Chronic Pain Management Guidelines
Non-Pharmacologic Therapies
- The American College of Physicians recommends cognitive behavioral therapy (CBT) as a first-line non-pharmacologic therapy for chronic pain management, promoting adaptive behaviors and addressing maladaptive pain-related thoughts 1, 2, 3
- The Centers for Disease Control and Prevention (CDC) suggests physical and occupational therapy as foundational treatments for chronic pain management 1, 2, 3
- The National Institutes of Health (NIH) recommends yoga specifically for chronic neck/back pain, headache, rheumatoid arthritis, and musculoskeletal pain 1, 2, 3
- Exercise therapy is recommended to reduce pain and improve function in osteoarthritis, low back pain, and fibromyalgia 4, 5
Pharmacologic Therapies for Chronic Pain
- The American Academy of Neurology recommends gabapentin as the first-line oral treatment for neuropathic pain, titrating to 1800-3600 mg/day in divided doses 1, 3, 6
- Pregabalin is an alternative for inadequate gabapentin response or post-herpetic neuralgia, according to the American Academy of Neurology 1, 3, 6
- The American Pain Society recommends capsaicin 8% topical patch for localized neuropathic pain, providing up to 12 weeks of relief with a single 30-minute application 1, 3, 6
- Acetaminophen is recommended as first-line treatment for osteoarthritis and low back pain, with a maximum daily dose of 3-4 grams to avoid hepatotoxicity risk, according to the CDC 4, 5
- NSAIDs are effective for musculoskeletal pain but carry gastrointestinal, renal, and cardiovascular risks that increase with duration and dose, as noted by the FDA 4, 5
Treatment Algorithms and Multimodal Therapy
- The CDC recommends initiating non-pharmacologic therapies first, including CBT, physical therapy, and condition-specific exercise programs 1, 4, 2
- The American College of Physicians suggests adding first-line pharmacotherapy based on pain type, such as gabapentin for neuropathic pain or acetaminophen for musculoskeletal pain 1, 3, 6
- Multimodal therapy combining pharmacologic and non-pharmacologic approaches is more effective than single modalities, according to the NIH 4, 5