pharmacy)\">tablet<\/a>,\u00a0<a title=\"Capsule (pharmacy)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Capsule_(pharmacy)\">capsule<\/a>\u00a0or liquid), but\u00a0<a title=\"Suppository\" href=\"https:\/\/en.wikipedia.org\/wiki\/Suppository\">suppositories<\/a>\u00a0and skin patches can be prescribed. An opioid\u00a0<a title=\"Injection (medicine)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Injection_(medicine)\">injection<\/a>\u00a0is rarely needed for patients with chronic pain.<\/p>\n<p>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.<sup id=\"cite_ref-63\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-63\">[63]<\/a><\/sup>\u00a0However, there are associated adverse effects, especially during the commencement or change in dose. When\u00a0<a class=\"mw-redirect\" title=\"Opioids\" href=\"https:\/\/en.wikipedia.org\/wiki\/Opioids\">opioids<\/a>\u00a0are used for prolonged periods\u00a0<a title=\"Drug tolerance\" href=\"https:\/\/en.wikipedia.org\/wiki\/Drug_tolerance\">drug tolerance<\/a>,\u00a0<a class=\"mw-redirect\" title=\"Chemical dependency\" href=\"https:\/\/en.wikipedia.org\/wiki\/Chemical_dependency\">chemical dependency<\/a>,\u00a0<a title=\"Drug diversion\" href=\"https:\/\/en.wikipedia.org\/wiki\/Drug_diversion\">diversion<\/a>\u00a0and\u00a0<a title=\"Substance use disorder\" href=\"https:\/\/en.wikipedia.org\/wiki\/Substance_use_disorder\">addiction<\/a>\u00a0may occur.<sup id=\"cite_ref-64\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-64\">[64]<\/a><\/sup><sup id=\"cite_ref-65\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-65\">[65]<\/a><\/sup><\/p>\n<p>Clinical guidelines for prescribing opioids for chronic pain have been issued by the\u00a0<a title=\"American Pain Society\" href=\"https:\/\/en.wikipedia.org\/wiki\/American_Pain_Society\">American Pain Society<\/a>\u00a0and 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.<sup id=\"cite_ref-66\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-66\">[66]<\/a><\/sup>\u00a0Physicians 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.<sup id=\"cite_ref-67\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-67\">[67]<\/a><\/sup><\/p>\n<p>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.<\/p>\n<ul>\n<li><a title=\"Oxycodone\" href=\"https:\/\/en.wikipedia.org\/wiki\/Oxycodone\">Oxycodone<\/a>\u00a0(OxyContin)<\/li>\n<li><a title=\"Hydromorphone\" href=\"https:\/\/en.wikipedia.org\/wiki\/Hydromorphone\">Hydromorphone<\/a>\u00a0(Exalgo, Hydromorph Contin,)<\/li>\n<li><a title=\"Morphine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Morphine\">Morphine<\/a>\u00a0(M-Eslon,MS Contin)<\/li>\n<li><a title=\"Oxymorphone\" href=\"https:\/\/en.wikipedia.org\/wiki\/Oxymorphone\">Oxymorphone<\/a>\u00a0(Opana ER)<\/li>\n<li><a title=\"Fentanyl\" href=\"https:\/\/en.wikipedia.org\/wiki\/Fentanyl\">Fentanyl<\/a>, transdermal (Duragesic)<\/li>\n<li><a title=\"Buprenorphine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Buprenorphine\">Buprenorphine<\/a>*, transdermal (Butrans)<\/li>\n<li><a title=\"Tramadol\" href=\"https:\/\/en.wikipedia.org\/wiki\/Tramadol\">Tramadol<\/a>\u00a0(Ultram ER)<\/li>\n<li><a title=\"Tapentadol\" href=\"https:\/\/en.wikipedia.org\/wiki\/Tapentadol\">Tapentadol<\/a>\u00a0(Nucynta ER)<\/li>\n<li><a title=\"Methadone\" href=\"https:\/\/en.wikipedia.org\/wiki\/Methadone\">Methadone<\/a>* (Metadol, Methadose)<\/li>\n<li><a title=\"Hydrocodone\" href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrocodone\">Hydrocodone<\/a>\u00a0bitartrate (Hysingla ER) and bicarbonate (Zohydro ER)<\/li>\n<\/ul>\n<p>*Methadone and buprenorphine are each used both for the treatment of\u00a0<a title=\"Opioid use disorder\" href=\"https:\/\/en.wikipedia.org\/wiki\/Opioid_use_disorder\">opioid addiction<\/a>\u00a0and as analgesics<\/p>\n<h3><span id=\"Nonsteroidal_anti-inflammatory_drugs\" class=\"mw-headline\">Nonsteroidal anti-inflammatory drugs<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Nonsteroidal anti-inflammatory drugs\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=23\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\n<p>The other major group of analgesics are\u00a0<a title=\"Nonsteroidal anti-inflammatory drug\" href=\"https:\/\/en.wikipedia.org\/wiki\/Nonsteroidal_anti-inflammatory_drug\">nonsteroidal anti-inflammatory drugs<\/a>\u00a0(NSAID). They work by inhibiting the release of\u00a0<a title=\"Prostaglandin\" href=\"https:\/\/en.wikipedia.org\/wiki\/Prostaglandin\">prostaglandins<\/a>, which cause inflammatory pain.\u00a0<a class=\"mw-redirect\" title=\"Acetaminophen\" href=\"https:\/\/en.wikipedia.org\/wiki\/Acetaminophen\">Acetaminophen<\/a>\/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\u00a0<a title=\"Ketoprofen\" href=\"https:\/\/en.wikipedia.org\/wiki\/Ketoprofen\">ketoprofen<\/a>\u00a0and\u00a0<a title=\"Piroxicam\" href=\"https:\/\/en.wikipedia.org\/wiki\/Piroxicam\">piroxicam<\/a>\u00a0have limited benefit in chronic pain disorders and with long-term use are associated with significant\u00a0<a title=\"Adverse effect\" href=\"https:\/\/en.wikipedia.org\/wiki\/Adverse_effect\">adverse effects<\/a>. The use of selective NSAIDs designated as\u00a0<a title=\"COX-2 inhibitor\" href=\"https:\/\/en.wikipedia.org\/wiki\/COX-2_inhibitor\">selective COX-2 inhibitors<\/a>\u00a0have significant cardiovascular and cerebrovascular risks which have limited their utilization.<sup id=\"cite_ref-Munir_MA,_Enany_N._68-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Munir_MA,_Enany_N.-68\">[68]<\/a><\/sup><sup id=\"cite_ref-Ballantyne_JC._69-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Ballantyne_JC.-69\">[69]<\/a><\/sup>\u00a0Common NSAIDs include\u00a0<a title=\"Aspirin\" href=\"https:\/\/en.wikipedia.org\/wiki\/Aspirin\">aspirin<\/a>,\u00a0<a title=\"Ibuprofen\" href=\"https:\/\/en.wikipedia.org\/wiki\/Ibuprofen\">ibuprofen<\/a>, and\u00a0<a title=\"Naproxen\" href=\"https:\/\/en.wikipedia.org\/wiki\/Naproxen\">naproxen<\/a>. 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.<sup id=\"cite_ref-70\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-70\">[70]<\/a><\/sup><\/p>\n<h3><span id=\"Antidepressants_and_antiepileptic_drugs\" class=\"mw-headline\">Antidepressants and antiepileptic drugs<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Antidepressants and antiepileptic drugs\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=24\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\n<p>Some\u00a0<a title=\"Antidepressant\" href=\"https:\/\/en.wikipedia.org\/wiki\/Antidepressant\">antidepressant<\/a>\u00a0and\u00a0<a class=\"mw-redirect\" title=\"Antiepileptic\" href=\"https:\/\/en.wikipedia.org\/wiki\/Antiepileptic\">antiepileptic<\/a>\u00a0drugs 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.\u00a0<a class=\"mw-redirect\" title=\"Neuropathy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Neuropathy\">Neuropathy<\/a>\u00a0can be due to chronic high blood sugar levels (<a title=\"Diabetic neuropathy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Diabetic_neuropathy\">diabetic neuropathy<\/a>). These drugs also reduce pain from viruses such as shingles,\u00a0<a class=\"mw-redirect\" title=\"Phantom limb pain\" href=\"https:\/\/en.wikipedia.org\/wiki\/Phantom_limb_pain\">phantom limb pain<\/a>\u00a0and post-stroke pain.<sup id=\"cite_ref-71\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-71\">[71]<\/a><\/sup>\u00a0These mechanisms vary and in general are more effective in\u00a0<a class=\"mw-redirect\" title=\"Neuropathy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Neuropathy\">neuropathic<\/a>\u00a0pain disorders as well as\u00a0<a title=\"Complex regional pain syndrome\" href=\"https:\/\/en.wikipedia.org\/wiki\/Complex_regional_pain_syndrome\">complex regional pain syndrome<\/a>.<sup id=\"cite_ref-Jackson_KC_2nd._72-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Jackson_KC_2nd.-72\">[72]<\/a><\/sup>\u00a0A common anti-epileptic drug is\u00a0<a title=\"Gabapentin\" href=\"https:\/\/en.wikipedia.org\/wiki\/Gabapentin\">gabapentin<\/a>, and an example of an antidepressant would be\u00a0<a title=\"Amitriptyline\" href=\"https:\/\/en.wikipedia.org\/wiki\/Amitriptyline\">amitriptyline<\/a>.<\/p>\n<h3><span id=\"Cannabinoids\" class=\"mw-headline\">Cannabinoids<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Cannabinoids\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=25\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\n<p>Evidence of medical marijuana&#8217;s effect on reducing pain is generally conclusive. Detailed in a 1999 report by the\u00a0<a class=\"mw-redirect\" title=\"Institute of Medicine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Institute_of_Medicine\">Institute of Medicine<\/a>, &#8220;the available evidence from animal and human studies indicates that cannabinoids can have a substantial analgesic effect&#8221;.<sup id=\"cite_ref-73\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-73\">[73]<\/a><\/sup>\u00a0In a 2013 review study published in\u00a0<i>Fundamental &amp; Clinical Pharmacology<\/i>, various studies were cited in demonstrating that cannabinoids exhibit comparable effectiveness to opioids in models of acute pain and even greater effectiveness in models of chronic pain.<sup id=\"cite_ref-74\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-74\">[74]<\/a><\/sup><\/p>\n<h3><span id=\"Other_analgesics\" class=\"mw-headline\">Other analgesics<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Other analgesics\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=26\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\n<p>Other drugs which can potentiate conventional analgesics or have analgesic properties in certain circumstances are called\u00a0<a title=\"Analgesic adjuvant\" href=\"https:\/\/en.wikipedia.org\/wiki\/Analgesic_adjuvant\">analgesic adjuvant<\/a>\u00a0medications.<sup id=\"cite_ref-:9_75-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:9-75\">[75]<\/a><\/sup>\u00a0<a title=\"Gabapentin\" href=\"https:\/\/en.wikipedia.org\/wiki\/Gabapentin\">Gabapentin<\/a>, an anticonvulsant, can reduce neuropathic pain itself and can also potentiate opiates.<sup id=\"cite_ref-gabapentin_76-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-gabapentin-76\">[76]<\/a><\/sup>\u00a0Drugs with\u00a0<a title=\"Anticholinergic\" href=\"https:\/\/en.wikipedia.org\/wiki\/Anticholinergic\">anticholinergic<\/a>\u00a0activity, such as\u00a0<a title=\"Orphenadrine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Orphenadrine\">orphenadrine<\/a>,\u00a0<a title=\"Cyclobenzaprine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Cyclobenzaprine\">cyclobenzaprine<\/a>, and\u00a0<a title=\"Trazodone\" href=\"https:\/\/en.wikipedia.org\/wiki\/Trazodone\">trazodone<\/a>, are given in conjunction with opioids for neuropathic pain. Orphenadrine and cyclobenzaprine are also\u00a0<a title=\"Muscle relaxant\" href=\"https:\/\/en.wikipedia.org\/wiki\/Muscle_relaxant\">muscle relaxants<\/a>, and are useful in painful musculoskeletal conditions.\u00a0<a title=\"Clonidine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Clonidine\">Clonidine<\/a>, an alpha-2 receptor agonist, is another drug that has found use as an analgesic adjuvant.<sup id=\"cite_ref-:9_75-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:9-75\">[75]<\/a><\/sup><\/p>\n<h2><span id=\"Self-management\" class=\"mw-headline\">Self-management<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Self-management\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=27\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h2>\n<p>Self-management of chronic pain has been described as the individual&#8217;s ability to manage various aspects of their chronic pain.<sup id=\"cite_ref-:4_77-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:4-77\">[77]<\/a><\/sup>\u00a0Self-management can include building self-efficacy, monitoring one&#8217;s own symptoms, goal setting and action planning. It also includes patient-physician shared decision-making, among others.<sup id=\"cite_ref-:4_77-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:4-77\">[77]<\/a><\/sup>\u00a0The benefits of self-management vary depending on self-management techniques used. They only have marginal benefits in management of chronic musculoskeletal pain.<sup id=\"cite_ref-78\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-78\">[78]<\/a><\/sup><\/p>\n<h2><span id=\"Society_and_culture\" class=\"mw-headline\">Society and culture<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Society and culture\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=28\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h2>\n<p>The medical treatment of pain as practiced in\u00a0<a title=\"Greece\" href=\"https:\/\/en.wikipedia.org\/wiki\/Greece\">Greece<\/a>\u00a0and\u00a0<a title=\"Turkey\" href=\"https:\/\/en.wikipedia.org\/wiki\/Turkey\">Turkey<\/a>\u00a0is called\u00a0<b>algology<\/b>\u00a0(from the Greek \u03ac\u03bb\u03b3\u03bf\u03c2,\u00a0<a title=\"Algos\" href=\"https:\/\/en.wikipedia.org\/wiki\/Algos\">algos<\/a>, &#8220;<a title=\"Pain\" href=\"https:\/\/en.wikipedia.org\/wiki\/Pain\">pain<\/a>&#8220;). The Hellenic Society of Algology<sup id=\"cite_ref-79\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-79\">[79]<\/a><\/sup>\u00a0and the Turkish Algology-Pain Society<sup id=\"cite_ref-80\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-80\">[80]<\/a><\/sup>\u00a0are the relevant local bodies affiliated to the\u00a0<a title=\"International Association for the Study of Pain\" href=\"https:\/\/en.wikipedia.org\/wiki\/International_Association_for_the_Study_of_Pain\">International Association for the Study of Pain<\/a>\u00a0(IASP).<sup id=\"cite_ref-81\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-81\">[81]<\/a><\/sup><\/p>\n<h3><span id=\"Undertreatment\" class=\"mw-headline\">Undertreatment<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: Undertreatment\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=29\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\n<div class=\"hatnote navigation-not-searchable\" role=\"note\">Main article:\u00a0<a title=\"Undertreatment of pain\" href=\"https:\/\/en.wikipedia.org\/wiki\/Undertreatment_of_pain\">Undertreatment of pain<\/a><\/div>\n<p>Undertreatment of pain is the absence of pain management therapy for a person in\u00a0<a title=\"Pain\" href=\"https:\/\/en.wikipedia.org\/wiki\/Pain\">pain<\/a>\u00a0when treatment is\u00a0<a title=\"Indication (medicine)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Indication_(medicine)\">indicated<\/a>.<\/p>\n<p>Consensus in\u00a0<a title=\"Evidence-based medicine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Evidence-based_medicine\">evidence-based medicine<\/a>\u00a0and the recommendations of\u00a0<a title=\"Medical specialty\" href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_specialty\">medical specialty<\/a>\u00a0organizations establish guidelines to determine the treatment for pain which health care providers ought to offer.<sup id=\"cite_ref-State_of_Pain_Treatment_2011_82-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-State_of_Pain_Treatment_2011-82\">[82]<\/a><\/sup>\u00a0For various social reasons, persons in pain may not seek or may not be able to access treatment for their pain.<sup id=\"cite_ref-State_of_Pain_Treatment_2011_82-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-State_of_Pain_Treatment_2011-82\">[82]<\/a><\/sup>\u00a0The Joint Commission, which has long recognized nonpharmacological approaches to pain, emphasizes the importance of strategies needed to facilitate both access and coverage to nonpharmacological therapies. Users of nonpharmacological therapy for pain management generally have lower insurance expenditures than those who did not use them.<sup id=\"cite_ref-:2_83-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:2-83\">[83]<\/a><\/sup>\u00a0At the same time, health care providers may not provide the treatment which authorities recommend.<sup id=\"cite_ref-State_of_Pain_Treatment_2011_82-2\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-State_of_Pain_Treatment_2011-82\">[82]<\/a><\/sup>\u00a0The need for an informed strategy including all evidence-based comprehensive pain care is demonstrated to be in the patients&#8217; best interest. Healthcare providers&#8217; failure to educate patients and recommend nonpharmacologic care should be considered unethical.<sup id=\"cite_ref-:2_83-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-:2-83\">[83]<\/a><\/sup><\/p>\n<h3><span id=\"In_children\" class=\"mw-headline\">In children<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">[<\/span><a title=\"Edit section: In children\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Pain_management&amp;action=edit&amp;section=30\">edit<\/a><span class=\"mw-editsection-bracket\">]<\/span><\/span><\/h3>\n<div class=\"hatnote navigation-not-searchable\" role=\"note\">Main article:\u00a0<a title=\"Pain management in children\" href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management_in_children\">Pain management in children<\/a><\/div>\n<p>Acute pain is common in children and adolescents as a result of injury, illness, or necessary medical procedures.<sup id=\"cite_ref-AAP._84-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-AAP.-84\">[84]<\/a><\/sup>\u00a0<a title=\"Chronic pain\" href=\"https:\/\/en.wikipedia.org\/wiki\/Chronic_pain\">Chronic pain<\/a>\u00a0is present in approximately 15\u201325% of children and adolescents. It may be caused by an underlying disease, such as\u00a0<a class=\"mw-redirect\" title=\"Sickle cell anemia\" href=\"https:\/\/en.wikipedia.org\/wiki\/Sickle_cell_anemia\">sickle cell anemia<\/a>,\u00a0<a title=\"Cystic fibrosis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Cystic_fibrosis\">cystic fibrosis<\/a>,\u00a0<a title=\"Rheumatoid arthritis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Rheumatoid_arthritis\">rheumatoid arthritis<\/a>. Cancer or\u00a0<a title=\"Functional disorder\" href=\"https:\/\/en.wikipedia.org\/wiki\/Functional_disorder\">functional disorders<\/a>\u00a0such as migraines,\u00a0<a title=\"Fibromyalgia\" href=\"https:\/\/en.wikipedia.org\/wiki\/Fibromyalgia\">fibromyalgia<\/a>, and complex regional pain could also cause chronic pain in children.<sup id=\"cite_ref-Weydert_85-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Weydert-85\">[85]<\/a><\/sup><\/p>\n<dl>\n<dt>Assessment<\/dt>\n<\/dl>\n<div class=\"thumb tright\">\n<div class=\"thumbinner\"><a class=\"image\" href=\"https:\/\/en.wikipedia.org\/wiki\/File:Children%27s_pain_scale.JPG\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage aligncenter\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a7\/Children%27s_pain_scale.JPG\/400px-Children%27s_pain_scale.JPG\" alt=\"\" width=\"400\" height=\"155\" \/><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\" style=\"text-align: center\"><\/div>\n<p>Young children can indicate their level of pain by pointing to the appropriate face on a children&#8217;s pain scale.<sup id=\"cite_ref-86\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-86\">[86]<\/a><\/sup><\/div>\n<\/div>\n<\/div>\n<p>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&#8217;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.<sup id=\"cite_ref-AMA_87-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-AMA-87\">[87]<\/a><\/sup>\u00a0Questionnaires for older children and adolescents include the Varni-Thompson Pediatric Pain Questionnaire (PPQ) and the Children\u2019s Comprehensive Pain Questionnaire. They are often utilized for individuals with chronic or persistent pain.<sup id=\"cite_ref-AMA_87-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-AMA-87\">[87]<\/a><\/sup><\/p>\n<dl>\n<dt>Nonpharmacologic<\/dt>\n<\/dl>\n<p>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,\u00a0<a title=\"Massage\" href=\"https:\/\/en.wikipedia.org\/wiki\/Massage\">massage<\/a>, or\u00a0<a title=\"Acupuncture\" href=\"https:\/\/en.wikipedia.org\/wiki\/Acupuncture\">acupuncture<\/a>.<sup id=\"cite_ref-Wente._88-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Wente.-88\">[88]<\/a><\/sup>\u00a0<a title=\"Cognitive behavioral therapy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Cognitive_behavioral_therapy\">Cognitive behavioral therapy<\/a>\u00a0(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\u00a0<a class=\"mw-redirect\" title=\"Coping (psychology)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Coping_(psychology)\">coping<\/a>\u00a0strategies. Integrated interventions in CBT include\u00a0<a class=\"mw-redirect\" title=\"Relaxation training\" href=\"https:\/\/en.wikipedia.org\/wiki\/Relaxation_training\">relaxation technique<\/a>,\u00a0<a title=\"Mindfulness\" href=\"https:\/\/en.wikipedia.org\/wiki\/Mindfulness\">mindfulness<\/a>,\u00a0<a title=\"Biofeedback\" href=\"https:\/\/en.wikipedia.org\/wiki\/Biofeedback\">biofeedback<\/a>, and\u00a0<a title=\"Acceptance\" href=\"https:\/\/en.wikipedia.org\/wiki\/Acceptance\">acceptance<\/a>\u00a0(in the case of chronic pain).<sup id=\"cite_ref-Zagustin_89-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Zagustin-89\">[89]<\/a><\/sup>\u00a0Many therapists will hold sessions for caregivers to provide them with effective management strategies.<sup id=\"cite_ref-Weydert_85-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-Weydert-85\">[85]<\/a><\/sup><\/p>\n<dl>\n<dt>Pharmacologic<\/dt>\n<\/dl>\n<p>Acetaminophen,\u00a0<a class=\"mw-redirect\" title=\"Nonsteroidal anti-inflammatory agents\" href=\"https:\/\/en.wikipedia.org\/wiki\/Nonsteroidal_anti-inflammatory_agents\">nonsteroidal anti-inflammatory agents<\/a>, and\u00a0<a title=\"Opioid\" href=\"https:\/\/en.wikipedia.org\/wiki\/Opioid\">opioid analgesics<\/a>\u00a0are commonly used to treat acute or chronic pain symptoms in children and adolescents. However a pediatrician should be consulted before administering any medication.<sup id=\"cite_ref-AMA_87-2\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management#cite_note-AMA-87\">[87]<\/a><\/sup><\/p>\n\n\t\t\t <section class=\"citations-section\" role=\"contentinfo\">\n\t\t\t <h3>Candela Citations<\/h3>\n\t\t\t\t\t <div>\n\t\t\t\t\t\t <div id=\"citation-list-300\">\n\t\t\t\t\t\t\t <div class=\"licensing\"><div class=\"license-attribution-dropdown-subheading\">Public domain content<\/div><ul class=\"citation-list\"><li><strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management\">https:\/\/en.wikipedia.org\/wiki\/Pain_management<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><\/ul><\/div>\n\t\t\t\t\t\t <\/div>\n\t\t\t\t\t <\/div>\n\t\t\t <\/section>","protected":false},"author":142337,"menu_order":2,"template":"","meta":{"_candela_citation":"[{\"type\":\"pd\",\"description\":\"\",\"author\":\"\",\"organization\":\"\",\"url\":\"https:\/\/en.wikipedia.org\/wiki\/Pain_management\",\"project\":\"\",\"license\":\"cc-by-sa\",\"license_terms\":\"\"}]","CANDELA_OUTCOMES_GUID":"","pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-300","chapter","type-chapter","status-publish","hentry"],"part":101,"_links":{"self":[{"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/pressbooks\/v2\/chapters\/300","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/wp\/v2\/users\/142337"}],"version-history":[{"count":1,"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/pressbooks\/v2\/chapters\/300\/revisions"}],"predecessor-version":[{"id":301,"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/pressbooks\/v2\/chapters\/300\/revisions\/301"}],"part":[{"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/pressbooks\/v2\/parts\/101"}],"metadata":[{"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/pressbooks\/v2\/chapters\/300\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/wp\/v2\/media?parent=300"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/pressbooks\/v2\/chapter-type?post=300"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/wp\/v2\/contributor?post=300"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/wp\/v2\/license?post=300"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}