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- Develop an explicit treatment plan including specific and realistic goals for therapy, e.g., getting a good night's sleep, being able to go shopping, or returning to work.
- A multidisciplinary approach that utilizes medications, counseling, physical therapy, nerve blocks, and even surgery may be required to improve quality of life.
- Psychological evaluation is key; behaviorally based treatment paradigms are frequently helpful.
- Some pts may require referral to a pain clinic; for others, pharmacologic management alone can provide significant help.
- Tricyclic antidepressants are useful in management of chronic pain from many causes, including headache, diabetic neuropathy, postherpetic neuralgia, chronic low back pain, cancer, and central post-stroke pain.
- Anticonvulsants or antiarrhythmics benefit pts with neuropathic pain (e.g., diabetic neuropathy, trigeminal neuralgia).
- The long-term use of opioids is accepted for pain due to malignant disease, but is controversial for chronic pain of nonmalignant origin.
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