Chronic pain is defined as persistent pain that lasts longer than three to six months, and/or outlast the normal time of healing (Hylands-White et al., 2016). Chronic pain can be present without any obvious physical damage, and/or without any apparent medical explanation. Chronic pain differs from acute pain in that chronic pain is persistent and more complex to manage. Chronic pain is thought to affect nearly 1 in 5 individuals, and up to 1 in 3 older individuals, in some populations. Chronic pain has been further classified as nociceptive, neuropathic, and idiopathic. Nociceptive chronic pain arises from damage to non-neural tissue, and involves activation of pain receptors. Neuropathic chronic pain is caused by damage to or disease of the nervous system, while idiopathic chronic pain is characterized by a pain that cannot be clearly defined. Chronic pain can be classified as active or remitted based on the duration of chronic pain.
Pain is thought to affect one in seven individuals globally, accounting for physical, emotional, and social impairment. The prevalence of many pain conditions, including chronic pain, is often higher in women than men. Chronic pain is thought to affect nearly one in five individuals, and up to one in three older individuals, in some populations. Common chronic pain conditions, such as back pain or arthritis, often go unreported and untreated. Chronic pain can severely affect physical function and health, mood and emotions, sleep, work and daily activities, as well as social life and relationships. Chronic pain can become a stand-alone condition that requires management in its own right. Currently, the most effective management strategies take a holistic approach, addressing chronic pain physiologically, psychologically, and socially.
Definition and Types of Chronic Pain
The purpose of this section is to define chronic pain, describe different types of chronic pain, and address some nuances associated with those definitions. Chronic pain is generally understood to be pain that persists beyond the usual course of acute illness or injury (Hylands-White et al., 2016). The International Association for the Study of Pain defines chronic pain as that which lasts longer than three months. However, this three-month demarcation should be understood as a convenient categorization rather than an absolute boundary. Underlying anachronisms in classification schemes are also addressed, as it is recognized that pain syndromes such as fibromyalgia and arthritis represent the diversity of experiences in chronic pain. Chronic pain is categorized into nociceptive pain, neuropathic pain, and psychosomatic pain. Nociceptive pain is usually caused by inflammation or physical injury to somatic or visceral tissues, which then evokes pain stimuli via nociceptors. Neuropathic pain is usually caused by inflammatory or physical trauma to the nervous system and is characterized by paraesthesias, dysesthesias, and allodynia—aberrant pain stimuli either inappropriately perceived or perceived at a lower stimulus threshold (Rahman et al., 2023). Many consider psychosomatic or psychogenic pain to be purely aberrant pain perceptions caused by psychological issues. However, stress, anxiety, and depression can amplify pain stimuli, and pain may be experienced as wholly somatic even when there are no organic injuries. Thus, the biopsychosocial model is suggested for chronic pain assessment. In considering chronic nociceptive pain, some nuances associated with inflammatory pain versus injury-related pain are laid out. Acute inflammatory pain usually presents as a continuum of sensations, while acute injury-related pain has nuances associated with injury location and nature. Similarly, it is discussed how the terms used in the International Classification of Diseases describe chronic nociceptive pain syndromes poorly.
Prevalence and Impact
Chronic pain, defined as pain lasting longer than 3–6 months, affects an estimated 15–45% of the general adult population. Higher prevalence rates are associated with older age, female sex, being divorced or widowed, low education, low income, and living in rural areas. Chronic pain affects more than 50% of the older population and up to 80% of nursing home residents. Estimates for chronic pain prevalence among individuals with neurological conditions range from 11 to 99%. In stroke survivors, the prevalence of chronic pain is estimated to be between 10 and 59%. In multiple sclerosis, the most commonly reported chronic pain conditions are musculoskeletal pain, heat sensitivity pain, and paresthesia (tingling sensation) or pain (Rahman et al., 2023).
Globally, chronic pain does not come without significant personal and economic burden, affecting more than thirty percent of the world population. Chronic pain is associated with substantial healthcare costs, lost productivity, and disability. In individuals suffering from chronic pain, there is often an interplay of decreased productivity, increased healthcare costs, comorbid psychiatric conditions (such as suicide ideation, anxiety, and depression), and other life changes affecting personal and familial relationships. Personal stories or testimonials demonstrating life before and after chronic pain, or during chronic pain flares, are essential to accentuate the emotional and psychological aspects of chronic pain (I. Johnson, 2019). Literature Research has shown how chronic pain affects everyday life, work, emotional health, and relationships. These stories capture the lifestyle “turning points,” describing how chronic pain is often inadequately controlled despite treatment escalation and how chronic pain leads to feelings of hopelessness. Overall, topics addressing the prevalence of chronic pain, what chronic pain is, and the current challenges in appropriately managing chronic pain are the most relevant and impactful for the audience.
Understanding the Mechanisms of Chronic Pain
Chronic pain is a complex experience with many underlying mechanisms. Understanding these mechanisms helps set the stage for examining techniques and treatments to manage chronic pain. Four major aspects of the pain experience provide a scientific framework for considering its complexity: pain transmission and modulation, the understanding of which is essential for grasping the mechanisms of chronic pain; sensitization and central pain processing; the importance of the nervous system in understanding pain and its management; the role of emotion and cognition as part of the pain experience and coping; (D. Greenwald and M. Shafritz, 2018) the need to understand the biological, psychological, and social interplay of pain in its management throughout life. These aspects do not form empirically discrete categories, but the breakdown helps clarify the issues involved in examining pain techniques and treatments.
Neurophysiological processes are involved in the transmission and modulation of pain. Noxious stimuli excite free nerve endings associated with dorsal root ganglia in the periphery. Stimulation initiates action potentials that propagate along Aδ and C fibers. Aδ fibers convey sharp pain and are myelinated for fast conduction. C fibers convey dull, aching pain and are unmyelinated with slow conduction. In the spinal cord, the dorsal horns contain the terminations of primary afferents and second-order projection neurons that convey pain information to the brain. In the brainstem, processes from descending systems modulate spinal transmission. Neurotransmitters such as substance P and glutamate are involved in the transmission process. A wide array of mediators modulate pain, affecting its intensity and quality (Roditi and E Robinson, 2011). Chronic pain can result from changes at the nerve level.
Neurophysiology of Pain
Peripheral nociceptive input is transduced by specialized sensory neurons, so called nociceptors. Nociceptors are unmyelinated (C-fibers) or thinly myelinated (Aδ) primary afferent neurons whose peripheral terminals express a range of receptors sensitive to noxious thermal, mechanical, and chemical stimuli. When activated, nociceptors discharge action potentials that propagate centripetally, transmitting pain signals to the spinal cord and brainstem. In the spinal cord, nociceptive inputs mainly synapse onto excitatory projection neurons that release glutamate and substance P onto two key neuropeptide expressing neuronal populations in the spinal dorsal horn. Dorsal horn neurons integrate convergent inputs from nociceptors and non-nociceptive primary afferents and from descending pathways originating from the brainstem and forebrain, shaping the transmission and modulation of nociceptive signals in a lamina-specific manner. Dorsal horn projection neurons primarily give rise to long ascending pathways to the brain, mediating the perception of pain (D. Greenwald and M. Shafritz, 2018). Other local circuits contribute to both the feed-forward and feedback inhibition of dorsal horn projection neurons, serving to limit the spread of nociceptive information and to process it in a temporal manner.
Nociceptive inputs activate a range of spinal interneurons, both excitatory and inhibitory. The latter are classified as gamma-aminobutyric acid (GABA)ergic or glycinergic. Spinal projection neurons integrate excitatory and inhibitory inputs and transmit pain signals along ascending pathways to the brain. Both peripheral and central mechanisms are implicated in the development of chronic pain. Acute pain is a protective mechanism that facilitates recovery from injury. Neurologically, acute pain is characterized by the transient activation of a particular population of nociceptive-specific and wide dynamic range dorsal horn neurons. Nociceptive inputs evoke action potential firing in dorsal horn projection neurons, which then activate ascending pathways to the brain, resulting in the perception of pain. Chronic pain is pathologically amplified pain sensitivity that persists long after recovery from injury. Neurologically, chronic pain is characterized by the aberrant activation of pain signaling pathways, where pro-inflammatory cytokines, growth factors, and other mediators released in response to tissue or nerve injury alter the activity and connectivity of dorsal horn neurons and their input excitatory and inhibitory circuits.
Dorsal horn plasticity enhances the efficacy of synaptic transmission in pain signaling pathways. Central sensitization is the most studied mechanism for altered pain signaling. Key mechanisms for central sensitization include an increase in neurotransmitter release and receptor sensitivity in pain signaling pathways and the addition of new receptors. Neurotransmitters and neuromodulators involved in central sensitization include glutamate, neurokinins, brain-derived neurotrophic factor, serotonin, and prostaglandin E2. Many of these molecules exert their actions via neuroplasticity-associated signaling cascades, including increased intracellular calcium, protein kinase C, mitogen-activated protein kinases, and nitric oxide. As a result of these cascades, pro-inflammatory mediators activate pain signaling pathways, leading to the activation of protein kinases that phosphorylate glutamate receptors, ion channels, or intracellular signaling proteins, altering their activity or localization. Long-term potentiation (LTP)-like changes in the efficacy of glutamatergic synaptic transmission in pain signaling pathways have been observed in both experimental and pathological conditions, which, along with alterations in the excitatory input of pain signaling pathways, play a key role in the development and maintenance of chronic pain. Pain-induced LTP involves the activation of NMDA receptors, calcium influx, and the activation of calcium-dependent proteases and kinases. Neurogenic inflammation is an immune response induced by the release of pro-inflammatory mediators from the peripheral terminals of injured primary afferent neurons. This process enhances nociceptive transmission and is involved in the maintenance of inflammatory pain.
Psychological Factors
Physical health and psychological health are interconnected. For example, when an individual becomes unwell, low in energy, or suffers from an injury or chronic pain, it will affect their emotional state. Similarly, if someone is stressed or anxious, their body may respond with a racing heart or tight shoulders. The complex relationship between an individual’s mind and body plays a significant role in how they experience chronic pain (Roditi and E Robinson, 2011).
To better understand how psychological factors influence the experience of pain, it is necessary to explore the role of cognitive and emotional aspects. The role of cognitive processes, such as attention, beliefs, and expectations about pain, will be examined to understand how these factors can shape an individual’s perception of pain. Furthermore, emotional factors – stress, anxiety, depression – will be explored to illustrate how they can have a direct impact on pain severity and coping strategies.
Chronic pain can create a vicious cycle, as individuals with chronic pain often experience higher levels of emotional distress. Individuals with chronic pain employ maladaptive coping mechanisms that inadvertently make the pain worse. For example, an individual may avoid activity because it exacerbates their pain, but this can lead to muscle weakness and, ultimately, increased pain. Psychological interventions, such as cognitive-behavioral therapy, can help patients counter negative thought patterns and better manage chronic pain.
A comprehensive pain management plan should address psychological factors as well as physical ones. Understanding the psychological factors involved in chronic pain can improve patient outcomes and quality of life. The experience of chronic pain can be better understood by addressing how both physical health and psychological health impact one another. A holistic approach to chronic pain treatment will be advocated, as it is vital to encompass everything from physical health to psychological health.
Non-Pharmacological Approaches
A variety of non-pharmacological approaches could alleviate chronic pain. These strategies are useful compliments to medical treatments. Different options are described below for consideration.
Physical therapy and exercise are vital chronic pain interventions. Remaining mobile and maintaining functional capacity reduces chronic pain levels. Evidence-based physical therapy techniques include: stretching and strengthening exercises; aerobic exercise; and manual therapy. One study found those receiving exercise had less disability than those who did not. Group exercise was shown to be effective for lower back pain. A review of 47 studies found that flexibility, strengthening, and functional training on a daily basis enhanced physical and psychosocial function and reduced pain. Manual therapy minimizes pain and restores mobilization through passive movement. A review of 30 studies found manual therapy was as effective as physical therapy for neck pain.
Mindfulness and meditation practices enhance emotional regulation and recovery from distress. These strategies involve observing thoughts, emotions, and bodily sensations to increase awareness. By developing awareness of pain, perception of pain weakens. One review shows that mindfulness-based interventions greatly improve chronic pain. A meta-analysis found that mindfulness decreased pain and improved quality of life among fibromyalgia patients. There is also evidence meditation practice boosts grey matter in areas of pain regulation. It is therefore reasonable to attempt daily meditation or a local class for those suffering chronic pain.
Alternative approaches are efficacious and growing in acceptance for pain management. Acupuncture is an invasive therapy that reduces pain through stimulation. A review found acupuncture effective for back pain, headache, and arthritis. A similar review also found acupuncture effective for chronic pain. Massage therapy manipulates muscles and tissues to alleviate pain. A meta-analysis found massage therapy significantly improved chronic back pain. A another review highlighted its effectiveness for fibromyalgia. Both acupuncture and massage therapy are recommended treatments by the American Pain Society (Tajerian and David Clark, 2017).
Personalized treatment plans broadly encompassing these options are most effective for chronic pain. Treatments should be tailored to individual needs. Patient engagement and education is essential for utilizing these strategies effectively. While one-on-one classes are always beneficial, resources such as books and online videos better enable self-directed trials (M Bove et al., 2018). Chronic pain remains a challenging problem but a multifaceted approach greatly enhances the well-being of those who suffer.
Physical Therapy and Exercise
Chronic pain can significantly affect quality of life, independence, and mental well-being. It can arise from accidents, diseases, or become self-perpetuating over time. A personalized treatment plan, based on patient history and pain interference, is essential for optimal management. Patients should be actively involved and educated about their condition. Professional input plays a vital role in pain management, starting with general practitioners who can refer patients to specific professionals. Physical therapists play a crucial role in chronic pain management, conducting in-depth evaluations, designing treatments, and facilitating recovery through exercise and education (De la Corte-Rodriguez et al., 2024). Chronic pain is not only unpleasant but can also provoke negative emotions such as anxiety, depression, stress, and anger. These feelings are naturally expressed through different behaviors, which, when exaggerated, can interfere with daily life and lead to avoidance behavior and emotional withdrawal. Moreover, chronic pain can change perception, cognition, and attention, with a tendency to magnify pain signals while localizing and identifying them inaccurately.
Physical therapy addresses the physiological, psychological, and social aspects of chronic pain. Education is an essential component of treatment, helping patients learn about the mechanisms and effects of their pain and how it can change. This knowledge can alleviate fears and anxieties, empowering patients to take control of their rehabilitation. Chronic pain treatments should be personalized, as each case is unique. Considerations such as pain location and intensity, medical history, personality traits, and coping strategies should be taken into account. When trained professionals prescribe treatment, patients are more likely to adhere to it diligently. Safe exercises should be gradually introduced alongside treatments involving education, manual therapy, and other techniques. Exercises improve joint circulation and speed, encourage optimal postures, and strengthen muscles to prevent future injuries. It is vital that precautions and barriers to physical activity be addressed so that patients understand how to exercise safely. If pain exacerbates during exercises, patients should be advised that only modest increases in pain are acceptable. Some patients fear that exercising will worsen their pain and feel discouraged when they experience pain following an exercise. Exercise-induced pain is often localized to the same area where pain is felt chronically but should dissipate within 24 hours post-exercise.
Mindfulness and Meditation
Mindfulness and meditation are psychological and physiological techniques that have been suggested to alleviate chronic pain. Mindfulness cultivates an awareness of the present moment and an acceptance of what is occurring (Wright Voss et al., 2019). Mindfulness is not overly sympathetic or hostile to pain; it is a technique that can help with pain management and foster feelings of peace. Mindfulness practices have been demonstrated to reduce pain perception, as well as psychological distress such as anxiety, depression, and fear of movement (A. Paley and I. Johnson, 2023). A growing body of evidence supports the claim that mindfulness practices reduce the negative judgments surrounding pain and thereby reduce its perception. Mindfulness may also circumvent the neuroplastic changes caused by chronic pain by promoting a differential brain processing state. These practices are easy and simple to incorporate into everyday life and can be done just about anywhere. Mindfulness does not necessarily require a completely quiet room; mindfulness can be practiced anywhere from an office cubicle to a busy train. In addition to mindfulness, other forms of meditation such as guided imagery, body scanning, and progressive muscle relaxation techniques could all foster comfort, relaxation, and peace, creating an inner sanctuary where nothing else matters but that inner space, especially when pain becomes overwhelming. Guided imagery involves envisaging calming scenes, recalling a place that promotes safety, warmth, or tranquility that engages the five senses. Body scanning consists of mentally scanning the body to foster awareness and relaxation; it usually starts at the feet, slowly moving to the head while focusing on each body part, noting aches or pains, and allowing those parts to relax. Progressive muscle relaxation involves tense and relaxing various muscle groups to promote physical relaxation, usually starting from the feet and moving up to the head. All of these meditative practices can be achieved in as little as five minutes, and though practice is essential, a person can gain a sense of control over chronic pain. There are several ways to implement these techniques. Simple techniques only require several minutes and can be easily integrated into daily life. For instance, being mindful while brushing teeth or in the shower can be practiced by focusing entirely on the task at hand, noticing how it feels to hold the toothbrush, how the bristles feel against the teeth, and focusing on every action involved in the task, rather than worrying about what lies ahead in the day. Eating can also be an excellent opportunity to practice mindfulness; paying full attention to the texture and flavors of the food rather than eating on autopilot while working is a great way to enhance mindfulness. Other daily routines such as walking, waiting, or playing with children can also be transformed into moments of mindfulness. It may be easier to practice meditation with trained professionals who can guide patients through the techniques, ensuring everything is done correctly and maximizing the benefits of the practice. For ill patients, it might be best to seek out a support group or institution that focuses on mindfulness and meditation practices. Mindfulness and meditation address the physical aspect of chronic pain and the emotional aspects neglected by conventional treatments. Although prescription and over-the-counter medications address the physical aspects, a mental component still exists. Mindfulness and meditation are valuable tools that comprehensively address chronic pain. Since chronic pain consists of both physical and emotional components, chronic pain should be approached with treatments targeting both.
Pharmacological Treatments
Chronic pain is characterized by persistent pain lasting beyond the expected healing time of an injury or illness, often exceeding three to six months. It can arise from various causes, including injuries, infections, muscle and joint disorders, nerve diseases, cancer, and other medical conditions. Chronic pain can develop without a clear underlying pathology, as typically seen with headaches or fibromyalgia. Regardless of its origin, chronic pain can severely impact the quality of life and daily activities, becoming a disease in its own right (M Alorfi, 2023). Both clinical observations and scientific research advancements have heightened awareness of chronic pain as complex health conditions involving multiple physiological systems and requiring various therapeutic approaches. The treatment of chronic pain should ideally be devised and coordinated by a physician with specialized training and expertise, considering the associated comorbidities and concerns. Assessment and treatment decisions should involve a multidisciplinary team, including educated health professionals with complementary knowledge and skills in rehabilitation, exercise therapy, psychology, pharmacology, and neurophysiology. This overview emphasizes the role of medications in mitigating chronic pain and highlights how pharmacological treatments integrate into a broader pain management strategy. A comprehensive summary of how various medications can alleviate chronic pain is provided, focusing on the class of medications, mode of action, and delivery route. Additionally, emerging research guiding pharmacological treatment options is reviewed.
Commonly Used Medications
Chronic pain is a common condition that can severely impact the quality of life. However, there are often complex underlying factors involved. This text focuses on a basic understanding of pain, treatments, and how to best utilize them for patient benefits. Pain can generally be classified as acute or chronic based on its duration. Acute pain is temporary and typically resolves as the underlying cause heals. While chronic pain generally exceeds three to six months, it may also occur in the absence of obvious injury or illness. Pain ratings on an eleven-point scale from zero (no pain) to ten (worst possible pain) can guide treatment decisions. A rating of zero to three indicates mild pain, four to six moderate pain, and seven or greater severe pain. Simple analgesics usually suffice for mildly painful conditions, while stronger medications or adjuvants might be needed for moderate to severe pain (M Alorfi, 2023).
Medications for the treatment of chronic pain can be classified into four basic groups: non-opioid analgesics, opioid analgesics, adjuvant analgesics, and corticosteroids. Non-opioid analgesics are commonly used to manage mild to moderate pain. The two most widely used non-opioid analgesics are non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen. NSAIDs inhibit the cyclooxygenase enzymes, which lowers the production of inflammatory prostaglandins. Therefore, these medications are effective for treating pain due to inflammation. With acetaminophen, the exact mechanism of action remains unclear. Still, it is thought to work centrally by inhibiting a cyclooxygenase variant with more significant activity in the brain. Indications for use include mild to moderate pain or as an adjunct to opioid analgesics for severe pain. Since these medications do not cause sedation, they are often the first choice for pain management. However, patient safety should be ensured by careful assessment of risks when using these medications, as potentially serious side effects can occur even in patients without prior risk factors. For example, NSAIDs can cause upper gastrointestinal bleeding, peptic ulcers, acute kidney injury, and heart failure exacerbation.
Adjuvant analgesics are medications not primarily intended for pain but have proven effective in this regard. Most commonly, antidepressants and anticonvulsants are used for managing neuropathic pain, resulting from damage or disease affecting the somatosensory system. Evidence of the antinociceptive effect of different antidepressants exists, but most efficacy and safety evidence is available for the tricyclic antidepressants. Anticonvulsants, especially gabapentinoids, are also commonly used for chronic pain. The preclinical and clinical efficacy of gabapentinoids in neuropathic pain conditions is well-documented, making them an adequate choice for such pain. Topical treatments are an emerging area of interest in pain management. These are medications in cream or patch form that exert their action primarily on the skin, resulting in minimal systemic blood levels and side effects. These treatments typically involve NSAIDs but also capsaicin and lidocaine. Unlike oral NSAIDs, topical NSAIDs have proven effective and are safer for patients at higher risk for gastrointestinal complications when using systemic NSAIDs.
Opioid Therapy
Opioids are considered for patients suffering severe pain or whose pain has not responded to other treatments. Opioids have significant analgesic effects; however, there are also significant risks associated with their use. Opioids come in a variety of classes. Full agonists including, for example, morphine, oxycodone, and fentanyl, and less commonly used full agonists such as hydromorphone, oxymorphone, and tapentadol can be used for chronic pain control (Khan and Mehan, 2021). There are short-acting and long-acting formulations of most opioids. Short acting opioids are appropriate for use in patients with intermittent pain. Long-acting opioids are generally used for patients with chronic pain that is not well controlled with non-opioid analgesics or for whom non-opioid analgesics are contraindicated. Methadone is a unique long-acting opioid that can be very effective for certain pain syndromes but is rarely used for chronic pain due to the risks associated with its use. Thorough consideration of the potential side effects of opioids prior to prescribing them is crucial for patient safety. Side effects common to most opioids include constipation, sedation, nausea, vomiting, pruritis, and confusion. Opioids also have a well-described dose-dependent risk for causing respiratory depression in some patients. Respiratory depression from opioids is usually the result of initiating therapy in a patient with adequate pain control. Respiratory depression can also occur during dose escalation if the patient develops tolerance poorly. Finally, the use of opioids carries the risk of dependency. Opioids can lead to physical dependence characterized by withdrawal symptoms in patients who are on opioids chronically and subsequently stop taking them or reduce the dose too rapidly. Opioid use can also lead to psychological dependence and addiction in some patients. In general, it is critical to monitor all patients on opioid therapy carefully. Opioid therapy should be regularly reassessed to determine whether the benefits still outweigh the risks. The dose of the opioid should generally not be increased until the patient has been reassessed in person, although brief exceptions may be warranted in some cases. To reduce risk and enhance treatment efficacy, guidelines and best practices have been developed to assist clinicians in prescribing opioids responsibly (O. Coffin et al., 2022). In general, opioids should only be prescribed after non-opioid analgesics and non-pharmacologic treatments have been considered. If an opioid is to be prescribed, an immediate-release formulation should generally be chosen, and the lowest effective dose should be prescribed. After initiation, careful monitoring for efficacy and side effects should occur, and patients should be reassessed within three to four weeks of starting therapy. Most patients will require a dose increase after starting opioid therapy due to the development of tolerance to many side effects. Patients on high doses of opioids need to be monitored particularly closely as the need for dose increases is an indicator of potentially problematic opioid use/misuse. Opioid should be tapered and discontinued in patients with escalating doses or concerning behavior. Finally, it is important to explore and discuss treatment options other than opioids in patients on them long term.
Emerging Therapies and Technologies
Innovative therapies and technologies, including neuromodulation, digital health, regenerative medicine, and a growing focus on multidisciplinary pain strategies, are becoming more common in chronic pain management. Spinal cord stimulation and peripheral nerve stimulation, with new waveforms and approaches, are being used in structural and bilateral neurostimulation approaches (R. Deer et al., 2019). Dorsal root ganglion stimulation, now with FDA approval, offers new pain regions to target. Transcranial magnetic stimulation, approved for migraines and designed for at-home use, may help address the epidemic/technological approach to chronic pain. Mobile applications for pain tracking, health behavior modification, medication education, and monitoring side effects are being embraced by hospitals and practices. Telehealth services are also gaining momentum for follow-ups and counseling. While unproven and experimental, regenerative medicine techniques like stem cell therapy and platelet-rich plasma injections are relatively safe and easy to implement until definitive proof is available. Education and research focus on the growing importance of collaborative treatment for complex diseases like chronic pain, utilizing all available skills from various healthcare branches. Patients would benefit from a collaborative multi/disciplinary approach where any healthcare provider can contribute to pain management. Ongoing studies and clinical trials bring hope for new solutions in treating chronic pain. Combining existing and innovative strategies can lead to better outcomes for patients with intractable pain. It is imperative for healthcare providers to stay up to date on new treatment options and procedures and for patients to be aware of emerging possibilities.
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