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7439066 
Journal Article 
Management of Chronic Pain: Medication 
Hall, BH; , 
2020 
Springer International Publishing 
Cham 
Evaluation and Management of Chronic Pain for Primary Care 
49-81 
The pharmacological management of chronic pain begins with diagnosing the pain as neuropathic or nociceptive. There is a general consensus amongst experts that neuropathic pain can be treated with first line agents such as tricyclic antidepressants (TCAs), anticonvulsants, and selective serotonin norepinephrine reuptake inhibitors. Nociceptive pain is pain arising outside of the nervous system as a result of dysfunction (inflammation, musculoskeletal, compressive etiologies). This is a heterogeneous group of disorders and treatment is based on diagnosis. Pharmacological classes often used in nociceptive pain include nonsteroidal anti-inflammatory medications and acetaminophen. Second line agents include the adjunctives used in neuropathic pain: TCA’s, anticonvulsants, and SNRIs. The pharmacology and metabolism of opioids are described in detail. The cytochrome enzyme system may metabolize some opioids, causing potential drug interactions. Some opioids have metabolites such as hydromorphone, making interpretation of drug tests challenging. Opioid therapy can cause harm to many body systems. The long term benefits of opioid therapy are not known. The decision to offer chronic opioid therapy must be individualized. Chronic opioid therapy does not need to be offered for every patient with chronic pain if risks outweigh the benefits.