Pain Core Curriculum Module 2: Basic Tenets of Pain Treatment for Common Chronic Pain Conditions-Presentation

Video Transcription

Video Summary

Dr. Roger Chow presents an evidence-based overview of chronic pain management from a socio-psychobiological perspective, emphasizing that chronic pain is influenced by biological, psychological, and social factors. Effective chronic pain treatment prioritizes improving function over eliminating pain, using a combination of active therapies—like cognitive behavioral therapy (CBT), exercise, meditation, and interdisciplinary rehabilitation—and adjunctive passive therapies such as acupuncture, massage, and spinal manipulation. Pharmacological treatments, including NSAIDs, SNRIs, gabapentinoids, and cautious use of opioids, play a limited role and should be individualized considering benefits and risks. Opioids carry high risk and are not first or second-line treatments for conditions like low back pain. Psychological factors like anxiety, depression, and fear-avoidance behaviors significantly affect pain outcomes and must be addressed. CBT targets maladaptive thoughts and behaviors, providing small to moderate improvements in pain, function, and mood. Exercise combats fear avoidance and enhances overall health. Interdisciplinary rehabilitation combines physical and psychological treatments for refractory cases. Physical modalities often lack consistent evidence and should complement active treatments if used. An example case illustrates a stepwise, multimodal approach to persistent low back pain, showing improvement through combined therapies. Overall, managing chronic pain requires a patient-centered, multimodal strategy emphasizing self-care, addressing psychosocial factors, functional goals, and careful pharmacologic use.

Keywords

chronic pain management

socio-psychobiological perspective

cognitive behavioral therapy

interdisciplinary rehabilitation

pharmacological treatments

opioid risks

psychological factors

multimodal treatment approach