Consider referring any patient with chronic pain to a psychologist or therapist to address the psychological effects of chronic pain.

Neuropathic pain: pain caused by abnormal neural activity that arises secondary to injury, disease, or dysfunction of the nervous system

Acupuncture. Acupuncture in traditional Chinese medicine uses the insertion of needles into specific areas to manipulate anatomical energetic meridians. The nature of the psychological effect continues to be debated, but efficacy has been established for many chronic pain conditions.

Herbal supplements. Patients frequently request information about herbal supplements. The evidence for the use of some supplements is growing. Many are safe and may be considered when patients are interested. See Table seis.

Anticonvulsants are useful adjuncts in the management of neuropathic pain. They typically will not be helpful for acute pain, rather are more commonly used for chronic neuropathic pain.

Plan for treatment of reinjury or exacerbation during the subacute pain phase. Often subacute pain occurs with increase in activity before tissue is completely restored to health.

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Key to developing an effective treatment plan is a supportive relationship with an empathetic clinician who acknowledges and empathizes with the patient’s experience. Set expectations regarding the available treatments for chronic pain. Establish realistic treatment goals for functional improvement or maintenance, not analgesia alone.

When cravings hit, divert your attention with activities like exercise, listening to music, or engaging in hobbies. Keeping your mind and hands busy helps reduce the urge to smoke. The goal is to replace the habit with a healthier alternative.

Many patients with chronic pain have long and sometimes complex treatment histories. Obtain a full history, website including:

Self-regulatory and psychophysiological approaches. The experience of chronic pain elicits strong physiological reactions that are often accompanied by cognitive thoughts and processes.

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If you have a cigarette with your morning coffee or on your afternoon work break, rethink what you do during those times.