Treatment of acute pain in general medical practice

Abstract

One-third of patients attending a general practitioner’s office have some type of medical problem associated with pain. The most common types of acute pain in patients who consult a general practitioner are musculoskeletal pain in the neck and lower back with or without irradiation to the extremities and joint pain. The primary source of pain is very difficult to ascertain in the usual outpatient setting. However, therapeutic strategies do not directly depend on the primary source of pain, but are based on the pathogenetic mechanisms of pain. Acute nociceptive pain is often accompanied by inflammation, which is a key component of the transition of acute pain to the chronic phase, which should be taken into account when choosing therapeutic strategies. To date, the mechanisms associated with chronic pain are not fully understood due to their complex nature and the involvement of both peripheral and central mechanisms. In addition, complex interacting individual physical (age, female gender and overweight) and psychological factors also affect the transition from acute to chronic pain. The clinical management of acute pain requires an optimal balance between effective pain relief and the associated safety risks. Non-steroidal anti-inflammatory drugs are the most effective drugs for the relief of inflammatory pain. To achieve optimal results, a personalized approach is needed to ensure that the properties of the drugs best match the patient’s characteristics. Because of its multifactorial mechanism of analgesic action, nimesulide is an attractive therapeutic choice for the treatment of patients with acute pain.