Algorithm: Chronic non-cancer pain diagnosis-targeted therapy

TENS: transcutaneous electrical nerve stimulation; CBT: cognitive behavioral therapy; MBSR: mindfulness-based stress reduction; NSAIDs: nonsteroidal antiinflammatory drugs; SNRIs: serotonin-norepinephrine reuptake inhibitors.
* For patients with very impactful pain, multimodal therapy with early addition of pharmacologic therapy may be appropriate.
¶ Nociceptive pain is caused by stimuli that threaten or result from body tissue damage and is associated with a range of musculoskeletal and visceral conditions that involve inflammatory, ischemic, infectious, or mechanical/compressive injury.
Neuropathic pain consists of a central and/or peripheral disorder of pain modulation. Patients often describe neuropathic pain as tingling or pins and needles, burning, and shooting or electric shock. Physical examination often reveals allodynia or hyperalgesia.
Central sensitization involves altered central pain processing and modulation and can cause allodynia, hyperalgesia, and reduced effectiveness of pain therapies.
Δ The choice among treatments for neuropathic pain should be based on the pain condition (if known), patient comorbid conditions, concurrent medications, medication side effect profile, cost, and patient preference regarding dosing frequency. Central sensitization involves altered central pain processing and modulation and can cause allodynia, hyperalgesia, and reduced effectiveness of pain therapies.
◊ If NSAIDs are ineffective in patients with presumed nociceptive pain, the possibility of neuropathic pain or central sensitization should be considered, and a trial of a pain-relieving antidepressant or antiseizure medication may be appropriate.