Abstract:
Chronic pain of uncertain etiology often presents a challenge to both patients and
their health care providers. It is a complex condition influenced by structural and physiological
changes in the peripheral and central nervous systems, and it directly influences, and is
modulated by, psychological well-being and personality style, mood, sleep, activity level and
social circumstances. Consequently, in order to effectively treat the pain, all of these need to
be evaluated and addressed. An effective management strategy takes a multidisciplinary
biopsychosocial approach, with review of all current medications and identification and
careful withdrawal of those that may actually be contributing to ongoing pain. The management
approach is primarily nonpharmacological, with carefully considered addition of
medication, beginning with pain-modulating treatments, if necessary. In this article, we
present a primary care approach to the assessment and management of a patient with chronic
pain where the cause cannot be identified.
