Chronic Pain Management
What Is It?
Persistent pain lasting more than 3 months, often without clear ongoing tissue damage. Involves central sensitization. Conditions: chronic low back pain, fibromyalgia, chronic headache, neuropathic pain, post-surgical pain. Biopsychosocial approach required.
How Is It Diagnosed?
Comprehensive pain assessment: location, quality, severity (NRS 0-10), aggravating/relieving factors, functional impact. PEG scale. Psychological screening (PHQ-9, GAD-7). Rule out treatable structural or inflammatory causes.
How Is It Treated?
Multimodal: physical therapy, CBT, mindfulness, pain neuroscience education. Pharmacology: SNRIs (duloxetine, venlafaxine), TCAs, gabapentinoids, topical agents. Opioids: last resort, structured monitoring with UDS and PDMP check.
Tests and Imaging Typically Needed
Targeted labs per pain cause. X-ray or MRI if structural cause suspected. UDS for patients on controlled substances. PDMP review.
Approximate Self-Pay Costs
Office visit: $95-$150. Labs and imaging vary by cause. Physical therapy varies. Duloxetine (generic): $15-$30/month.