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June 20, 2017

Primary Care of Patients With Chronic Pain

Author Affiliations
  • 1University of Michigan Health System, Ann Arbor
  • 2University of Nevada, Reno School of Medicine
JAMA. 2017;317(23):2367-2368. doi:10.1001/jama.2017.5787

Primary care physicians have the responsibility for the care of patients with chronic pain, often in follow-up to an episode of acute pain treated in an urgent care center, emergency department, or specialty clinic setting. The lack of a full understanding of how chronic pain differs from acute pain can lead to all pain being treated as acute pain, often with opioids. The current widespread use of opioids is essentially a case-finding system that identifies the roughly one-sixth of the adult population particularly susceptible to opioid misuse, sometimes leading to escalating doses, a shift to illegal nonprescription opioids, addiction, and unintentional overdose.1 The solution to this crisis is not simply a more responsible approach to the use of opioids but rather a comprehensive approach based on an understanding of chronic pain pathophysiology that emphasizes the patient-physician relationship, shared decision making, nonpharmacological treatments, and selective use of nonopioid pharmacotherapy.

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