Choose initial drug therapy based on pain intensity and patient-specific pathophysiology, risks, and drug interactions. Begin therapy with acetaminophen or NSAIDs in most patients with mild pain and with opioids in most patients with severe pain.
Use opioids alone or in combination with non-opioids (as in multimodal therapy) for patients with severe pain or pain despite maximal non-opioid therapy, and for patients who cannot tolerate non-opioids or for whom the harms outweigh the benefits.
Consider adjuvant analgesics for specific types of pain including tricyclic antidepressants or gabapentin for neuropathic or chronic pain.
Consider cutaneous techniques such as the application of ice and heat, especially for pain associated with muscle spasm or tension.
Use a multimodal approach including drug therapy and other therapeutic interventions such as acupuncture, ablative techniques, and blocks in patients with chronic pain.
Predict, recognize, and treat side effects of opioids, including nausea, constipation, somnolence, ataxia, and pruritus.
Realize that psychological dependence (addiction) may occur in patients who receive opioids for pain control.
Understand “drug seeking” behavior, drug abuse, misuse, or diversion, and doctor shopping; concepts of tolerance and psychological dependence (addiction); and monitor for each regularly.