University of Lynchburg DMSc Doctoral Project Assignment Repository

University of Lynchburg DMSc Doctoral Project Assignment Repository


Primary Care


Dr. Tom Colletti



Purpose: This article aims to review the best treatment options available to optimize the pain management of common sources encountered in primary care.

Method: A PubMed literature search was conducted with search terms such as pain management, primary care, low back pain, neuropathy, peripheral neuropathy, and chronic pain. Several combinations of these terms were employed. Numerous recent relevant articles were reviewed and utilized for the foundation of this clinical review.

Results: The use of non-pharmacological treatments should be first-line for chronic (non-acute) musculoskeletal pain. It is achieved with a combination of physical and occupational therapy, acupuncture, massage therapy, chiropractic treatment, transcutaneous electric nerve stimulation, and behavioral or cognitive therapy. The addition of topical pain-relieving medications can be initiated at that time. Second-line options usually consist of a form of non-steroidal anti-inflammatory agents (NSAIDs). Depending on the type of pain, certain psychiatric or adjuvant medications are also beneficial for nerve pain or other chronic pain origins. Novel studies using certain non-pharmaceutical supplements have been effective in managing chronic low back and nerve pain. The use of narcotics should be considered a last resort to have an established treatment plan written with clear goals. Narcotics should also be used in combination with primary interventions to minimize dose, frequency, and dependence.

Conclusion: The use of non-pharmacological treatments for chronic low back and neuropathic pain, in combination with self-care and pharmacological therapy, is recommended in guidelines established in the clinical practice guidelines of the American College of Physicians and the American Pain Society. The key to adequate pain relief is to have the patient understand the source of the pain. Pharmacological treatment will use opioid pain medication conservatively as a last resort and use a multidisciplinary approach to optimize pain relief.

Keywords: Pain Management, primary care, lower back pain, neuropathic pain, musculoskeletal pain, chronic pain, peripheral neuropathy.


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