Chronic pain is a broad term encompassing many nociceptive, inflammatory, and neuropathic pain subtypes that can result from complex mechanisms affecting multiple pathophysiological pathways in the peripheral and central nervous systems; such complexity leads to difficulty for physicians in determining the mechanisms causing pain and, consequently, in finding an effective treatment for each patient. Primary care physicians and pain specialists use several drug classes, including antiepileptics, antidepressants, NSAIDs, and opioid analgesics, largely in an escalating sequence to provide adequate analgesia to patients, each of whom responds differently to available therapies based on individual pain etiologies. Opioid analgesics remain the class leader in treating chronic pain, although recent efforts in the United States to curb problems with overprescribing of opioid analgesics and to reduce the risk of abuse/misuse associated with these therapies have had a small but steadily growing impact on prescribing of this class for chronic pain patients with a history of, or at high risk of, abuse.


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