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Chronic pain

From theory to practical management

From the Departments of Neurology and Anesthesia and the Pain Clinical Research Center, University of California, San Francisco, CA.
Supported by NIDA grant DA-01696 and NINDS grant NS21445.
Address correspondence and reprint requests to Dr. Michael C. Rowbotham, UCSF Pain Clinical Research Center, 2233 Post Street, Suite 104, San Francisco, CA 94115.

The neurologist is an important part of the pain management team.Factors that can alter presentation and complicate establishing a diagnosis are reviewed. A multidisciplinary approach to evaluation is advocated, particularly the inclusion of independent psychiatric or psychological evaluation. Treatment planning consists of addressing potential sources of failure of pain management, setting appropriate goals, and using the diagnostic assessment to plan pharmacologic and nonpharmacologic interventions based on pain mechanisms. Even if pharmacologic interventions do not alter pain, an education-oriented behavioral pain program integrated with physical therapy can improve function and foster self-reliance in controlling pain.

NEUROLOGY 1995;45(suppl 9): S5-S10

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