Handbook of Pain Syndromes: Biopsychosocial Perspectives

By Andrew R. Block; Edwin F. Kremer et al. | Go to book overview

Chapter 8
Pharmacological Treatment in Chronic Pain

Harold Merskey

London Health Sciences Centre

Dwight Moulin

London Health Sciences Centre

As in many books on pain, the contents list of this volume and the range of disciplines of contributors bear witness to the need for a comprehensive approach to the management of chronic pain. The psychological causes and consequences of chronic pain--the latter probably being more important than the former--occur in practice cheek by jowl with both physical and psychological treatments. Among the physical treatments, and especially so with the common diagnoses of musculoskeletal disorders, general and specific exercises take pride of place for moral and (dare we say it?) politically correct reasons. Which is not to say that exercise is unimportant but only that it should not become a shibboleth.

Another shibboleth holds that drug treatments are bad and morally suspect, and the more psychotropic or more narcotic the drug, the more this is the case. These attitudes reflect concerns that should be taken into account, but not to the extent of disturbing the standard balanced view, which is that a combination of psychological techniques, exercise, other physical measures, and medication is required to provide the best available pattern of treatment for patients seeking help in the care of chronic pain. The purpose of this chapter is, of course, to provide information on pharmacological matters. In doing so we regard the importance of the other treatments as established, and not requiring discussion here because it is provided elsewhere in this volume.

As the contents list also makes clear there are many taxonomic categories of pain. Pain is arranged there both by system (gastrointestinal disorders and

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