Management of chronic pain in primary care

Abstract

To examine recent and current evidence available to guide the management of chronic pain in primary care. The growing profile of chronic pain has facilitated some important consensus and guideline statements. Pharmacological management, based on available evidence and consensus, is essential in managing chronic pain in primary care, as part of a holistic approach, and with regular review. Studies of primary care management of chronic pain face considerable challenges, with assessment and interventions that are complex, and involving multidisciplinary approaches. Recent research evidence points to the effectiveness and feasibility of multidisciplinary interventions, with appropriate assessment and training. Specifically, a self-management programme, 'collaborative care', a cognitive-behavioural approach, and the Alexander technique show evidence of effectiveness in primary care, the latter two also proving cost-effective. Most chronic pain presents and is managed in primary care; yet, most evidence for its management is difficult to apply in the primary care setting. Despite growing evidence for the management of chronic pain generally, management in primary care must be largely guided by consensus, experience, and judicious extrapolation from research in other contexts or conditions. A need for increased and on-going education and resources is apparent, as is the need for more research based in primary care.