Update in Pain Medicine for Primary Care Providers: A Narrative Review, 2010–2012

Authors

  • Joseph W. Frank MD, MPH,

    Corresponding author
    1. Denver VA Medical Center, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
    • Reprint requests to: Joseph W. Frank, MD, MPH, Division of General Internal Medicine, University of Colorado School of Medicine, 8th floor, Academic Office 1, Mailstop B180, 12631 E. 17th Avenue, Aurora, CO 80045, USA. Tel: (317) 509-0071; Fax: (303) 724 2270; E-mail: joseph.frank@ucdenver.edu.

    Search for more papers by this author
  • Matthew J. Bair MD, MS,

    1. Roudebush VA Medical Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
    Search for more papers by this author
  • William C. Becker MD,

    1. VA Connecticut Healthcare System, Yale University School of Medicine, New Haven, Connecticut, USA
    Search for more papers by this author
  • Erin E. Krebs MD, MPH,

    1. Minneapolis VA Medical Center, University of Minnesota Medical School, Minneapolis, Minnesota, USA
    Search for more papers by this author
  • Jane M. Liebschutz MD, MPH,

    1. Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
    2. Boston University School of Public Health, Boston, Massachusetts, USA
    Search for more papers by this author
  • Daniel P. Alford MD, MPH

    1. Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
    Search for more papers by this author

  • Disclosure: The authors report no potential conflicts of interest.

Abstract

Objective

This manuscript reviews peer-reviewed literature published from 2010–2012 relevant to the management of chronic pain in the primary care setting.

Design

Narrative review of peer-reviewed literature.

Methods

We searched MEDLINE, PubMed, and reference lists and queried expert contacts for English-language studies related to the management of chronic noncancer pain in adult patients in primary care settings. One investigator reviewed all eligible studies for relevance, and 47 studies were reviewed by all authors and rated according to their impact on 1) primary care clinical practice, 2) policy, 3) research, and 4) quality of study methods. Through iterative discussion, nine articles were selected for detailed review and discussion.

Results

We present articles in six topic areas: interventional pain management; opioid dose and risk of overdose death; neuropathic pain; yoga for chronic low back pain; cognitive behavioral therapy; and systematic approaches to treating back pain. We discuss implications for pain management in primary care.

Conclusions

There is growing evidence for the risks, benefits, and limitations of the multiple modalities available to primary care providers for the management of chronic pain. The dissemination and implementation of the evidence from these studies as well as novel system-level interventions warrant additional study and support from clinicians, educators, and policy makers.

Ancillary