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vector-toc-level-2"> <a class="vector-toc-link" href="#TENS"> <div class="vector-toc-text"> 3.3 TENS </div> </a> <ul id="toc-TENS-sublist" class="vector-toc-list"> <li id="toc-tDCS" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#tDCS"> <div class="vector-toc-text"> 3.3.1 tDCS </div> </a> <ul id="toc-tDCS-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Acupuncture" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Acupuncture"> <div class="vector-toc-text"> 3.4 Acupuncture </div> </a> <ul id="toc-Acupuncture-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Light_therapy" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Light_therapy"> <div class="vector-toc-text"> 3.5 Light therapy </div> </a> <ul id="toc-Light_therapy-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Sound_therapy" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Sound_therapy"> <div class="vector-toc-text"> 3.6 Sound therapy </div> </a> <ul id="toc-Sound_therapy-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Interventional_procedures" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Interventional_procedures"> <div class="vector-toc-text"> 3.7 Interventional procedures </div> </a> <ul id="toc-Interventional_procedures-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Intra-articular_ozone_therapy" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Intra-articular_ozone_therapy"> <div class="vector-toc-text"> 3.8 Intra-articular ozone therapy </div> </a> <ul id="toc-Intra-articular_ozone_therapy-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Psychological_approach" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Psychological_approach"> <div class="vector-toc-text"> 4 Psychological approach </div> </a> <button aria-controls="toc-Psychological_approach-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> Toggle Psychological approach subsection </button> <ul id="toc-Psychological_approach-sublist" class="vector-toc-list"> <li id="toc-Acceptance_and_commitment_therapy" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Acceptance_and_commitment_therapy"> <div class="vector-toc-text"> 4.1 Acceptance and commitment therapy </div> </a> <ul id="toc-Acceptance_and_commitment_therapy-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Cognitive_behavioral_therapy" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Cognitive_behavioral_therapy"> <div class="vector-toc-text"> 4.2 Cognitive behavioral therapy </div> </a> <ul id="toc-Cognitive_behavioral_therapy-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Hypnosis" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Hypnosis"> <div class="vector-toc-text"> 4.3 Hypnosis </div> </a> <ul id="toc-Hypnosis-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Mindfulness_meditation" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Mindfulness_meditation"> <div class="vector-toc-text"> 4.4 Mindfulness meditation </div> </a> <ul id="toc-Mindfulness_meditation-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Mindfulness-based_pain_management" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Mindfulness-based_pain_management"> <div class="vector-toc-text"> 4.5 Mindfulness-based pain management </div> </a> <ul id="toc-Mindfulness-based_pain_management-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Medications" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Medications"> <div class="vector-toc-text"> 5 Medications </div> </a> <button aria-controls="toc-Medications-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> Toggle Medications subsection </button> <ul id="toc-Medications-sublist" class="vector-toc-list"> <li id="toc-Mild_pain" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Mild_pain"> <div class="vector-toc-text"> 5.1 Mild pain </div> </a> <ul id="toc-Mild_pain-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Mild_to_moderate_pain" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Mild_to_moderate_pain"> <div class="vector-toc-text"> 5.2 Mild to moderate pain </div> </a> <ul id="toc-Mild_to_moderate_pain-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Moderate_to_severe_pain" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Moderate_to_severe_pain"> <div class="vector-toc-text"> 5.3 Moderate to severe pain </div> </a> <ul id="toc-Moderate_to_severe_pain-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Opioids" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Opioids"> <div class="vector-toc-text"> 5.4 Opioids </div> </a> <ul id="toc-Opioids-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Nonsteroidal_anti-inflammatory_drugs" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Nonsteroidal_anti-inflammatory_drugs"> <div class="vector-toc-text"> 5.5 Nonsteroidal anti-inflammatory drugs </div> </a> <ul id="toc-Nonsteroidal_anti-inflammatory_drugs-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Antidepressants_and_antiepileptic_drugs" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Antidepressants_and_antiepileptic_drugs"> <div class="vector-toc-text"> 5.6 Antidepressants and antiepileptic drugs </div> </a> <ul id="toc-Antidepressants_and_antiepileptic_drugs-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Cannabinoids" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Cannabinoids"> <div class="vector-toc-text"> 5.7 Cannabinoids </div> </a> <ul id="toc-Cannabinoids-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Ketamine" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Ketamine"> <div class="vector-toc-text"> 5.8 Ketamine </div> </a> <ul id="toc-Ketamine-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Other_analgesics" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Other_analgesics"> <div class="vector-toc-text"> 5.9 Other analgesics </div> </a> <ul id="toc-Other_analgesics-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Self-management" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Self-management"> <div class="vector-toc-text"> 6 Self-management </div> </a> <ul id="toc-Self-management-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Society_and_culture" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Society_and_culture"> <div class="vector-toc-text"> 7 Society and culture </div> </a> <button aria-controls="toc-Society_and_culture-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> Toggle Society and culture subsection </button> <ul id="toc-Society_and_culture-sublist" class="vector-toc-list"> <li id="toc-Undertreatment" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Undertreatment"> <div class="vector-toc-text"> 7.1 Undertreatment </div> </a> <ul id="toc-Undertreatment-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-In_children" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#In_children"> <div class="vector-toc-text"> 7.2 In children </div> </a> <ul id="toc-In_children-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Professional_certification" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Professional_certification"> <div class="vector-toc-text"> 7.3 Professional certification </div> </a> <ul id="toc-Professional_certification-sublist" class="vector-toc-list"> <li id="toc-Pain_medicine_in_the_United_States" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Pain_medicine_in_the_United_States"> <div class="vector-toc-text"> 7.3.1 Pain medicine in the United States </div> </a> <ul id="toc-Pain_medicine_in_the_United_States-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> </ul> </li> <li id="toc-See_also" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#See_also"> <div class="vector-toc-text"> 8 See also </div> </a> <ul id="toc-See_also-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> 9 References </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Further_reading" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Further_reading"> <div class="vector-toc-text"> 10 Further reading </div> </a> <ul id="toc-Further_reading-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> 11 External links </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" title="Table of Contents" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-vector-page-titlebar-toc" class="vector-dropdown-checkbox " aria-label="Toggle the table of contents" > <label id="vector-page-titlebar-toc-label" for="vector-page-titlebar-toc-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--icon-only " aria-hidden="true" > Toggle the table of contents </label> <div class="vector-dropdown-content"> <div id="vector-page-titlebar-toc-unpinned-container" class="vector-unpinned-container"> </div> </div> </div> </nav> <h1 id="firstHeading" class="firstHeading mw-first-heading">Pain management</h1> <div id="p-lang-btn" class="vector-dropdown mw-portlet mw-portlet-lang" > <input 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Available in 26 languages" > <label id="p-lang-btn-label" for="p-lang-btn-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--action-progressive mw-portlet-lang-heading-26" aria-hidden="true" > 26 languages </label> <div class="vector-dropdown-content"> <div class="vector-menu-content"> <ul class="vector-menu-content-list"> <li class="interlanguage-link interwiki-ar mw-list-item"><a href="https://ar.wikipedia.org/wiki/%D8%A5%D8%AF%D8%A7%D8%B1%D8%A9_%D8%A7%D9%84%D8%A3%D9%84%D9%85" title="إدارة الألم – Arabic" lang="ar" hreflang="ar" data-title="إدارة الألم" data-language-autonym="العربية" data-language-local-name="Arabic" class="interlanguage-link-target">العربية</a></li><li class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/Tractament_del_dolor" title="Tractament del dolor – Catalan" lang="ca" hreflang="ca" data-title="Tractament del dolor" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target">Català</a></li><li class="interlanguage-link interwiki-da mw-list-item"><a href="https://da.wikipedia.org/wiki/Smertebehandling" title="Smertebehandling – Danish" lang="da" hreflang="da" data-title="Smertebehandling" data-language-autonym="Dansk" data-language-local-name="Danish" class="interlanguage-link-target">Dansk</a></li><li class="interlanguage-link interwiki-de mw-list-item"><a href="https://de.wikipedia.org/wiki/Schmerztherapie" title="Schmerztherapie – German" lang="de" hreflang="de" data-title="Schmerztherapie" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target">Deutsch</a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/Algolog%C3%ADa_(medicina)" title="Algología (medicina) – Spanish" lang="es" hreflang="es" data-title="Algología (medicina)" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target">Español</a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%D9%85%D8%AF%DB%8C%D8%B1%DB%8C%D8%AA_%D8%AF%D8%B1%D8%AF" title="مدیریت درد – Persian" lang="fa" hreflang="fa" data-title="مدیریت درد" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target">فارسی</a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/Traitement_de_la_douleur" title="Traitement de la douleur – French" lang="fr" hreflang="fr" data-title="Traitement de la douleur" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target">Français</a></li><li class="interlanguage-link interwiki-hr mw-list-item"><a href="https://hr.wikipedia.org/wiki/Lije%C4%8Denje_boli" title="Liječenje boli – Croatian" lang="hr" hreflang="hr" data-title="Liječenje boli" data-language-autonym="Hrvatski" data-language-local-name="Croatian" class="interlanguage-link-target">Hrvatski</a></li><li class="interlanguage-link interwiki-id mw-list-item"><a href="https://id.wikipedia.org/wiki/Penanganan_nyeri" title="Penanganan nyeri – Indonesian" lang="id" hreflang="id" data-title="Penanganan nyeri" data-language-autonym="Bahasa Indonesia" data-language-local-name="Indonesian" class="interlanguage-link-target">Bahasa Indonesia</a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Terapia_del_dolore" title="Terapia del dolore – Italian" lang="it" hreflang="it" data-title="Terapia del dolore" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target">Italiano</a></li><li class="interlanguage-link interwiki-la mw-list-item"><a href="https://la.wikipedia.org/wiki/Algologia" title="Algologia – Latin" lang="la" hreflang="la" data-title="Algologia" data-language-autonym="Latina" data-language-local-name="Latin" class="interlanguage-link-target">Latina</a></li><li class="interlanguage-link interwiki-lv mw-list-item"><a href="https://lv.wikipedia.org/wiki/Ats%C4%81pin%C4%81%C5%A1ana" title="Atsāpināšana – Latvian" lang="lv" hreflang="lv" data-title="Atsāpināšana" data-language-autonym="Latviešu" data-language-local-name="Latvian" class="interlanguage-link-target">Latviešu</a></li><li class="interlanguage-link interwiki-nl mw-list-item"><a href="https://nl.wikipedia.org/wiki/Algologie_(geneeskunde)" title="Algologie (geneeskunde) – Dutch" lang="nl" hreflang="nl" data-title="Algologie (geneeskunde)" data-language-autonym="Nederlands" data-language-local-name="Dutch" class="interlanguage-link-target">Nederlands</a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a href="https://ja.wikipedia.org/wiki/%E7%96%BC%E7%97%9B%E7%AE%A1%E7%90%86" title="疼痛管理 – Japanese" lang="ja" hreflang="ja" data-title="疼痛管理" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target">日本語</a></li><li class="interlanguage-link interwiki-no mw-list-item"><a href="https://no.wikipedia.org/wiki/Smertebehandling" title="Smertebehandling – Norwegian Bokmål" lang="nb" hreflang="nb" data-title="Smertebehandling" data-language-autonym="Norsk bokmål" data-language-local-name="Norwegian Bokmål" class="interlanguage-link-target">Norsk bokmål</a></li><li class="interlanguage-link interwiki-pl mw-list-item"><a href="https://pl.wikipedia.org/wiki/Algezjologia" title="Algezjologia – Polish" lang="pl" hreflang="pl" data-title="Algezjologia" data-language-autonym="Polski" data-language-local-name="Polish" class="interlanguage-link-target">Polski</a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/Tratamento_da_dor" title="Tratamento da dor – Portuguese" lang="pt" hreflang="pt" data-title="Tratamento da dor" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target">Português</a></li><li class="interlanguage-link interwiki-sq mw-list-item"><a href="https://sq.wikipedia.org/wiki/Kategoria:Menaxhim_i_dhimbjes" title="Kategoria:Menaxhim i dhimbjes – Albanian" lang="sq" hreflang="sq" data-title="Kategoria:Menaxhim i dhimbjes" data-language-autonym="Shqip" data-language-local-name="Albanian" class="interlanguage-link-target">Shqip</a></li><li class="interlanguage-link interwiki-sr mw-list-item"><a href="https://sr.wikipedia.org/wiki/%D0%A3%D0%BF%D1%80%D0%B0%D0%B2%D1%99%D0%B0%D1%9A%D0%B5_%D0%B1%D0%BE%D0%BB%D0%BE%D0%BC" title="Управљање болом – Serbian" lang="sr" hreflang="sr" data-title="Управљање болом" data-language-autonym="Српски / srpski" data-language-local-name="Serbian" class="interlanguage-link-target">Српски / srpski</a></li><li class="interlanguage-link interwiki-sh mw-list-item"><a href="https://sh.wikipedia.org/wiki/Terapija_boli" title="Terapija boli – Serbo-Croatian" lang="sh" hreflang="sh" data-title="Terapija boli" data-language-autonym="Srpskohrvatski / српскохрватски" data-language-local-name="Serbo-Croatian" class="interlanguage-link-target">Srpskohrvatski / српскохрватски</a></li><li class="interlanguage-link interwiki-fi mw-list-item"><a href="https://fi.wikipedia.org/wiki/Kivunlievitys" title="Kivunlievitys – Finnish" lang="fi" hreflang="fi" data-title="Kivunlievitys" data-language-autonym="Suomi" data-language-local-name="Finnish" class="interlanguage-link-target">Suomi</a></li><li class="interlanguage-link interwiki-sv mw-list-item"><a href="https://sv.wikipedia.org/wiki/Sm%C3%A4rtbehandling" title="Smärtbehandling – Swedish" lang="sv" hreflang="sv" data-title="Smärtbehandling" data-language-autonym="Svenska" data-language-local-name="Swedish" class="interlanguage-link-target">Svenska</a></li><li class="interlanguage-link interwiki-tr mw-list-item"><a href="https://tr.wikipedia.org/wiki/A%C4%9Fr%C4%B1_tedavisi" title="Ağrı tedavisi – Turkish" lang="tr" hreflang="tr" data-title="Ağrı tedavisi" data-language-autonym="Türkçe" data-language-local-name="Turkish" class="interlanguage-link-target">Türkçe</a></li><li class="interlanguage-link interwiki-ur mw-list-item"><a href="https://ur.wikipedia.org/wiki/%D8%AF%D8%B1%D8%AF_%DA%A9%DB%8C_%D9%86%D8%B8%D8%A7%D9%85%D8%AA" title="درد کی نظامت – Urdu" lang="ur" hreflang="ur" data-title="درد کی نظامت" data-language-autonym="اردو" data-language-local-name="Urdu" class="interlanguage-link-target">اردو</a></li><li class="interlanguage-link interwiki-vi mw-list-item"><a href="https://vi.wikipedia.org/wiki/%C4%90i%E1%BB%81u_tr%E1%BB%8B_%C4%91au" title="Điều trị đau – Vietnamese" lang="vi" hreflang="vi" data-title="Điều trị đau" data-language-autonym="Tiếng Việt" data-language-local-name="Vietnamese" class="interlanguage-link-target">Tiếng Việt</a></li><li class="interlanguage-link interwiki-zh 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style="display:none">Interdisciplinary approach for easing pain</div> <style data-mw-deduplicate="TemplateStyles:r1236090951">.mw-parser-output .hatnote{font-style:italic}.mw-parser-output div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">This article is about pain management across medicine. For cancer-related pain management specifically, see <a href="/wiki/Cancer_pain" title="Cancer pain">Cancer pain</a>. For the album by Bubba Sparxxx, see <a href="/wiki/Pain_Management_(album)" title="Pain Management (album)">Pain Management (album)</a>.</div> <style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox"><caption class="infobox-title">Pain Medicine Physician</caption><tbody><tr><th colspan="2" class="infobox-header">Occupation</th></tr><tr><th scope="row" class="infobox-label">Names</th><td class="infobox-data">Physician</td></tr><tr><th scope="row" class="infobox-label"><div style="display: inline-block; line-height: 1.2em; padding: .1em 0;">Occupation type</div></th><td class="infobox-data"><a href="/wiki/Specialty_(medicine)" class="mw-redirect" title="Specialty (medicine)">Specialty</a></td></tr><tr><th scope="row" class="infobox-label"><div style="display: inline-block; line-height: 1.2em; padding: .1em 0;">Activity sectors</div></th><td class="infobox-data"><a href="/wiki/Medicine" title="Medicine">Medicine</a></td></tr><tr><th colspan="2" class="infobox-header">Description</th></tr><tr><th scope="row" class="infobox-label"><div style="display: inline-block; line-height: 1.2em; padding: .1em 0;">Education required</div></th><td class="infobox-data"> <ul><li><a href="/wiki/Doctor_of_Medicine" title="Doctor of Medicine">Doctor of Medicine</a> (M.D.)</li> <li><a href="/wiki/Doctor_of_Osteopathic_medicine" class="mw-redirect" title="Doctor of Osteopathic medicine">Doctor of Osteopathic medicine</a> (D.O.)</li> <li><a href="/wiki/Bachelor_of_Medicine,_Bachelor_of_Surgery" title="Bachelor of Medicine, Bachelor of Surgery">Bachelor of Medicine, Bachelor of Surgery</a> (M.B.B.S.)</li> <li><a href="/wiki/Bachelor_of_Medicine,_Bachelor_of_Surgery" title="Bachelor of Medicine, Bachelor of Surgery">Bachelor of Medicine, Bachelor of Surgery</a> (MBChB)</li></ul> </td></tr><tr><th scope="row" class="infobox-label"><div style="display: inline-block; line-height: 1.2em; padding: .1em 0;">Fields of employment</div></th><td class="infobox-data"><a href="/wiki/Hospital" title="Hospital">Hospitals</a>, <a href="/wiki/Clinic" title="Clinic">clinics</a></td></tr></tbody></table> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Mu-opioid_receptor.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/b/b6/Mu-opioid_receptor.png/250px-Mu-opioid_receptor.png" decoding="async" width="220" height="299" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/b/b6/Mu-opioid_receptor.png/330px-Mu-opioid_receptor.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/b/b6/Mu-opioid_receptor.png/500px-Mu-opioid_receptor.png 2x" data-file-width="772" data-file-height="1048" /></a><figcaption>Active and inactive <a href="/wiki/%CE%9C-opioid_receptor" title="Μ-opioid receptor">μ-opioid receptors</a><a href="#cite_note-pmid10683246-1">[1]</a></figcaption></figure> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:OuchFlintGoodrichShot1941.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/c/ca/OuchFlintGoodrichShot1941.jpg/220px-OuchFlintGoodrichShot1941.jpg" decoding="async" width="220" height="174" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/c/ca/OuchFlintGoodrichShot1941.jpg/330px-OuchFlintGoodrichShot1941.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/c/ca/OuchFlintGoodrichShot1941.jpg/440px-OuchFlintGoodrichShot1941.jpg 2x" data-file-width="600" data-file-height="475" /></a><figcaption>Image of visual pain</figcaption></figure> Pain management is an aspect of <a href="/wiki/Medicine" title="Medicine">medicine</a> and <a href="/wiki/Health_care" title="Health care">health care</a> involving relief of <a href="/wiki/Pain" title="Pain">pain</a> (pain relief, analgesia, pain control) in various dimensions, from <a href="/wiki/Acute_(medicine)" title="Acute (medicine)">acute</a> and simple to <a href="/wiki/Chronic_condition" title="Chronic condition">chronic</a> and challenging. Most <a href="/wiki/Physician" title="Physician">physicians</a> and other <a href="/wiki/Health_professional" title="Health professional">health professionals</a> provide some pain control in the normal course of their practice, and for the more complex instances of pain, they also call on additional help from a specific <a href="/wiki/Medical_specialty" title="Medical specialty">medical specialty</a> devoted to pain, which is called pain medicine. Pain management often uses a <a href="/wiki/Interdisciplinarity" title="Interdisciplinarity">multidisciplinary</a> approach for easing the suffering and improving the <a href="/wiki/Quality_of_life" title="Quality of life">quality of life</a> of anyone experiencing pain,<a href="#cite_note-2">[2]</a> whether acute pain or <a href="/wiki/Chronic_pain" title="Chronic pain">chronic pain</a>. Relief of pain in general (analgesia) is often an acute affair, whereas managing chronic pain requires additional dimensions. A typical multidisciplinary pain management team may include: <a href="/wiki/Medical_practitioner" class="mw-redirect" title="Medical practitioner">medical practitioners</a>, <a href="/wiki/Pharmacist" title="Pharmacist">pharmacists</a>, <a href="/wiki/Clinical_psychologist" class="mw-redirect" title="Clinical psychologist">clinical psychologists</a>, <a href="/wiki/Physiotherapist" class="mw-redirect" title="Physiotherapist">physiotherapists</a>, <a href="/wiki/Occupational_therapist" title="Occupational therapist">occupational therapists</a>, <a href="/wiki/Recreational_therapist" class="mw-redirect" title="Recreational therapist">recreational therapists</a>, <a href="/wiki/Physician_assistant" title="Physician assistant">physician assistants</a>, <a href="/wiki/Nurse" class="mw-redirect" title="Nurse">nurses</a>, and <a href="/wiki/Dentist" title="Dentist">dentists</a>.<a href="#cite_note-3">[3]</a> The team may also include other <a href="/wiki/Mental_health" title="Mental health">mental health</a> specialists and <a href="/wiki/Massage_therapist" class="mw-redirect" title="Massage therapist">massage therapists</a>. Pain sometimes resolves quickly once the underlying <a href="/wiki/Trauma_(medicine)" class="mw-redirect" title="Trauma (medicine)">trauma</a> or <a href="/wiki/Pathology" title="Pathology">pathology</a> has healed, and is treated by one practitioner, with drugs such as pain relievers (<a href="/wiki/Analgesic" title="Analgesic">analgesics</a>) and occasionally also <a href="/wiki/Anxiolytic" title="Anxiolytic">anxiolytics</a>. Effective management of <a href="/wiki/Chronic_pain" title="Chronic pain">chronic (long-term) pain</a>, however, frequently requires the coordinated efforts of the pain management team.<a href="#cite_note-4">[4]</a> Effective pain management does not always mean total eradication of all pain. Rather, it often means achieving adequate quality of life in the presence of pain, through any combination of lessening the pain and/or better understanding it and being able to live happily despite it. Medicine treats <a href="/wiki/Injury" title="Injury">injuries</a> and diseases to support and speed healing. It treats distressing symptoms such as pain and discomfort to reduce any <a href="/wiki/Suffering" title="Suffering">suffering</a> during treatment, healing, and <a href="/wiki/Dying" title="Dying">dying</a>. The task of medicine is to relieve suffering under three circumstances. The first is when a painful injury or pathology is resistant to treatment and persists. The second is when pain persists after the injury or pathology has healed. Finally, the third circumstance is when medical science cannot identify the cause of pain. Treatment approaches to chronic pain include <a href="/wiki/Pharmacology" title="Pharmacology">pharmacological</a> measures, such as <a href="/wiki/Analgesic" title="Analgesic">analgesics</a> (pain killer drugs), <a href="/wiki/Antidepressant" title="Antidepressant">antidepressants</a>, and <a href="/wiki/Anticonvulsant" title="Anticonvulsant">anticonvulsants</a>; interventional procedures, <a href="/wiki/Physical_therapy" title="Physical therapy">physical therapy</a>, <a href="/wiki/Physical_exercise" class="mw-redirect" title="Physical exercise">physical exercise</a>, application of ice or heat; and <a href="/wiki/Psychological" class="mw-redirect" title="Psychological">psychological</a> measures, such as <a href="/wiki/Biofeedback" title="Biofeedback">biofeedback</a> and <a href="/wiki/Cognitive_behavioral_therapy" title="Cognitive behavioral therapy">cognitive behavioral therapy</a>. [<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Defining_pain">Defining pain</h2>[<a href="/w/index.php?title=Pain_management&action=edit&section=1" title="Edit section: Defining pain">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951" /><div role="note" class="hatnote navigation-not-searchable">See also: <a href="/wiki/Threshold_of_pain" title="Threshold of pain">Threshold of pain</a> and <a href="/wiki/Pain_tolerance" title="Pain tolerance">Pain tolerance</a></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Pain_scale_with_words.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/5/5a/Pain_scale_with_words.png/220px-Pain_scale_with_words.png" decoding="async" width="220" height="328" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/5/5a/Pain_scale_with_words.png/330px-Pain_scale_with_words.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/5/5a/Pain_scale_with_words.png/440px-Pain_scale_with_words.png 2x" data-file-width="610" data-file-height="910" /></a><figcaption>Commonly used[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] scale to depict pain levels</figcaption></figure> In the nursing profession, one common definition of pain is any problem that is "whatever the experiencing person says it is, existing whenever the experiencing person says it does".<a href="#cite_note-5">[5]</a> Pain management includes patient and communication about the pain problem.<a href="#cite_note-Consumer_Reports_pain_relief_April_2016-6">[6]</a> To define the pain problem, a health care provider will likely ask questions such as:<a href="#cite_note-Consumer_Reports_pain_relief_April_2016-6">[6]</a> <ul><li>How intense is the pain?</li> <li>How does the pain feel?</li> <li>Where is the pain?</li> <li>What, if anything, makes the pain lessen?</li> <li>What, if anything, makes the pain increase?</li> <li>When did the pain start?</li></ul> After asking such questions, the health care provider will have a description of the pain.<a href="#cite_note-Consumer_Reports_pain_relief_April_2016-6">[6]</a> Pain management will then be used to address that pain.<a href="#cite_note-Consumer_Reports_pain_relief_April_2016-6">[6]</a> <div class="mw-heading mw-heading2"><h2 id="Adverse_effects">Adverse effects</h2>[<a href="/w/index.php?title=Pain_management&action=edit&section=2" title="Edit section: Adverse effects">edit</a>]</div> There are many types of pain management. Each have their own benefits, drawbacks, and limits.<a href="#cite_note-Consumer_Reports_pain_relief_April_2016-6">[6]</a> A common challenge in pain management is communication between the health care provider and the person experiencing pain.<a href="#cite_note-Consumer_Reports_pain_relief_April_2016-6">[6]</a> People experiencing pain may have difficulty recognizing or describing what they feel and how intense it is.<a href="#cite_note-Consumer_Reports_pain_relief_April_2016-6">[6]</a> Health care providers and patients may have difficulty communicating with each other about how pain responds to treatments.<a href="#cite_note-Consumer_Reports_pain_relief_April_2016-6">[6]</a> There is a risk in many types of pain management for the patient to take treatment that is less effective than needed or which causes other difficulties and side effects.<a href="#cite_note-Consumer_Reports_pain_relief_April_2016-6">[6]</a> Some treatments for pain can be harmful if overused.<a href="#cite_note-Consumer_Reports_pain_relief_April_2016-6">[6]</a> A goal of pain management for the patient and their health care provider is to identify the amount of treatment needed to address the pain without going beyond that limit.<a href="#cite_note-Consumer_Reports_pain_relief_April_2016-6">[6]</a> Another problem with pain management is that pain is the body's natural way of communicating a problem.<a href="#cite_note-Consumer_Reports_pain_relief_April_2016-6">[6]</a> Pain is supposed to resolve as the body heals itself with time and pain management.<a href="#cite_note-Consumer_Reports_pain_relief_April_2016-6">[6]</a> Sometimes pain management covers a problem, and the patient might be less aware that they need treatment for a deeper problem.<a href="#cite_note-Consumer_Reports_pain_relief_April_2016-6">[6]</a> <div class="mw-heading mw-heading2"><h2 id="Physical_approach">Physical approach</h2>[<a href="/w/index.php?title=Pain_management&action=edit&section=3" title="Edit section: Physical approach">edit</a>]</div> <div class="mw-heading mw-heading3"><h3 id="Physical_medicine_and_rehabilitation">Physical medicine and rehabilitation</h3>[<a href="/w/index.php?title=Pain_management&action=edit&section=4" title="Edit section: Physical medicine and rehabilitation">edit</a>]</div> <a href="/wiki/Physical_medicine_and_rehabilitation" title="Physical medicine and rehabilitation">Physical medicine and rehabilitation</a> (PM&R), a <a href="/wiki/Medical_specialty" title="Medical specialty">medical specialty</a>, uses a range of physical techniques, such as <a href="/wiki/Heat_therapy" title="Heat therapy">heat</a> and <a href="/wiki/Electrotherapy" title="Electrotherapy">electrotherapy</a>, as well as therapeutic exercises and behavioral therapy in the management of pain.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] PM&R techniques are usually part of an interdisciplinary or multidisciplinary program that might also include pharmaceuticals.<a href="#cite_note-Geertzen_JH,_Van_Wilgen_CP.-7">[7]</a> Spa therapy has showed positive effects in reducing pain among patients with chronic <a href="/wiki/Low_back_pain" title="Low back pain">low back pain</a>, but its evidence base is limited.<a href="#cite_note-8">[8]</a> Studies have shown that <a href="/wiki/Elastic_therapeutic_tape" title="Elastic therapeutic tape">kinesiotape</a> can be used to reduce chronic low back pain.<a href="#cite_note-9">[9]</a> The <a href="/wiki/Centers_for_Disease_Control_and_Prevention" title="Centers for Disease Control and Prevention">US Centers for Disease Control</a> recommended that <a href="/wiki/Physical_therapy" title="Physical therapy">physical therapy</a> and exercise be prescribed as <a href="/wiki/First-line_treatment" class="mw-redirect" title="First-line treatment">first-line treatments</a> (rather than <a href="/wiki/Opioid" title="Opioid">opioids</a>) for multiple causes of chronic pain in 2016 guidelines.<a href="#cite_note-:0-10">[10]</a> Applicable disorders include chronic low back pain, <a href="/wiki/Osteoarthritis" title="Osteoarthritis">osteoarthritis</a> of the hip and knee, and <a href="/wiki/Fibromyalgia" title="Fibromyalgia">fibromyalgia</a>.<a href="#cite_note-:0-10">[10]</a> Exercise alone or with other rehabilitation disciplines (including psychotherapeutic approaches) can have a positive effects on pain.<a href="#cite_note-:0-10">[10]</a> Besides improving the experience of pain itself, exercise can also improve individuals' well-being and general health.<a href="#cite_note-:0-10">[10]</a> <a href="/wiki/Manual_therapy" title="Manual therapy">Manipulative</a> and <a href="/wiki/Joint_mobilization" title="Joint mobilization">mobilization</a> therapies are considered safe interventions for low back pain, with manipulation potentially offering a larger therapeutic effect.<a href="#cite_note-11">[11]</a> Specifically in chronic low back pain, education about the way the brain processes pain in conjunction with routine physiotherapy interventions may provide short-term relief of disability and pain.<a href="#cite_note-12">[12]</a> <div class="mw-heading mw-heading3"><h3 id="Exercise_interventions">Exercise interventions</h3>[<a href="/w/index.php?title=Pain_management&action=edit&section=5" title="Edit section: Exercise interventions">edit</a>]</div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Exercise_Treadmill_Convey_Motion.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/9/95/Exercise_Treadmill_Convey_Motion.jpg/220px-Exercise_Treadmill_Convey_Motion.jpg" decoding="async" width="220" height="147" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/9/95/Exercise_Treadmill_Convey_Motion.jpg/330px-Exercise_Treadmill_Convey_Motion.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/9/95/Exercise_Treadmill_Convey_Motion.jpg/440px-Exercise_Treadmill_Convey_Motion.jpg 2x" data-file-width="2250" data-file-height="1500" /></a><figcaption>Aerobic exercise can help when it comes to pain management</figcaption></figure> Physical activity interventions, such as <a href="/wiki/Tai_chi" title="Tai chi">tai chi</a>, <a href="/wiki/Yoga" title="Yoga">yoga</a>, and <a href="/wiki/Pilates" title="Pilates">Pilates</a>, promote harmony of the mind and body through total body awareness. These practices incorporate breathing techniques, meditation, and a wide variety of movements while training the body to perform functionally by increasing strength, flexibility, and range of motion.<a href="#cite_note-:1-13">[13]</a> Physical activity can also benefit chronic sufferers by reducing inflammation and sensitivity and boosting overall energy.<a href="#cite_note-14">[14]</a> Physical activity and exercise may improve chronic pain (pain lasting more than 12 weeks),<a href="#cite_note-15">[15]</a> and overall quality of life, while minimizing the need for pain medications.<a href="#cite_note-:1-13">[13]</a> More specifically, walking has been effective in improving pain management in chronic low back pain.<a href="#cite_note-16">[16]</a> <div class="mw-heading mw-heading3"><h3 id="TENS">TENS</h3>[<a href="/w/index.php?title=Pain_management&action=edit&section=6" title="Edit section: TENS">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951" /><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Transcutaneous_electrical_nerve_stimulation" title="Transcutaneous electrical nerve stimulation">Transcutaneous electrical nerve stimulation</a></div> Transcutaneous electrical nerve stimulation (TENS) is a self-operated portable device intended to help regulate and control chronic pain via electrical impulses.<a href="#cite_note-:24-17">[17]</a> Limited research has explored the effectiveness of TENS in relation to pain management of multiple sclerosis (MS). MS is a chronic autoimmune neurological disorder, which consists of the demyelination of the nerve axons and the disruption of nerve conduction velocity and efficiency.<a href="#cite_note-:24-17">[17]</a> In one study, electrodes were placed over the lumbar spine, and participants received treatment twice a day and at any time when they experienced a painful episode.<a href="#cite_note-:24-17">[17]</a> This study found that TENS would benefit MS patients with localized or limited symptoms in one limb.<a href="#cite_note-:24-17">[17]</a> The research is mixed with whether or not TENS helps manage pain in MS patients.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] <a href="/wiki/Transcutaneous_electrical_nerve_stimulation" title="Transcutaneous electrical nerve stimulation">Transcutaneous electrical nerve stimulation</a> is ineffective for <a href="/wiki/Lower_back_pain" class="mw-redirect" title="Lower back pain">lower back pain</a>. However, it might help with <a href="/wiki/Diabetic_neuropathy" title="Diabetic neuropathy">diabetic neuropathy</a><a href="#cite_note-pmid20042705-18">[18]</a> as well as other illnesses. [<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] <div class="mw-heading mw-heading4"><h4 id="tDCS">tDCS</h4>[<a href="/w/index.php?title=Pain_management&action=edit&section=7" title="Edit section: tDCS">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951" /><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Transcranial_direct-current_stimulation" title="Transcranial direct-current stimulation">Transcranial direct-current stimulation</a></div> Transcranial direct current stimulation (tDCS) is a non-invasive technique of brain stimulation that can modulate activity in specific brain cortex regions, and it involves the application of low-intensity (up to 2 mA) constant direct current to the scalp through electrodes in order to modulate the excitability of large cortical areas.<a href="#cite_note-:12-19">[19]</a> tDCS may have a role in pain assessment by contributing to efforts in distinguishing between somatic and affective aspects of pain experience.<a href="#cite_note-:12-19">[19]</a> Zaghi and colleagues (2011) found that the motor cortex, when stimulated with tDCS, increases the threshold for both the perception of non-painful and painful stimuli.<a href="#cite_note-:12-19">[19]</a> Although there is a greater need for research examining the mechanism of electrical stimulation in pain treatment, one theory suggests that the changes in thalamic activity may be due to the influence of motor cortex stimulation on the decrease in pain sensations.<a href="#cite_note-:12-19">[19]</a> Concerning MS, a study found that daily tDCS sessions resulted in an individual's subjective report of pain decreased when compared to a sham condition.<a href="#cite_note-:24-17">[17]</a> In addition, the study found a similar improvement at 1 to 3 days before and after each tDCS session.<a href="#cite_note-:24-17">[17]</a> Fibromyalgia is a disorder in which an individual experiences dysfunctional brain activity, musculoskeletal pain, fatigue, and tenderness in localized areas.<a href="#cite_note-:32-20">[20]</a> Research examining tDCS for pain treatment in fibromyalgia has found initial evidence for pain decreases.<a href="#cite_note-:32-20">[20]</a> Specifically, the stimulation of the primary motor cortex resulted in significantly greater pain improvement in comparison to the control group (e.g., sham stimulation, stimulation of the DLPFC).<a href="#cite_note-:32-20">[20]</a> However, this effect decreased after treatment ended, but remained significant for three weeks following the extinction of treatment.<a href="#cite_note-:32-20">[20]</a> <div class="mw-heading mw-heading3"><h3 id="Acupuncture">Acupuncture</h3>[<a href="/w/index.php?title=Pain_management&action=edit&section=8" title="Edit section: Acupuncture">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951" /><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Acupuncture" title="Acupuncture">Acupuncture</a></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Tso%C3%AB-Bosi.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/5/5b/Tso%C3%AB-Bosi.jpg/220px-Tso%C3%AB-Bosi.jpg" decoding="async" width="220" height="369" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/5/5b/Tso%C3%AB-Bosi.jpg/330px-Tso%C3%AB-Bosi.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/5/5b/Tso%C3%AB-Bosi.jpg/440px-Tso%C3%AB-Bosi.jpg 2x" data-file-width="2070" data-file-height="3474" /></a><figcaption>Acupuncture can sometimes help to relieve pain</figcaption></figure> Acupuncture involves the insertion and manipulation of needles into specific points on the body to relieve pain or for therapeutic purposes. An analysis of the 13 highest quality studies of pain treatment with acupuncture, published in January 2009 in the <a href="/wiki/British_Medical_Journal" class="mw-redirect" title="British Medical Journal">British Medical Journal</a>, was unable to quantify the difference in the effect on pain of real, <a href="/wiki/Sham_surgery" title="Sham surgery">sham</a> and no acupuncture.<a href="#cite_note-21">[21]</a> A systematic review in 2019 reported that acupuncture injection therapy was an effective treatment for patients with nonspecific chronic low back pain, and is widely used in Southeast Asian countries.<a href="#cite_note-22">[22]</a> <div class="mw-heading mw-heading3"><h3 id="Light_therapy">Light therapy</h3>[<a href="/w/index.php?title=Pain_management&action=edit&section=9" title="Edit section: Light therapy">edit</a>]</div> Research has found evidence that <a href="/wiki/Light_therapy" title="Light therapy">light therapy</a> such as <a href="/wiki/Low_level_laser_therapy" class="mw-redirect" title="Low level laser therapy">low level laser therapy</a> is an effective therapy for relieving <a href="/wiki/Low_back_pain" title="Low back pain">low back pain</a>.<a href="#cite_note-Chou-23">[23]</a><a href="#cite_note-24">[24]</a> Instead of thermal therapy, where reactant energy is originated through heat, Low-Level Light Therapy (LLLT) utilizes photochemical reactions requiring light to function.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] Photochemical reactions need light in order to function. <a href="/wiki/Photon" title="Photon">Photons</a>, the energy created from light, from these photochemical reactions provide the reactants with energy to embed in muscles, thus managing pain.<a href="#cite_note-25">[25]</a> One study conducted by Stausholm et al. showed that at certain wavelengths, LLLT reduced pain in participants with knee osteoarthritis.<a href="#cite_note-26">[26]</a> LLLT stimulates a variety of cell types, which in turn can help treat tendonitis, arthritis, and pain relating to muscles.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] <div class="mw-heading mw-heading3"><h3 id="Sound_therapy">Sound therapy</h3>[<a href="/w/index.php?title=Pain_management&action=edit&section=10" title="Edit section: Sound therapy">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951" /><div role="note" class="hatnote navigation-not-searchable">Main articles: <a href="/wiki/Audioanalgesia" title="Audioanalgesia">Audioanalgesia</a> and <a href="/wiki/Music_therapy" title="Music therapy">Music therapy</a></div> <a href="/wiki/Audioanalgesia" title="Audioanalgesia">Audioanalgesia</a> and <a href="/wiki/Music_therapy" title="Music therapy">music therapy</a> are both examples of using <a href="/wiki/Auditory_stimuli" class="mw-redirect" title="Auditory stimuli">auditory stimuli</a> to manage pain or other distress. They are generally viewed as insufficient when used alone but also as helpful <a href="/wiki/Adjuvant_therapy" title="Adjuvant therapy">adjuncts</a> to other forms of <a href="/wiki/Therapy" title="Therapy">therapy</a>.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] <div class="mw-heading mw-heading3"><h3 id="Interventional_procedures">Interventional procedures</h3>[<a href="/w/index.php?title=Pain_management&action=edit&section=11" title="Edit section: Interventional procedures">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951" /><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Interventional_pain_management" title="Interventional pain management">Interventional pain management</a></div> <a href="/wiki/Interventional_radiology" title="Interventional radiology">Interventional radiology</a> procedures for pain control, typically used for <a href="/wiki/Back_pain" title="Back pain">chronic back pain</a>, include <a href="/wiki/Epidural" class="mw-redirect" title="Epidural">epidural steroid injections</a>, <a href="/wiki/Facet_joint_injection" title="Facet joint injection">facet joint injections</a>, <a href="/wiki/Cordotomy" title="Cordotomy">neurolytic blocks</a>, <a href="/wiki/Spinal_cord_stimulator" title="Spinal cord stimulator">spinal cord stimulators</a> and <a href="/wiki/Intrathecal" class="mw-redirect" title="Intrathecal">intrathecal</a> drug delivery system implants. <a href="/wiki/Pulsed_radiofrequency" title="Pulsed radiofrequency">Pulsed radiofrequency</a>, <a href="/wiki/Neuromodulation_(medicine)" title="Neuromodulation (medicine)">neuromodulation</a>, direct introduction of medication and nerve <a href="/wiki/Ablation" title="Ablation">ablation</a> may be used to target either the tissue structures and organ/systems responsible for persistent <a href="/wiki/Nociception" title="Nociception">nociception</a> or the <a href="/wiki/Nociceptor" title="Nociceptor">nociceptors</a> from the structures implicated as the source of chronic pain.<a href="#cite_note-Varrassi_G,_Paladini_A-27">[27]</a><a href="#cite_note-Meglio_M.-28">[28]</a><a href="#cite_note-29">[29]</a><a href="#cite_note-Boswell_MV,_Trescott_AM-30">[30]</a><a href="#cite_note-Romanelli_P,_Esposito_V-31">[31]</a> Radiofrequency treatment has been seen to improve pain in patients with facet joint low back pain. However, continuous radiofrequency is more effective in managing pain than pulsed radiofrequency.<a href="#cite_note-32">[32]</a> An <a href="/wiki/Intrathecal_pump" title="Intrathecal pump">intrathecal pump</a> is sometimes used to deliver very small quantities of medications directly to the spinal fluid. This is similar to epidural infusions used in <a href="/wiki/Childbirth" title="Childbirth">labour</a> and postoperatively. The major differences are that it is much more common for the drug to be delivered into the spinal fluid (intrathecal) rather than epidurally, and the pump can be fully implanted under the skin. [<a href="/wiki/Wikipedia:Identifying_reliable_sources_(medicine)" title="Wikipedia:Identifying reliable sources (medicine)">medical citation needed</a>] A <a href="/wiki/Spinal_cord_stimulator" title="Spinal cord stimulator">spinal cord stimulator</a> is an implantable medical device that creates electric impulses and applies them near the dorsal surface of the spinal cord, providing a <a href="/wiki/Paresthesia" title="Paresthesia">paresthesia</a> ("tingling") sensation that alters the perception of pain by the patient.[<a href="/wiki/Wikipedia:Identifying_reliable_sources_(medicine)" title="Wikipedia:Identifying reliable sources (medicine)">medical citation needed</a>] <div class="mw-heading mw-heading3"><h3 id="Intra-articular_ozone_therapy">Intra-articular ozone therapy</h3>[<a href="/w/index.php?title=Pain_management&action=edit&section=12" title="Edit section: Intra-articular ozone therapy">edit</a>]</div> Intra-articular ozone therapy has been seen to alleviate chronic pain in patients with knee osteoarthritis efficiently.<a href="#cite_note-33">[33]</a> <div class="mw-heading mw-heading2"><h2 id="Psychological_approach">Psychological approach</h2>[<a href="/w/index.php?title=Pain_management&action=edit&section=13" title="Edit section: Psychological approach">edit</a>]</div> <div class="mw-heading mw-heading3"><h3 id="Acceptance_and_commitment_therapy">Acceptance and commitment therapy</h3>[<a href="/w/index.php?title=Pain_management&action=edit&section=14" title="Edit section: Acceptance and commitment therapy">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951" /><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Acceptance_and_commitment_therapy" title="Acceptance and commitment therapy">Acceptance and commitment therapy</a></div> Acceptance and Commitment Therapy (ACT) is a form of cognitive behavioral therapy that focuses on behavior change rather than symptom change, includes methods designed to alter the context around psychological experiences rather than to alter the makeup of the experiences, and emphasizes the use of experiential behavior change methods.<a href="#cite_note-:02-34">[34]</a> The central process in ACT revolves around psychological flexibility, which in turn includes processes of acceptance, awareness, a present-oriented quality in interacting with experiences, an ability to persist or change behavior, and an ability to be guided by one's values.<a href="#cite_note-:02-34">[34]</a> ACT has an increased evidence base for range of health and behavior problems, including chronic pain.<a href="#cite_note-:02-34">[34]</a> ACT influences patients to adopt a tandem process to acceptance and change, which allows for a greater flexibility in the focus of treatment.<a href="#cite_note-:02-34">[34]</a> Recent research has applied ACT successfully to chronic pain in older adults due to in part of its direction from individual values and being highly customizable to any stage of life.<a href="#cite_note-:02-34">[34]</a> In line with the therapeutic model of ACT, significant increases in process variables, pain acceptance, and mindfulness were also observed in a study applying ACT to chronic pain in older adults.<a href="#cite_note-:02-34">[34]</a> In addition, these primary results suggested that an ACT based treatment may significantly improve levels of physical disability, psychosocial disability, and depression post-treatment and at a three-month follow-up for older adults with chronic pain.<a href="#cite_note-:02-34">[34]</a> <div class="mw-heading mw-heading3"><h3 id="Cognitive_behavioral_therapy">Cognitive behavioral therapy</h3>[<a href="/w/index.php?title=Pain_management&action=edit&section=15" title="Edit section: Cognitive behavioral therapy">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951" /><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Cognitive_behavioral_therapy" title="Cognitive behavioral therapy">Cognitive behavioral therapy</a></div> Cognitive behavioral therapy (CBT) helps patients with pain to understand the relationship between their pain, thoughts, emotions, and behaviors. A main goal in treatment is cognitive (thinking, reasoning or remembering) restructuring to encourage helpful thought patterns.<a href="#cite_note-35">[35]</a> This will target healthy activities such as regular exercise and pacing. Lifestyle changes are also trained to improve sleep patterns and to develop better coping skills for pain and other stressors using various techniques (e.g., relaxation, diaphragmatic breathing, and even biofeedback).[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] Studies have demonstrated the usefulness of cognitive behavioral therapy in the management of chronic low back pain, producing significant decreases in physical and psychosocial disability.<a href="#cite_note-36">[36]</a> CBT is significantly more effective than standard care in treatment of people with body-wide pain, like fibromyalgia. Evidence for the usefulness of CBT in the management of adult chronic pain is generally poorly understood, due partly to the proliferation of techniques of doubtful quality, and the poor quality of reporting in clinical trials.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] The crucial content of individual interventions has not been isolated and the important contextual elements, such as therapist training and development of treatment manuals, have not been determined. The widely varying nature of the resulting data makes useful <a href="/wiki/Systematic_review" title="Systematic review">systematic review</a> and <a href="/wiki/Meta-analysis" title="Meta-analysis">meta-analysis</a> within the field very difficult.<a href="#cite_note-Eccleston1-37">[37]</a> In 2020, a <a href="/wiki/Systematic_review" title="Systematic review">systematic review</a> of <a href="/wiki/Randomized_controlled_trial" title="Randomized controlled trial">randomized controlled trials</a> (RCTs) evaluated the clinical effectiveness of psychological therapies for the management of adult chronic pain (excluding headaches). There is no evidence that <a href="/wiki/Behaviour_therapy" title="Behaviour therapy">behaviour therapy</a> (BT) is effective for reducing this type of pain, however BT may be useful for improving a person's mood immediately after treatment. This improvement appears to be small, and is short term in duration.<a href="#cite_note-:7-38">[38]</a> CBT may have a small positive short-term effect on pain immediately following treatment. CBT may also have a small effect on reducing <a href="/wiki/Disability" title="Disability">disability</a> and potential <a href="/wiki/Pain_catastrophizing" title="Pain catastrophizing">catastrophizing</a> that may be associated with adult chronic pain. These benefits do not appear to last very long following the therapy.<a href="#cite_note-:7-38">[38]</a> CBT may contribute towards improving the mood of an adult who experiences chronic pain, which could possibility be maintained for longer periods of time.<a href="#cite_note-:7-38">[38]</a> For children and adolescents, a review of RCTs evaluating the effectiveness of psychological therapy for the management of chronic and recurrent pain found that psychological treatments are effective in reducing pain when people under 18 years old have headaches.<a href="#cite_note-39">[39]</a> This beneficial effect may be maintained for at least three months following the therapy.<a href="#cite_note-:3-40">[40]</a> Psychological treatments may also improve pain control for children or adolescents who experience pain not related to headaches. It is not known if psychological therapy improves a child or adolescents mood and the potential for disability related to their chronic pain.<a href="#cite_note-:3-40">[40]</a> <div class="mw-heading mw-heading3"><h3 id="Hypnosis">Hypnosis</h3>[<a href="/w/index.php?title=Pain_management&action=edit&section=16" title="Edit section: Hypnosis">edit</a>]</div> A 2007 review of 13 studies found evidence for the efficacy of <a href="/wiki/Hypnosis" title="Hypnosis">hypnosis</a> in the reduction of pain in some conditions. However the studies had some limitations like small study sizes, bringing up issues of power to detect group differences, and lacking credible controls for placebo or expectation. The authors concluded that "although the findings provide support for the general applicability of hypnosis in the treatment of chronic pain, considerably more research will be needed to fully determine the effects of hypnosis for different chronic-pain conditions."<a href="#cite_note-Elkins2007-41">[41]</a>: 283  Hypnosis has reduced the pain of some harmful medical procedures in children and adolescents.<a href="#cite_note-Accardi-42">[42]</a> In clinical trials addressing other patient groups, it has significantly reduced pain compared to no treatment or some other non-hypnotic interventions.<a href="#cite_note-APA-43">[43]</a> The effects of self hypnosis on chronic pain are roughly comparable to those of progressive muscle relaxation.<a href="#cite_note-Jensen-44">[44]</a> A 2019 systematic review of 85 studies showed it to be significantly effective at reducing pain for people with high and medium levels of suggestibility, but of minimal effectiveness for people with low suggestibility. However, high quality clinical data is needed to generalize to the whole chronic pain population.<a href="#cite_note-45">[45]</a> <div class="mw-heading mw-heading3"><h3 id="Mindfulness_meditation">Mindfulness meditation</h3>[<a href="/w/index.php?title=Pain_management&action=edit&section=17" title="Edit section: Mindfulness meditation">edit</a>]</div> A 2013 meta-analysis of studies that used techniques centered around the concept of <a href="/wiki/Mindfulness_(psychology)" class="mw-redirect" title="Mindfulness (psychology)">mindfulness</a>, concluded, "that MBIs [mindfulness-based interventions] decrease the intensity of pain for chronic pain patients."<a href="#cite_note-46">[46]</a> A 2019 review of studies of brief mindfulness-based interventions (BMBI) concluded that BMBI are not recommended as a first-line treatment and could not confirm their efficacy in managing chronic or acute pain.<a href="#cite_note-47">[47]</a> <div class="mw-heading mw-heading3"><h3 id="Mindfulness-based_pain_management">Mindfulness-based pain management</h3>[<a href="/w/index.php?title=Pain_management&action=edit&section=18" title="Edit section: Mindfulness-based pain management">edit</a>]</div> <a href="/wiki/Mindfulness-based_pain_management" title="Mindfulness-based pain management">Mindfulness-based pain management</a> (MBPM) is a mindfulness-based intervention (MBI) providing specific applications for people living with chronic pain and illness.<a href="#cite_note-:5-48">[48]</a><a href="#cite_note-:22-49">[49]</a> Adapting the core concepts and practices of <a href="/wiki/Mindfulness-based_stress_reduction" title="Mindfulness-based stress reduction">mindfulness-based stress reduction</a> (MBSR) and <a href="/wiki/Mindfulness-based_cognitive_therapy" title="Mindfulness-based cognitive therapy">mindfulness-based cognitive therapy</a> (MBCT), MBPM includes a distinctive emphasis on the practice of '<a href="/wiki/Maitr%C4%AB" title="Maitrī">loving-kindness</a>', and has been seen as sensitive to concerns about removing mindfulness teaching from its original ethical framework within <a href="/wiki/Buddhism" title="Buddhism">Buddhism</a>.<a href="#cite_note-:5-48">[48]</a><a href="#cite_note-:8-50">[50]</a> It was developed by <a href="/wiki/Vidyamala_Burch" title="Vidyamala Burch">Vidyamala Burch</a> and is delivered through the programs of <a href="/wiki/Breathworks" title="Breathworks">Breathworks</a>.<a href="#cite_note-:5-48">[48]</a><a href="#cite_note-:22-49">[49]</a> It has been subject to a range of clinical studies demonstrating its effectiveness.<a href="#cite_note-:6-51">[51]</a><a href="#cite_note-:16-52">[52]</a><a href="#cite_note-:17-53">[53]</a><a href="#cite_note-:13-54">[54]</a><a href="#cite_note-:14-55">[55]</a><a href="#cite_note-:15-56">[56]</a><a href="#cite_note-:42-57">[57]</a><a href="#cite_note-:5-48">[48]</a>[<a href="/wiki/Wikipedia:Citing_sources#Bundling_citations" title="Wikipedia:Citing sources">excessive citations</a>] <div class="mw-heading mw-heading2"><h2 id="Medications">Medications</h2>[<a href="/w/index.php?title=Pain_management&action=edit&section=19" title="Edit section: Medications">edit</a>]</div> The <a href="/wiki/World_Health_Organization" title="World Health Organization">World Health Organization</a> (WHO) recommends a <a href="/wiki/Pain_ladder" title="Pain ladder">pain ladder</a> for managing pain relief with pharmaceutical medicine. It was first described for use in <a href="/wiki/Cancer_pain" title="Cancer pain">cancer pain</a>. However it can be used by medical professionals as a general principle when managing any type of pain.<a href="#cite_note-58">[58]</a><a href="#cite_note-HoMBRG-59">[59]</a> In the treatment of chronic pain, the three-step WHO Analgesic Ladder provides guidelines for selecting the appropriate medicine. The exact medications recommended will vary by country and the individual treatment center, but the following gives an example of the WHO approach to treating chronic pain with medications. If, at any point, treatment fails to provide adequate pain relief, then the doctor and patient move onto the next step.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] <table class="wikitable sortable"> <tbody><tr> <th colspan="4" style="background-color: #CCEEEE;">Common types of pain and typical drug management </th></tr> <tr> <th>Pain type </th> <th>typical initial drug treatment </th> <th>comments </th></tr> <tr> <td><a href="/wiki/Headache" title="Headache">headache</a> </td> <td>paracetamol/acetaminophen, <a href="/wiki/NSAIDs" class="mw-redirect" title="NSAIDs">NSAIDs</a><a href="#cite_note-BBDchronicpain-60">[60]</a> </td> <td>doctor consultation is appropriate if headaches are severe, persistent, accompanied by fever, vomiting, or speech or balance problems;<a href="#cite_note-BBDchronicpain-60">[60]</a> self-medication should be limited to two weeks<a href="#cite_note-BBDchronicpain-60">[60]</a> </td></tr> <tr> <td><a href="/wiki/Migraine" title="Migraine">migraine</a> </td> <td>paracetamol, NSAIDs<a href="#cite_note-BBDchronicpain-60">[60]</a> </td> <td><a href="/wiki/Triptans" class="mw-redirect" title="Triptans">triptans</a> are used when the others do not work, or when migraines are frequent or severe<a href="#cite_note-BBDchronicpain-60">[60]</a> </td></tr> <tr> <td><a href="/wiki/Menstrual_cramps" class="mw-redirect" title="Menstrual cramps">menstrual cramps</a> </td> <td>NSAIDs<a href="#cite_note-BBDchronicpain-60">[60]</a> </td> <td>some NSAIDs are marketed for cramps, but any NSAID would work<a href="#cite_note-BBDchronicpain-60">[60]</a> </td></tr> <tr> <td>minor trauma, such as a <a href="/wiki/Bruise" title="Bruise">bruise</a>, <a href="/wiki/Abrasion_(medical)" class="mw-redirect" title="Abrasion (medical)">abrasions</a>, <a href="/wiki/Sprain" title="Sprain">sprain</a> </td> <td>paracetamol, NSAIDs<a href="#cite_note-BBDchronicpain-60">[60]</a> </td> <td>opioids not recommended<a href="#cite_note-BBDchronicpain-60">[60]</a> </td></tr> <tr> <td>severe trauma, such as a <a href="/wiki/Wound" title="Wound">wound</a>, <a href="/wiki/Burn" title="Burn">burn</a>, <a href="/wiki/Bone_fracture" title="Bone fracture">bone fracture</a>, or severe sprain </td> <td>opioids<a href="#cite_note-BBDchronicpain-60">[60]</a> </td> <td>more than two weeks of pain requiring opioid treatment is unusual<a href="#cite_note-BBDchronicpain-60">[60]</a> </td></tr> <tr> <td><a href="/wiki/Strain_(injury)" title="Strain (injury)">strain</a> or pulled muscle </td> <td>NSAIDs, muscle relaxants<a href="#cite_note-BBDchronicpain-60">[60]</a> </td> <td>if inflammation is involved, NSAIDs may work better; short-term use only<a href="#cite_note-BBDchronicpain-60">[60]</a> </td></tr> <tr> <td>minor pain after surgery </td> <td>paracetamol, NSAIDs<a href="#cite_note-BBDchronicpain-60">[60]</a> </td> <td>opioids rarely needed<a href="#cite_note-BBDchronicpain-60">[60]</a> </td></tr> <tr> <td>severe pain after surgery </td> <td>opioids<a href="#cite_note-BBDchronicpain-60">[60]</a> </td> <td>combinations of opioids may be prescribed if pain is severe<a href="#cite_note-BBDchronicpain-60">[60]</a> </td></tr> <tr> <td><a href="/wiki/Muscle_ache" class="mw-redirect" title="Muscle ache">muscle ache</a> </td> <td>paracetamol, NSAIDs<a href="#cite_note-BBDchronicpain-60">[60]</a> </td> <td>if inflammation involved, NSAIDs may work better.<a href="#cite_note-BBDchronicpain-60">[60]</a> </td></tr> <tr> <td><a href="/wiki/Toothache" title="Toothache">toothache</a> or pain from dental procedures </td> <td>paracetamol, NSAIDs<a href="#cite_note-BBDchronicpain-60">[60]</a> </td> <td>this should be short term use; opioids may be necessary for severe pain<a href="#cite_note-BBDchronicpain-60">[60]</a> </td></tr> <tr> <td><a href="/wiki/Kidney_stone" class="mw-redirect" title="Kidney stone">kidney stone</a> pain </td> <td>paracetamol, NSAIDs, opioids<a href="#cite_note-BBDchronicpain-60">[60]</a> </td> <td>opioids usually needed if pain is severe.<a href="#cite_note-BBDchronicpain-60">[60]</a> </td></tr> <tr> <td>pain due to <a href="/wiki/Heartburn" title="Heartburn">heartburn</a> or <a href="/wiki/Gastroesophageal_reflux_disease" title="Gastroesophageal reflux disease">gastroesophageal reflux disease</a> </td> <td><a href="/wiki/Antacid" title="Antacid">antacid</a>, <a href="/wiki/H2_antagonist" class="mw-redirect" title="H2 antagonist">H2 antagonist</a>, <a href="/wiki/Proton-pump_inhibitor" title="Proton-pump inhibitor">proton-pump inhibitor</a><a href="#cite_note-BBDchronicpain-60">[60]</a> </td> <td>heartburn lasting more than a week requires medical attention; aspirin and NSAIDs should be avoided<a href="#cite_note-BBDchronicpain-60">[60]</a> </td></tr> <tr> <td>chronic back pain </td> <td>paracetamol, NSAIDs<a href="#cite_note-BBDchronicpain-60">[60]</a> </td> <td>opioids may be necessary if other drugs do not control pain and pain is persistent<a href="#cite_note-BBDchronicpain-60">[60]</a> </td></tr> <tr> <td><a href="/wiki/Osteoarthritis" title="Osteoarthritis">osteoarthritis</a> pain </td> <td>paracetamol, NSAIDs<a href="#cite_note-BBDchronicpain-60">[60]</a> </td> <td>medical attention is recommended if pain persists.<a href="#cite_note-BBDchronicpain-60">[60]</a> </td></tr> <tr> <td><a href="/wiki/Fibromyalgia" title="Fibromyalgia">fibromyalgia</a> </td> <td><a href="/wiki/Antidepressant" title="Antidepressant">antidepressant</a>, <a href="/wiki/Anticonvulsant" title="Anticonvulsant">anticonvulsant</a><a href="#cite_note-BBDchronicpain-60">[60]</a> </td> <td>evidence suggests that opioids are not effective in treating fibromyalgia<a href="#cite_note-BBDchronicpain-60">[60]</a> </td></tr> </tbody></table> <div class="mw-heading mw-heading3"><h3 id="Mild_pain">Mild pain</h3>[<a href="/w/index.php?title=Pain_management&action=edit&section=20" title="Edit section: Mild pain">edit</a>]</div> <a href="/wiki/Paracetamol" title="Paracetamol">Paracetamol</a> (acetaminophen), or a <a href="/wiki/Nonsteroidal_anti-inflammatory_drug" title="Nonsteroidal anti-inflammatory drug">nonsteroidal anti-inflammatory drug</a> (NSAID) such as <a href="/wiki/Ibuprofen" title="Ibuprofen">ibuprofen</a> will relieve mild pain.<a href="#cite_note-61">[61]</a> <div class="mw-heading mw-heading3"><h3 id="Mild_to_moderate_pain">Mild to moderate pain</h3>[<a href="/w/index.php?title=Pain_management&action=edit&section=21" title="Edit section: Mild to moderate pain">edit</a>]</div> Paracetamol, an NSAID or paracetamol in a combination product with a weak <a href="/wiki/Opioid" title="Opioid">opioid</a> such as <a href="/wiki/Tramadol" title="Tramadol">tramadol</a>, may provide greater relief than their separate use. A combination of opioid with <a href="/wiki/Paracetamol" title="Paracetamol">acetaminophen</a> can be frequently used such as Percocet, <a href="/wiki/Vicodin" class="mw-redirect" title="Vicodin">Vicodin</a>, or Norco. [<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] <div class="mw-heading mw-heading3"><h3 id="Moderate_to_severe_pain">Moderate to severe pain</h3>[<a href="/w/index.php?title=Pain_management&action=edit&section=22" title="Edit section: Moderate to severe pain">edit</a>]</div> When treating moderate to severe pain, the type of the pain, acute or chronic, needs to be considered. The type of pain can result in different medications being prescribed. Certain medications may work better for acute pain, others for chronic pain, and some may work equally well on both. Acute pain medication is for rapid onset of pain such as from an inflicted <a href="/wiki/Trauma_(medicine)" class="mw-redirect" title="Trauma (medicine)">trauma</a> or to treat <a href="/wiki/Surgery" title="Surgery">post-operative pain</a>. <a href="/wiki/Chronic_pain" title="Chronic pain">Chronic pain</a> medication is for alleviating long-lasting, ongoing pain.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] <a href="/wiki/Morphine" title="Morphine">Morphine</a> is the <a href="/wiki/Gold_standard" title="Gold standard">gold standard</a> to which all <a href="/wiki/Narcotic" title="Narcotic">narcotics</a> are compared. Semi-synthetic derivatives of morphine such as <a href="/wiki/Hydromorphone" title="Hydromorphone">hydromorphone</a> (Dilaudid), <a href="/wiki/Oxymorphone" title="Oxymorphone">oxymorphone</a> (Numorphan, Opana), <a href="/wiki/Nicomorphine" title="Nicomorphine">nicomorphine</a> (Vilan), <a href="/wiki/Hydromorphinol" title="Hydromorphinol">hydromorphinol</a> and others vary in such ways as duration of action, side effect profile and milligramme potency. <a href="/wiki/Fentanyl" title="Fentanyl">Fentanyl</a> has the benefit of less <a href="/wiki/Histamine" title="Histamine">histamine</a> release and thus fewer <a href="/wiki/Side_effect" title="Side effect">side effects</a>. It can also be administered via <a href="/wiki/Transdermal_patch" title="Transdermal patch">transdermal patch</a> which is convenient for chronic pain management. In addition to the transdermal patch and injectable fentanyl formulations, the FDA (Food and Drug Administration) has approved various immediate release fentanyl products for breakthrough cancer pain (Actiq/OTFC/Fentora/Onsolis/Subsys/Lazanda/Abstral). <a href="/wiki/Oxycodone" title="Oxycodone">Oxycodone</a> is used across the Americas and Europe for relief of serious chronic pain. Its main slow-release formula is known as <a href="/wiki/OxyContin" class="mw-redirect" title="OxyContin">OxyContin</a>. Short-acting tablets, capsules, syrups and <a href="/wiki/Ampule" class="mw-redirect" title="Ampule">ampules</a> which contain oxycodone are available making it suitable for acute intractable pain or <a href="/wiki/Pain#Breakthrough_pain" title="Pain">breakthrough pain</a>. <a href="/wiki/Diamorphine" class="mw-redirect" title="Diamorphine">Diamorphine</a>, and <a href="/wiki/Methadone" title="Methadone">methadone</a> are used less frequently.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] Clinical studies have shown that transdermal <a href="/wiki/Buprenorphine" title="Buprenorphine">buprenorphine</a> is effective at reducing chronic pain.<a href="#cite_note-62">[62]</a> <a href="/wiki/Pethidine" title="Pethidine">Pethidine</a>, known in North America as meperidine, is not recommended [<a href="/wiki/Wikipedia:Manual_of_Style/Words_to_watch#Unsupported_attributions" title="Wikipedia:Manual of Style/Words to watch">by whom?</a>] for pain management due to its low potency, short duration of action, and toxicity associated with repeated use.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] <a href="/wiki/Pentazocine" title="Pentazocine">Pentazocine</a>, <a href="/wiki/Dextromoramide" title="Dextromoramide">dextromoramide</a> and <a href="/wiki/Dipipanone" title="Dipipanone">dipipanone</a> are also not recommended in new patients except for acute pain where other analgesics are not tolerated or are inappropriate, for pharmacological and misuse-related reasons. In some countries potent synthetics such as <a href="/wiki/Piritramide" title="Piritramide">piritramide</a> and <a href="/wiki/Ketobemidone" title="Ketobemidone">ketobemidone</a> are used for severe pain. <a href="/wiki/Tapentadol" title="Tapentadol">Tapentadol</a> is a newer agent introduced in the last decade.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] For moderate pain, <a href="/wiki/Tramadol" title="Tramadol">tramadol</a>, <a href="/wiki/Codeine" title="Codeine">codeine</a>, <a href="/wiki/Dihydrocodeine" title="Dihydrocodeine">dihydrocodeine</a>, and <a href="/wiki/Hydrocodone" title="Hydrocodone">hydrocodone</a> are used, with <a href="/wiki/Nicocodeine" title="Nicocodeine">nicocodeine</a>, <a href="/wiki/Ethylmorphine" title="Ethylmorphine">ethylmorphine</a> and <a href="/wiki/Propoxyphene" class="mw-redirect" title="Propoxyphene">propoxyphene</a> or <a href="/wiki/Dextropropoxyphene" title="Dextropropoxyphene">dextropropoxyphene</a> (less commonly). Drugs of other types can be used to help opioids combat certain types of pain. <a href="/wiki/Amitriptyline" title="Amitriptyline">Amitriptyline</a> is prescribed for chronic muscular pain in the arms, legs, neck and lower back with an opiate, or sometimes without it or with an NSAID. While <a href="/wiki/Opiate" title="Opiate">opiates</a> are often used in the management of chronic pain, high doses are associated with an increased risk of <a href="/wiki/Opioid_overdose" title="Opioid overdose">opioid overdose</a>.<a href="#cite_note-63">[63]</a> <div class="mw-heading mw-heading3"><h3 id="Opioids">Opioids</h3>[<a href="/w/index.php?title=Pain_management&action=edit&section=23" title="Edit section: Opioids">edit</a>]</div> In 2009, the <a href="/wiki/Food_and_Drug_Administration" title="Food and Drug Administration">Food and Drug Administration</a> stated: "According to the <a href="/wiki/National_Institutes_of_Health" title="National Institutes of Health">National Institutes of Health</a>, studies have shown that properly managed medical use of opioid analgesic compounds (taken exactly as prescribed) is safe, can manage pain effectively, and rarely causes addiction."<a href="#cite_note-64">[64]</a> In 2013, the FDA stated that "abuse and misuse of these products have created a serious and growing public health problem".<a href="#cite_note-65">[65]</a> <a href="/wiki/Opioid" title="Opioid">Opioid</a> medications can provide short, intermediate or long acting analgesia depending upon the specific properties of the medication and whether it is formulated as an extended release drug. Opioid medications may be administered orally, by injection, via nasal mucosa or oral mucosa, rectally, transdermally, intravenously, epidurally and intrathecally. In chronic pain conditions that are opioid responsive, a combination of a long-acting (OxyContin, MS Contin, Opana ER, Exalgo and Methadone) or <a href="/wiki/Time_release_technology" class="mw-redirect" title="Time release technology">extended release</a> medication is often prescribed along with a shorter-acting medication (oxycodone, morphine or hydromorphone) for breakthrough pain, or exacerbations. Most opioid treatment used by patients outside of healthcare settings is oral (<a href="/wiki/Tablet_(pharmacy)" title="Tablet (pharmacy)">tablet</a>, <a href="/wiki/Capsule_(pharmacy)" title="Capsule (pharmacy)">capsule</a> or liquid), but <a href="/wiki/Suppository" title="Suppository">suppositories</a> and skin patches can be prescribed. An opioid <a href="/wiki/Injection_(medicine)" title="Injection (medicine)">injection</a> is rarely needed for patients with chronic pain. Although opioids are strong analgesics, they do not provide complete analgesia regardless of whether the pain is acute or chronic in origin. Opioids are effective analgesics in chronic malignant pain and modestly effective in nonmalignant pain management.<a href="#cite_note-66">[66]</a> However, there are associated adverse effects, especially during the commencement or change in dose. When <a href="/wiki/Opioids" class="mw-redirect" title="Opioids">opioids</a> are used for prolonged periods <a href="/wiki/Drug_tolerance" title="Drug tolerance">drug tolerance</a> will occur. Other risks can include <a href="/wiki/Chemical_dependency" class="mw-redirect" title="Chemical dependency">chemical dependency</a>, <a href="/wiki/Drug_diversion" title="Drug diversion">diversion</a> and <a href="/wiki/Substance_use_disorder" title="Substance use disorder">addiction</a>.<a href="#cite_note-67">[67]</a><a href="#cite_note-68">[68]</a> Clinical guidelines for prescribing opioids for chronic pain have been issued by the <a href="/wiki/American_Pain_Society" title="American Pain Society">American Pain Society</a> and the American Academy of Pain Medicine. Included in these guidelines is the importance of assessing the patient for the risk of substance abuse, misuse, or addiction. Factors correlated with an elevated risk of opioid misuse include a history of substance use disorder, younger age, major depression, and the use of psychotropic medications.<a href="#cite_note-69">[69]</a> Physicians who prescribe opioids should integrate this treatment with any psychotherapeutic intervention the patient may be receiving. The guidelines also recommend monitoring not only the pain but also the level of functioning and the achievement of therapeutic goals. The prescribing physician should be suspicious of abuse when a patient reports a reduction in pain but has no accompanying improvement in function or progress in achieving identified goals.<a href="#cite_note-70">[70]</a> The list below consists of commonly used opioid analgesics which have long-acting formulations. Common brand names for the extended release formulation are in parentheses. <ul><li><a href="/wiki/Oxycodone" title="Oxycodone">Oxycodone</a> (OxyContin)</li> <li><a href="/wiki/Hydromorphone" title="Hydromorphone">Hydromorphone</a> (Exalgo, Hydromorph Contin)</li> <li><a href="/wiki/Morphine" title="Morphine">Morphine</a> (M-Eslon, MS Contin)</li> <li><a href="/wiki/Oxymorphone" title="Oxymorphone">Oxymorphone</a> (Opana ER)</li> <li><a href="/wiki/Fentanyl" title="Fentanyl">Fentanyl</a>, transdermal (Duragesic)</li> <li><a href="/wiki/Buprenorphine" title="Buprenorphine">Buprenorphine</a>*, transdermal (Butrans)</li> <li><a href="/wiki/Tramadol" title="Tramadol">Tramadol</a> (Ultram ER)</li> <li><a href="/wiki/Tapentadol" title="Tapentadol">Tapentadol</a> (Nucynta ER)</li> <li><a href="/wiki/Methadone" title="Methadone">Methadone</a>* (Metadol, Methadose)</li> <li><a href="/wiki/Hydrocodone" title="Hydrocodone">Hydrocodone</a> bitartrate (Hysingla ER) and bicarbonate (Zohydro ER)</li></ul> *Methadone and buprenorphine are each used both for the treatment of <a href="/wiki/Opioid_use_disorder" title="Opioid use disorder">opioid addiction</a> and as analgesics <div class="mw-heading mw-heading3"><h3 id="Nonsteroidal_anti-inflammatory_drugs">Nonsteroidal anti-inflammatory drugs</h3>[<a href="/w/index.php?title=Pain_management&action=edit&section=24" title="Edit section: Nonsteroidal anti-inflammatory drugs">edit</a>]</div> The other major group of analgesics are <a href="/wiki/Nonsteroidal_anti-inflammatory_drug" title="Nonsteroidal anti-inflammatory drug">nonsteroidal anti-inflammatory drugs</a> (NSAID). They work by inhibiting the release of <a href="/wiki/Prostaglandin" title="Prostaglandin">prostaglandins</a>, which cause inflammatory pain. <a href="/wiki/Acetaminophen" class="mw-redirect" title="Acetaminophen">Acetaminophen</a>/paracetamol is not always included in this class of medications. However, acetaminophen may be administered as a single medication or in combination with other analgesics (both NSAIDs and opioids). The alternatively prescribed NSAIDs such as <a href="/wiki/Ketoprofen" title="Ketoprofen">ketoprofen</a> and <a href="/wiki/Piroxicam" title="Piroxicam">piroxicam</a> have limited benefit in chronic pain disorders and with long-term use are associated with significant <a href="/wiki/Adverse_effect" title="Adverse effect">adverse effects</a>. The use of selective NSAIDs designated as <a href="/wiki/COX-2_inhibitor" class="mw-redirect" title="COX-2 inhibitor">selective COX-2 inhibitors</a> have significant cardiovascular and cerebrovascular risks which have limited their utilization.<a href="#cite_note-Munir_MA,_Enany_N.-71">[71]</a><a href="#cite_note-Ballantyne_JC.-72">[72]</a> Common NSAIDs include <a href="/wiki/Aspirin" title="Aspirin">aspirin</a>, <a href="/wiki/Ibuprofen" title="Ibuprofen">ibuprofen</a>, and <a href="/wiki/Naproxen" title="Naproxen">naproxen</a>. There are many NSAIDs such as parecoxib (selective COX-2 inhibitor) with proven effectiveness after different surgical procedures. Wide use of non-opioid analgesics can reduce opioid-induced side-effects.<a href="#cite_note-73">[73]</a> <div class="mw-heading mw-heading3"><h3 id="Antidepressants_and_antiepileptic_drugs">Antidepressants and antiepileptic drugs</h3>[<a href="/w/index.php?title=Pain_management&action=edit&section=25" title="Edit section: Antidepressants and antiepileptic drugs">edit</a>]</div> Some <a href="/wiki/Antidepressant" title="Antidepressant">antidepressant</a> and <a href="/wiki/Antiepileptic" class="mw-redirect" title="Antiepileptic">antiepileptic</a> drugs are used in chronic pain management and act primarily within the pain pathways of the central nervous system, though peripheral mechanisms have been attributed as well. They are generally used to treat nerve brain that results from injury to the nervous system. <a href="/wiki/Neuropathy" class="mw-redirect" title="Neuropathy">Neuropathy</a> can be due to chronic high blood sugar levels (<a href="/wiki/Diabetic_neuropathy" title="Diabetic neuropathy">diabetic neuropathy</a>). These drugs also reduce pain from viruses such as shingles, <a href="/wiki/Phantom_limb_pain" class="mw-redirect" title="Phantom limb pain">phantom limb pain</a> and post-stroke pain.<a href="#cite_note-74">[74]</a> These mechanisms vary and in general are more effective in <a href="/wiki/Neuropathy" class="mw-redirect" title="Neuropathy">neuropathic</a> pain disorders as well as <a href="/wiki/Complex_regional_pain_syndrome" title="Complex regional pain syndrome">complex regional pain syndrome</a>.<a href="#cite_note-Jackson_KC_2nd.-75">[75]</a> A common anti-epileptic drug is <a href="/wiki/Gabapentin" title="Gabapentin">gabapentin</a>, and an example of an antidepressant would be <a href="/wiki/Amitriptyline" title="Amitriptyline">amitriptyline</a>.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] <div class="mw-heading mw-heading3"><h3 id="Cannabinoids">Cannabinoids</h3>[<a href="/w/index.php?title=Pain_management&action=edit&section=26" title="Edit section: Cannabinoids">edit</a>]</div> Evidence of medical marijuana's effect on reducing pain is generally conclusive. Detailed in a 1999 report by the <a href="/wiki/Institute_of_Medicine" class="mw-redirect" title="Institute of Medicine">Institute of Medicine</a>, "the available evidence from animal and human studies indicates that cannabinoids can have a substantial analgesic effect".<a href="#cite_note-76">[76]</a> In a 2013 review study published in Fundamental & Clinical Pharmacology, various studies were cited in demonstrating that cannabinoids exhibit comparable effectiveness to opioids in models of acute pain and even greater effectiveness in models of chronic pain.<a href="#cite_note-77">[77]</a> It is mainly the THC strain of medical marijuana that provide analgesic benefits, as opposed to the CBD strain.[<a href="/wiki/Wikipedia:Identifying_reliable_sources_(medicine)" title="Wikipedia:Identifying reliable sources (medicine)">medical citation needed</a>] <div class="mw-heading mw-heading3"><h3 id="Ketamine">Ketamine</h3>[<a href="/w/index.php?title=Pain_management&action=edit&section=27" title="Edit section: Ketamine">edit</a>]</div> Low-dose <a href="/wiki/Ketamine" title="Ketamine">ketamine</a> is sometimes used as an alternative to opioids for the treatment of acute pain in hospital <a href="/wiki/Emergency_department" title="Emergency department">emergency departments</a>.<a href="#cite_note-ACEP_policy_2017-78">[78]</a><a href="#cite_note-pmid33098707-79">[79]</a> Ketamine probably? reduces pain more than opioids and with less nausea and vomiting.<a href="#cite_note-bmjopen-2020-038134-80">[80]</a> <div class="mw-heading mw-heading3"><h3 id="Other_analgesics">Other analgesics</h3>[<a href="/w/index.php?title=Pain_management&action=edit&section=28" title="Edit section: Other analgesics">edit</a>]</div> Other drugs which can potentiate conventional analgesics or have analgesic properties in certain circumstances are called <a href="/wiki/Analgesic_adjuvant" title="Analgesic adjuvant">analgesic adjuvant</a> medications.<a href="#cite_note-:9-81">[81]</a> <a href="/wiki/Gabapentin" title="Gabapentin">Gabapentin</a>, an anticonvulsant, can reduce neuropathic pain itself and can also potentiate opiates.<a href="#cite_note-gabapentin-82">[82]</a> Drugs with <a href="/wiki/Anticholinergic" title="Anticholinergic">anticholinergic</a> activity, such as <a href="/wiki/Orphenadrine" title="Orphenadrine">orphenadrine</a> and <a href="/wiki/Cyclobenzaprine" title="Cyclobenzaprine">cyclobenzaprine</a>, are given in conjunction with opioids for neuropathic pain. Orphenadrine and cyclobenzaprine are also <a href="/wiki/Muscle_relaxant" title="Muscle relaxant">muscle relaxants</a>, and are useful in painful musculoskeletal conditions. <a href="/wiki/Clonidine" title="Clonidine">Clonidine</a>, an alpha-2 receptor agonist, is another drug that has found use as an analgesic adjuvant.<a href="#cite_note-:9-81">[81]</a> In 2021, researchers described a novel type of pain therapy — a <a href="/wiki/CRISPR_activation#dCas9" title="CRISPR activation">CRISPR-dCas9</a> <a href="/wiki/Epigenome_editing" title="Epigenome editing">epigenome editing</a> method for repressing <a href="/wiki/Nav1.7" class="mw-redirect" title="Nav1.7">Nav1.7</a> <a href="/wiki/Gene_expression" title="Gene expression">gene expression</a> which showed therapeutic potential in three mouse models of chronic pain.<a href="#cite_note-83">[83]</a><a href="#cite_note-84">[84]</a> <div class="mw-heading mw-heading2"><h2 id="Self-management">Self-management</h2>[<a href="/w/index.php?title=Pain_management&action=edit&section=29" title="Edit section: Self-management">edit</a>]</div> Self-management of chronic pain has been described as the individual's ability to manage various aspects of their chronic pain.<a href="#cite_note-:4-85">[85]</a> Self-management can include building <a href="/wiki/Self-efficacy" title="Self-efficacy">self-efficacy</a>, monitoring one's own symptoms, goal setting and action planning. It also includes patient-physician shared decision-making, among others.<a href="#cite_note-:4-85">[85]</a> The benefits of self-management vary depending on self-management techniques used. They only have marginal benefits in management of chronic musculoskeletal pain.<a href="#cite_note-86">[86]</a> Some research has shown that self-management of pain can use different approaches. Those approaches can range from different therapies such as yoga, acupuncture, exercise and other relaxation techniques. Patients could also take a more natural approach by taking different minerals, vitamins or herbs. However, research has shown there is a difference between rural patients and non-rural patients having more access to different self-management approaches. Physicians in these areas may be readily prescribing more pain medication in these rural cities due to being less experienced with pain management. Simply put, it is sometimes easier for rural patients to get a prescription that insurance pays for instead of natural approaches that cost more money than they can afford to spend on their pain management. Self-management may be a more expensive alternative.<a href="#cite_note-87">[87]</a> <div class="mw-heading mw-heading2"><h2 id="Society_and_culture">Society and culture</h2>[<a href="/w/index.php?title=Pain_management&action=edit&section=30" title="Edit section: Society and culture">edit</a>]</div> The medical treatment of pain as practiced in <a href="/wiki/Greece" title="Greece">Greece</a> and <a href="/wiki/Turkey" title="Turkey">Turkey</a> is called algology (from the Greek άλγος, <a href="/wiki/Algos" class="mw-redirect" title="Algos">algos</a>, "<a href="/wiki/Pain" title="Pain">pain</a>"). The Hellenic Society of Algology<a href="#cite_note-88">[88]</a> and the Turkish Algology-Pain Society<a href="#cite_note-89">[89]</a> are the relevant local bodies affiliated to the <a href="/wiki/International_Association_for_the_Study_of_Pain" title="International Association for the Study of Pain">International Association for the Study of Pain</a> (IASP).<a href="#cite_note-90">[90]</a> <div class="mw-heading mw-heading3"><h3 id="Undertreatment">Undertreatment</h3>[<a href="/w/index.php?title=Pain_management&action=edit&section=31" title="Edit section: Undertreatment">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951" /><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Undertreatment_of_pain" title="Undertreatment of pain">Undertreatment of pain</a></div> Undertreatment of pain is the absence of pain management therapy for a person in <a href="/wiki/Pain" title="Pain">pain</a> when treatment is <a href="/wiki/Indication_(medicine)" title="Indication (medicine)">indicated</a>. Consensus in <a href="/wiki/Evidence-based_medicine" title="Evidence-based medicine">evidence-based medicine</a> and the recommendations of <a href="/wiki/Medical_specialty" title="Medical specialty">medical specialty</a> organizations establish guidelines to determine the treatment for pain which health care providers ought to offer.<a href="#cite_note-State_of_Pain_Treatment_2011-91">[91]</a> For various social reasons, persons in pain may not seek or may not be able to access treatment for their pain.<a href="#cite_note-State_of_Pain_Treatment_2011-91">[91]</a> Health care providers may not provide the treatment which authorities recommend.<a href="#cite_note-State_of_Pain_Treatment_2011-91">[91]</a> Some studies about gender biases have concluded that female pain recipients are often overlooked when it comes to the perception of their pain. Whether they appeared to be in high levels of pain didn't make a difference for their observers. The women participants in the studies were still perceived to be in less pain than they actually were. Men participants on the other hand were offered pain relief while their self reporting indicated that their pain levels didn't necessarily warrant treatment. Biases exist when it comes to gender. Prescribers have been seen over and under prescribing treatment to individuals based on them being male or female <a href="#cite_note-92">[92]</a>.There are other prevalent reasons that undertreatment of pain occurs. Gender is a factor as well as race. When it comes to prescribers treating patients racial disparities has become a real factor. Research has shown that non-white individuals pain perception has affected their pain treatment. The <a href="/wiki/African_Americans" title="African Americans">African-American</a> community has been shown to suffer significantly when it comes to trusting the medical community to treat them. Oftentimes medication although available to be prescribed is dispensed in less quantities due to their pain being perceived on a smaller scale. The black community could be undermined by physicians thinking they are not in as much pain as they are reporting. Another occurrence may be physicians simply making the choice not to treat the patient accordingly in spite of the self-reported pain level. Racial disparity is definitely a real issue in the world of pain management.<a href="#cite_note-93">[93]</a> <div class="mw-heading mw-heading3"><h3 id="In_children">In children</h3>[<a href="/w/index.php?title=Pain_management&action=edit&section=32" title="Edit section: In children">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951" /><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Pain_management_in_children" title="Pain management in children">Pain management in children</a></div> Acute pain is common in children and adolescents as a result of injury, illness, or necessary medical procedures.<a href="#cite_note-AAP.-94">[94]</a> <a href="/wiki/Chronic_pain" title="Chronic pain">Chronic pain</a> is present in approximately 15–25% of children and adolescents. It may be caused by an underlying disease, such as <a href="/wiki/Sickle_cell_anemia" class="mw-redirect" title="Sickle cell anemia">sickle cell anemia</a>, <a href="/wiki/Cystic_fibrosis" title="Cystic fibrosis">cystic fibrosis</a>, <a href="/wiki/Rheumatoid_arthritis" title="Rheumatoid arthritis">rheumatoid arthritis</a>. Cancer or <a href="/wiki/Functional_disorder" title="Functional disorder">functional disorders</a> such as migraines, <a href="/wiki/Fibromyalgia" title="Fibromyalgia">fibromyalgia</a>, and complex regional pain could also cause chronic pain in children.<a href="#cite_note-Weydert-95">[95]</a> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Wong-Baker_scale_with_emoji.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/c/c6/Wong-Baker_scale_with_emoji.png/250px-Wong-Baker_scale_with_emoji.png" decoding="async" width="220" height="74" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/c/c6/Wong-Baker_scale_with_emoji.png/330px-Wong-Baker_scale_with_emoji.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/c/c6/Wong-Baker_scale_with_emoji.png/500px-Wong-Baker_scale_with_emoji.png 2x" data-file-width="732" data-file-height="245" /></a><figcaption>Young children can indicate their level of pain by pointing to the appropriate face on a children's <a href="/wiki/Pain_scale" title="Pain scale">pain scale</a>.</figcaption></figure> Pain assessment in children is often challenging due to limitations in developmental level, cognitive ability, or their previous pain experiences. Clinicians must observe physiological and behavioral cues exhibited by the child to make an assessment. Self-report, if possible, is the most accurate measure of pain. Self-report pain scales involve younger kids matching their pain intensity to photographs of other children's faces, such as the Oucher Scale, pointing to schematics of faces showing different pain levels, or pointing out the location of pain on a body outline.<a href="#cite_note-AMA-96">[96]</a> Questionnaires for older children and adolescents include the Varni-Thompson Pediatric Pain Questionnaire (PPQ) and the Children's Comprehensive Pain Questionnaire. They are often utilized for individuals with chronic or persistent pain.<a href="#cite_note-AMA-96">[96]</a> Acetaminophen, <a href="/wiki/Nonsteroidal_anti-inflammatory_agents" class="mw-redirect" title="Nonsteroidal anti-inflammatory agents">nonsteroidal anti-inflammatory agents</a>, and <a href="/wiki/Opioid" title="Opioid">opioid analgesics</a> are commonly used to treat acute or chronic pain symptoms in children and adolescents. However a pediatrician should be consulted before administering any medication.<a href="#cite_note-AMA-96">[96]</a> Caregivers may provide nonpharmacological treatment for children and adolescents because it carries minimal risk and is cost effective compared to pharmacological treatment. Nonpharmacologic interventions vary by age and developmental factors. Physical interventions to ease pain in infants include swaddling, rocking, or sucrose via a pacifier. For children and adolescents physical interventions include hot or cold application, <a href="/wiki/Massage" title="Massage">massage</a>, or <a href="/wiki/Acupuncture" title="Acupuncture">acupuncture</a>.<a href="#cite_note-Wente.-97">[97]</a> <a href="/wiki/Cognitive_behavioral_therapy" title="Cognitive behavioral therapy">Cognitive behavioral therapy</a> (CBT) aims to reduce the emotional distress and improve the daily functioning of school-aged children and adolescents with pain by changing the relationship between their thoughts and emotions. In addition this therapy teaches them adaptive <a href="/wiki/Coping_(psychology)" class="mw-redirect" title="Coping (psychology)">coping</a> strategies. Integrated interventions in CBT include <a href="/wiki/Relaxation_training" class="mw-redirect" title="Relaxation training">relaxation technique</a>, <a href="/wiki/Mindfulness" title="Mindfulness">mindfulness</a>, <a href="/wiki/Biofeedback" title="Biofeedback">biofeedback</a>, and <a href="/wiki/Acceptance" title="Acceptance">acceptance</a> (in the case of chronic pain).<a href="#cite_note-Zagustin-98">[98]</a> Many therapists will hold sessions for caregivers to provide them with effective management strategies.<a href="#cite_note-Weydert-95">[95]</a> In red-haired individuals In recent studies, it has been noted that people who have red-hair through the MC1R receptor gene may react to opioids and perceive pain differently than the rest of the population.<a href="#cite_note-99">[99]</a> The studies on this developing topic have only become notable in the past few years with researchers looking into how red-haired individuals may experience a different threshold in pain and react to pain management differently than others. Most studies find that redheads with this gene have a higher pain tolerance and can also react more sensitively to opiates but require more anesthesia. <a href="#cite_note-100">[100]</a> <div class="mw-heading mw-heading3"><h3 id="Professional_certification">Professional certification</h3>[<a href="/w/index.php?title=Pain_management&action=edit&section=33" title="Edit section: Professional certification">edit</a>]</div> Pain management practitioners come from all fields of medicine. In addition to medical practitioners, a pain management team may often benefit from the input of <a href="/wiki/Pharmacists" class="mw-redirect" title="Pharmacists">pharmacists</a>, <a href="/wiki/Physiotherapist" class="mw-redirect" title="Physiotherapist">physiotherapists</a>, <a href="/wiki/Clinical_psychologist" class="mw-redirect" title="Clinical psychologist">clinical psychologists</a> and <a href="/wiki/Occupational_therapist" title="Occupational therapist">occupational therapists</a>, among others. Together the multidisciplinary team can help create a package of care suitable to the patient. <div class="mw-heading mw-heading4"><h4 id="Pain_medicine_in_the_United_States">Pain medicine in the United States</h4>[<a href="/w/index.php?title=Pain_management&action=edit&section=34" title="Edit section: Pain medicine in the United States">edit</a>]</div> Pain physicians are often fellowship-trained <a href="/wiki/American_Board_of_Medical_Specialties" title="American Board of Medical Specialties">board-certified</a> <a href="/wiki/Anesthesiology" title="Anesthesiology">anesthesiologists</a>, <a href="/wiki/Neurology" title="Neurology">neurologists</a>, <a href="/wiki/Physiatry" class="mw-redirect" title="Physiatry">physiatrists</a>, <a href="/wiki/Emergency_physicians" class="mw-redirect" title="Emergency physicians">emergency physicians</a>, or <a href="/wiki/Psychiatry" title="Psychiatry">psychiatrists</a>. <a href="/wiki/Palliative_care" title="Palliative care">Palliative care</a> doctors are also specialists in pain management. The American Society of Interventional Pain Physicians, the <a href="/wiki/American_Board_of_Anesthesiology" title="American Board of Anesthesiology">American Board of Anesthesiology</a>, the <a href="/wiki/American_Osteopathic_Board_of_Anesthesiology" title="American Osteopathic Board of Anesthesiology">American Osteopathic Board of Anesthesiology</a> (recognized by the <a href="/wiki/AOABOS" class="mw-redirect" title="AOABOS">AOABOS</a>), the American Board of Physical Medicine and Rehabilitation, the <a href="/wiki/American_Board_of_Emergency_Medicine" title="American Board of Emergency Medicine">American Board of Emergency Medicine</a> and the <a href="/wiki/American_Board_of_Psychiatry_and_Neurology" title="American Board of Psychiatry and Neurology">American Board of Psychiatry and Neurology</a><a href="#cite_note-101">[101]</a> each provide certification for a subspecialty in pain management following fellowship training. The fellowship training is recognized by the <a href="/wiki/American_Board_of_Medical_Specialties" title="American Board of Medical Specialties">American Board of Medical Specialties</a> (ABMS) or the <a href="/wiki/American_Osteopathic_Association_Bureau_of_Osteopathic_Specialists" title="American Osteopathic Association Bureau of Osteopathic Specialists">American Osteopathic Association Bureau of Osteopathic Specialists</a> (AOABOS). As the field of pain medicine has grown rapidly, many practitioners have entered the field, some non-ACGME board-certified.<a href="#cite_note-pmid23953018-102">[102]</a> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2>[<a href="/w/index.php?title=Pain_management&action=edit&section=35" title="Edit section: See also">edit</a>]</div> <style data-mw-deduplicate="TemplateStyles:r1184024115">.mw-parser-output .div-col{margin-top:0.3em;column-width:30em}.mw-parser-output .div-col-small{font-size:90%}.mw-parser-output .div-col-rules{column-rule:1px solid #aaa}.mw-parser-output .div-col dl,.mw-parser-output .div-col ol,.mw-parser-output .div-col ul{margin-top:0}.mw-parser-output .div-col li,.mw-parser-output .div-col dd{page-break-inside:avoid;break-inside:avoid-column}</style><div class="div-col" style="column-width: 30em;"> <ul><li><a href="/wiki/Equianalgesic" title="Equianalgesic">Equianalgesic</a></li> <li><a href="/wiki/List_of_investigational_analgesics" title="List of investigational analgesics">List of investigational analgesics</a></li> <li><a href="/wiki/Opioid_comparison" class="mw-redirect" title="Opioid comparison">Opioid comparison</a>, an example of an <a href="/wiki/Equianalgesic" title="Equianalgesic">equianalgesic</a> chart</li> <li><a href="/wiki/Pain_Catastrophizing_Scale" title="Pain Catastrophizing Scale">Pain Catastrophizing Scale</a></li> <li><a href="/wiki/Pain_ladder" title="Pain ladder">Pain ladder</a></li> <li><a href="/wiki/Pain_management_during_childbirth" title="Pain management during childbirth">Pain management during childbirth</a></li> <li><a href="/wiki/Pain_psychology" title="Pain psychology">Pain psychology</a></li></ul> </div> <div class="mw-heading mw-heading2"><h2 id="References">References</h2>[<a href="/w/index.php?title=Pain_management&action=edit&section=36" title="Edit section: References">edit</a>]</div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist reflist-columns references-column-width" style="column-width: 30em;"> <ol class="references"> <li id="cite_note-pmid10683246-1"><a href="#cite_ref-pmid10683246_1-0">^</a> <style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite id="CITEREFZhorovAnanthanarayanan2000" class="citation journal cs1">Zhorov BS, Ananthanarayanan VS (March 2000). 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PM & R. 5 (8): 697–704. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2Fj.pmrj.2013.05.009">10.1016/j.pmrj.2013.05.009</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/23953015">23953015</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:20013375">20013375</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=PM+%26+R&rft.atitle=The+role+of+cognitive+behavioral+therapy+for+chronic+pain+in+adolescents&rft.volume=5&rft.issue=8&rft.pages=%3Cspan+class%3D%22nowrap%22%3E697-%3C%2Fspan%3E704&rft.date=2013-08&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A20013375%23id-name%3DS2CID&rft_id=info%3Apmid%2F23953015&rft_id=info%3Adoi%2F10.1016%2Fj.pmrj.2013.05.009&rft.aulast=Zagustin&rft.aufirst=TK&rfr_id=info%3Asid%2Fen.wikipedia.org%3APain+management" class="Z3988"> </li> <li id="cite_note-99"><a href="#cite_ref-99">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222" /><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.nih.gov/news-events/nih-research-matters/study-finds-link-between-red-hair-pain-threshold">"Study finds link between red hair and pain threshold"</a>. National Institutes of Health (NIH). 2021-04-19. Retrieved 2024-09-21.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=National+Institutes+of+Health+%28NIH%29&rft.atitle=Study+finds+link+between+red+hair+and+pain+threshold&rft.date=2021-04-19&rft_id=https%3A%2F%2Fwww.nih.gov%2Fnews-events%2Fnih-research-matters%2Fstudy-finds-link-between-red-hair-pain-threshold&rfr_id=info%3Asid%2Fen.wikipedia.org%3APain+management" class="Z3988"> </li> <li id="cite_note-100"><a href="#cite_ref-100">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222" /><cite id="CITEREFCepedaCarr2003" class="citation journal cs1">Cepeda, M. Soledad; Carr, Daniel B. (November 2003). <a rel="nofollow" class="external text" href="https://dx.doi.org/10.1213/01.ane.0000080153.36643.83">"Women Experience More Pain and Require More Morphine Than Men to Achieve a Similar Degree of Analgesia"</a>. Anesthesia & Analgesia. 97 (5): 1464–1468. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1213%2F01.ane.0000080153.36643.83">10.1213/01.ane.0000080153.36643.83</a>. <a href="/wiki/ISSN_(identifier)" class="mw-redirect" title="ISSN (identifier)">ISSN</a> <a rel="nofollow" class="external text" href="https://search.worldcat.org/issn/0003-2999">0003-2999</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/14570666">14570666</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Anesthesia+%26+Analgesia&rft.atitle=Women+Experience+More+Pain+and+Require+More+Morphine+Than+Men+to+Achieve+a+Similar+Degree+of+Analgesia&rft.volume=97&rft.issue=5&rft.pages=%3Cspan+class%3D%22nowrap%22%3E1464-%3C%2Fspan%3E1468&rft.date=2003-11&rft.issn=0003-2999&rft_id=info%3Apmid%2F14570666&rft_id=info%3Adoi%2F10.1213%2F01.ane.0000080153.36643.83&rft.aulast=Cepeda&rft.aufirst=M.+Soledad&rft.au=Carr%2C+Daniel+B.&rft_id=http%3A%2F%2Fdx.doi.org%2F10.1213%2F01.ane.0000080153.36643.83&rfr_id=info%3Asid%2Fen.wikipedia.org%3APain+management" class="Z3988"> </li> <li id="cite_note-101"><a href="#cite_ref-101">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222" /><cite class="citation web cs1"><a rel="nofollow" class="external text" href="http://www.abpn.com/become-certified/taking-a-subspecialty-exam/">"Taking a Subspecialty Exam - American Board of Psychiatry and Neurology"</a>. Retrieved 2015-09-19.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Taking+a+Subspecialty+Exam+-+American+Board+of+Psychiatry+and+Neurology&rft_id=http%3A%2F%2Fwww.abpn.com%2Fbecome-certified%2Ftaking-a-subspecialty-exam%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3APain+management" class="Z3988"> </li> <li id="cite_note-pmid23953018-102"><a href="#cite_ref-pmid23953018_102-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222" /><cite id="CITEREFMayerIhmSibellPress2013" class="citation journal cs1">Mayer EK, Ihm JM, Sibell DM, Press JM, Kennedy DJ (August 2013). "ACGME sports, ACGME pain, or non-ACGME sports and spine: which is the ideal fellowship training for PM&R physicians interested in musculoskeletal medicine?". PM & R. 5 (8): 718–23, discussion 723–5. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2Fj.pmrj.2013.07.004">10.1016/j.pmrj.2013.07.004</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/23953018">23953018</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:39220409">39220409</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=PM+%26+R&rft.atitle=ACGME+sports%2C+ACGME+pain%2C+or+non-ACGME+sports+and+spine%3A+which+is+the+ideal+fellowship+training+for+PM%26R+physicians+interested+in+musculoskeletal+medicine%3F&rft.volume=5&rft.issue=8&rft.pages=%3Cspan+class%3D%22nowrap%22%3E718-%3C%2Fspan%3E23%2C+discussion+723-5&rft.date=2013-08&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A39220409%23id-name%3DS2CID&rft_id=info%3Apmid%2F23953018&rft_id=info%3Adoi%2F10.1016%2Fj.pmrj.2013.07.004&rft.aulast=Mayer&rft.aufirst=EK&rft.au=Ihm%2C+JM&rft.au=Sibell%2C+DM&rft.au=Press%2C+JM&rft.au=Kennedy%2C+DJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3APain+management" class="Z3988"> </li> </ol></div> <div class="mw-heading mw-heading2"><h2 id="Further_reading">Further reading</h2>[<a href="/w/index.php?title=Pain_management&action=edit&section=37" title="Edit section: Further reading">edit</a>]</div> <style data-mw-deduplicate="TemplateStyles:r1239549316">.mw-parser-output .refbegin{margin-bottom:0.5em}.mw-parser-output .refbegin-hanging-indents>ul{margin-left:0}.mw-parser-output .refbegin-hanging-indents>ul>li{margin-left:0;padding-left:3.2em;text-indent:-3.2em}.mw-parser-output .refbegin-hanging-indents ul,.mw-parser-output .refbegin-hanging-indents ul li{list-style:none}@media(max-width:720px){.mw-parser-output .refbegin-hanging-indents>ul>li{padding-left:1.6em;text-indent:-1.6em}}.mw-parser-output .refbegin-columns{margin-top:0.3em}.mw-parser-output .refbegin-columns ul{margin-top:0}.mw-parser-output .refbegin-columns li{page-break-inside:avoid;break-inside:avoid-column}@media screen{.mw-parser-output .refbegin{font-size:90%}}</style><div class="refbegin refbegin-columns references-column-width" style="column-width: 30em"> <ul><li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222" /><cite id="CITEREFDiwanStaats2015" class="citation book cs1">Diwan S, Staats P (January 2015). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=xvl8MAEACAAJ&q=diwan+staats">Atlas of Pain Medicine Procedures</a>. McGraw Hill. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-07-173876-7" title="Special:BookSources/978-0-07-173876-7"><bdi>978-0-07-173876-7</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Atlas+of+Pain+Medicine+Procedures&rft.pub=McGraw+Hill&rft.date=2015-01&rft.isbn=978-0-07-173876-7&rft.aulast=Diwan&rft.aufirst=S&rft.au=Staats%2C+P&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3Dxvl8MAEACAAJ%26q%3Ddiwan%2Bstaats&rfr_id=info%3Asid%2Fen.wikipedia.org%3APain+management" class="Z3988"></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222" /><cite id="CITEREFStaatsWallace2015" class="citation book cs1">Staats P, Wallace M (March 2015). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=YJWKoAEACAAJ&q=staats+wallace+just+the+facts">Pain Medicine and Management: Just the Facts</a>. McGraw Hill. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/9780071817455" title="Special:BookSources/9780071817455"><bdi>9780071817455</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Pain+Medicine+and+Management%3A+Just+the+Facts&rft.pub=McGraw+Hill&rft.date=2015-03&rft.isbn=9780071817455&rft.aulast=Staats&rft.aufirst=P&rft.au=Wallace%2C+M&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DYJWKoAEACAAJ%26q%3Dstaats%2Bwallace%2Bjust%2Bthe%2Bfacts&rfr_id=info%3Asid%2Fen.wikipedia.org%3APain+management" class="Z3988"></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222" /><cite id="CITEREFFausettWarfield2002" class="citation book cs1">Fausett HJ, Warfield CA (2002). Manual of pain management. Hagerstwon, MD: Lippincott Williams & Wilkins. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-7817-2313-8" title="Special:BookSources/978-0-7817-2313-8"><bdi>978-0-7817-2313-8</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Manual+of+pain+management&rft.place=Hagerstwon%2C+MD&rft.pub=Lippincott+Williams+%26+Wilkins&rft.date=2002&rft.isbn=978-0-7817-2313-8&rft.aulast=Fausett&rft.aufirst=HJ&rft.au=Warfield%2C+CA&rfr_id=info%3Asid%2Fen.wikipedia.org%3APain+management" class="Z3988"></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222" /><cite id="CITEREFBajwaWarfield2004" class="citation book cs1">Bajwa ZH, Warfield CA (2004). Principles and practice of pain medicine. New York: McGraw-Hill, Medical Publishing Division. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-07-144349-4" title="Special:BookSources/978-0-07-144349-4"><bdi>978-0-07-144349-4</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Principles+and+practice+of+pain+medicine&rft.place=New+York&rft.pub=McGraw-Hill%2C+Medical+Publishing+Division&rft.date=2004&rft.isbn=978-0-07-144349-4&rft.aulast=Bajwa&rft.aufirst=ZH&rft.au=Warfield%2C+CA&rfr_id=info%3Asid%2Fen.wikipedia.org%3APain+management" class="Z3988"></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222" /><cite id="CITEREFWaldman2006" class="citation book cs1">Waldman SD (2006). Pain Management. Philadelphia: Saunders. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-7216-0334-6" title="Special:BookSources/978-0-7216-0334-6"><bdi>978-0-7216-0334-6</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Pain+Management&rft.place=Philadelphia&rft.pub=Saunders&rft.date=2006&rft.isbn=978-0-7216-0334-6&rft.aulast=Waldman&rft.aufirst=SD&rfr_id=info%3Asid%2Fen.wikipedia.org%3APain+management" class="Z3988"></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222" /><cite id="CITEREFDaubresseChangYuViswanathan2013" class="citation journal cs1">Daubresse M, Chang HY, Yu Y, Viswanathan S, Shah ND, Stafford RS, et al. (October 2013). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3845222">"Ambulatory diagnosis and treatment of nonmalignant pain in the United States, 2000-2010"</a>. Medical Care. 51 (10): 870–878. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1097%2FMLR.0b013e3182a95d86">10.1097/MLR.0b013e3182a95d86</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3845222">3845222</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/24025657">24025657</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Medical+Care&rft.atitle=Ambulatory+diagnosis+and+treatment+of+nonmalignant+pain+in+the+United+States%2C+2000-2010&rft.volume=51&rft.issue=10&rft.pages=%3Cspan+class%3D%22nowrap%22%3E870-%3C%2Fspan%3E878&rft.date=2013-10&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3845222%23id-name%3DPMC&rft_id=info%3Apmid%2F24025657&rft_id=info%3Adoi%2F10.1097%2FMLR.0b013e3182a95d86&rft.aulast=Daubresse&rft.aufirst=M&rft.au=Chang%2C+HY&rft.au=Yu%2C+Y&rft.au=Viswanathan%2C+S&rft.au=Shah%2C+ND&rft.au=Stafford%2C+RS&rft.au=Kruszewski%2C+SP&rft.au=Alexander%2C+GC&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3845222&rfr_id=info%3Asid%2Fen.wikipedia.org%3APain+management" class="Z3988"></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222" /><cite id="CITEREFGraham2015" class="citation book cs1">Graham SS (2015). The Politics of Pain Medicine: A Rhetorical-Ontological Inquiry. Chicago Scholarship Online. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/9780226264059" title="Special:BookSources/9780226264059"><bdi>9780226264059</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Politics+of+Pain+Medicine%3A+A+Rhetorical-Ontological+Inquiry&rft.pub=Chicago+Scholarship+Online&rft.date=2015&rft.isbn=9780226264059&rft.aulast=Graham&rft.aufirst=SS&rfr_id=info%3Asid%2Fen.wikipedia.org%3APain+management" class="Z3988"></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222" /><cite id="CITEREFReynoldsTansey2004" class="citation book cs1">Reynolds LA, <a href="/wiki/Tilli_Tansey" title="Tilli Tansey">Tansey EM</a> (2004). Innovation in pain management : the transcript of a witness seminar held by the Wellcome Trust Centre for the History of Medicine at UCL, London, on 12 December 2002. Wellcome Trust Centre for the History of Medicine at UCL. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-85484-097-7" title="Special:BookSources/978-0-85484-097-7"><bdi>978-0-85484-097-7</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Innovation+in+pain+management+%3A+the+transcript+of+a+witness+seminar+held+by+the+Wellcome+Trust+Centre+for+the+History+of+Medicine+at+UCL%2C+London%2C+on+12+December+2002&rft.pub=Wellcome+Trust+Centre+for+the+History+of+Medicine+at+UCL&rft.date=2004&rft.isbn=978-0-85484-097-7&rft.aulast=Reynolds&rft.aufirst=LA&rft.au=Tansey%2C+EM&rfr_id=info%3Asid%2Fen.wikipedia.org%3APain+management" class="Z3988"></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222" /><cite id="CITEREFWailoo2014" class="citation book cs1">Wailoo K (2014). Pain: A Political History. Johns Hopkins University Press. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-1421413655" title="Special:BookSources/978-1421413655"><bdi>978-1421413655</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Pain%3A+A+Political+History&rft.pub=Johns+Hopkins+University+Press&rft.date=2014&rft.isbn=978-1421413655&rft.aulast=Wailoo&rft.aufirst=K&rfr_id=info%3Asid%2Fen.wikipedia.org%3APain+management" class="Z3988"></li></ul> </div> <div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2>[<a href="/w/index.php?title=Pain_management&action=edit&section=38" title="Edit section: External links">edit</a>]</div> <style data-mw-deduplicate="TemplateStyles:r1235681985">.mw-parser-output .side-box{margin:4px 0;box-sizing:border-box;border:1px solid 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plainlist">Wikimedia Commons has media related to <a href="https://commons.wikimedia.org/wiki/Category:Pain_management" class="extiw" title="commons:Category:Pain management">Pain management</a>.</div></div> </div> <ul><li><a rel="nofollow" class="external text" href="https://web.archive.org/web/20130327044726/http://www.who.int/medicines/areas/quality_safety/guide_on_pain/en/">World Health Organization (WHO) Treatment Guidelines on Pain</a></li></ul> <div class="navbox-styles"><style data-mw-deduplicate="TemplateStyles:r1129693374">.mw-parser-output .hlist dl,.mw-parser-output .hlist ol,.mw-parser-output .hlist ul{margin:0;padding:0}.mw-parser-output .hlist dd,.mw-parser-output .hlist dt,.mw-parser-output .hlist li{margin:0;display:inline}.mw-parser-output .hlist.inline,.mw-parser-output .hlist.inline dl,.mw-parser-output .hlist.inline ol,.mw-parser-output .hlist.inline ul,.mw-parser-output .hlist dl dl,.mw-parser-output .hlist dl ol,.mw-parser-output .hlist dl ul,.mw-parser-output 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.mw-parser-output .navbox{display:none!important}}</style></div><div role="navigation" class="navbox" aria-labelledby="Pain112" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374" /><style data-mw-deduplicate="TemplateStyles:r1239400231">.mw-parser-output .navbar{display:inline;font-size:88%;font-weight:normal}.mw-parser-output .navbar-collapse{float:left;text-align:left}.mw-parser-output .navbar-boxtext{word-spacing:0}.mw-parser-output .navbar ul{display:inline-block;white-space:nowrap;line-height:inherit}.mw-parser-output .navbar-brackets::before{margin-right:-0.125em;content:"[ "}.mw-parser-output .navbar-brackets::after{margin-left:-0.125em;content:" ]"}.mw-parser-output .navbar li{word-spacing:-0.125em}.mw-parser-output .navbar a>span,.mw-parser-output .navbar a>abbr{text-decoration:inherit}.mw-parser-output .navbar-mini abbr{font-variant:small-caps;border-bottom:none;text-decoration:none;cursor:inherit}.mw-parser-output .navbar-ct-full{font-size:114%;margin:0 7em}.mw-parser-output .navbar-ct-mini{font-size:114%;margin:0 4em}html.skin-theme-clientpref-night .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}@media(prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}}@media print{.mw-parser-output .navbar{display:none!important}}</style><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Pain" title="Template:Pain"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Pain" title="Template talk:Pain"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Pain" title="Special:EditPage/Template:Pain"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Pain112" style="font-size:114%;margin:0 4em"><a href="/wiki/Pain" title="Pain">Pain</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">By region/system</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">Head and neck</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Eye_strain" title="Eye strain">Eye strain</a></li> <li><a href="/wiki/Headache" title="Headache">Headache</a></li> <li><a href="/wiki/Neck_pain" title="Neck pain">Neck</a></li> <li><a href="/wiki/Odynophagia" title="Odynophagia">Odynophagia (swallowing)</a></li> <li><a href="/wiki/Toothache" title="Toothache">Toothache</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Respiratory_system" title="Respiratory system">Respiratory system</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Sore_throat" title="Sore throat">Sore throat</a></li> <li><a href="/wiki/Bornholm_disease" title="Bornholm disease">Pleurodynia</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Human_musculoskeletal_system" title="Human musculoskeletal system">Musculoskeletal</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Arthralgia" title="Arthralgia">Arthralgia (joint)</a></li> <li><a href="/wiki/Bone_pain" title="Bone pain">Bone pain</a></li> <li><a href="/wiki/Myalgia" title="Myalgia">Myalgia (muscle)</a></li> <li><a href="/wiki/Acute_muscle_soreness" title="Acute muscle soreness">Acute</a></li> <li><a href="/wiki/Delayed_onset_muscle_soreness" title="Delayed onset muscle soreness">Delayed-onset</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Neurology" title="Neurology">Neurologic</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Neuralgia" title="Neuralgia">Neuralgia</a></li> <li><a href="/wiki/Pain_asymbolia" title="Pain asymbolia">Pain asymbolia</a></li> <li><a href="/wiki/Pain_disorder" title="Pain disorder">Pain disorder</a></li> <li><a href="/wiki/Paroxysmal_extreme_pain_disorder" title="Paroxysmal extreme pain disorder">Paroxysmal extreme pain disorder</a></li> <li><a href="/wiki/Allodynia" title="Allodynia">Allodynia</a></li> <li><a href="/wiki/Chronic_pain" title="Chronic pain">Chronic pain</a></li> <li><a href="/wiki/Hyperalgesia" title="Hyperalgesia">Hyperalgesia</a></li> <li><a href="/wiki/Hypoalgesia" title="Hypoalgesia">Hypoalgesia</a></li> <li><a href="/wiki/Hyperpathia" title="Hyperpathia">Hyperpathia</a></li> <li><a href="/wiki/Phantom_pain" title="Phantom pain">Phantom pain</a></li> <li><a href="/wiki/Referred_pain" title="Referred pain">Referred pain</a></li> <li><a href="/wiki/Congenital_insensitivity_to_pain" title="Congenital insensitivity to pain">Congenital insensitivity to pain</a> <ul><li><a href="/wiki/Congenital_insensitivity_to_pain_with_anhidrosis" title="Congenital insensitivity to pain with anhidrosis">congenital insensitivity to pain with anhidrosis</a></li> <li><a href="/wiki/Congenital_insensitivity_to_pain_with_partial_anhidrosis" class="mw-redirect" title="Congenital insensitivity to pain with partial anhidrosis">congenital insensitivity to pain with partial anhidrosis</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Pelvic_pain" title="Pelvic pain">Pelvic pain</a></li> <li><a href="/wiki/Proctalgia_fugax" title="Proctalgia fugax">Proctalgia</a></li> <li><a href="/wiki/Back_pain" title="Back pain">Back</a></li> <li><a href="/wiki/Low_back_pain" title="Low back pain">Low back pain</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Measurement and testing</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Pain_scale" title="Pain scale">Pain scale</a></li> <li><a href="/wiki/Cold_pressor_test" title="Cold pressor test">Cold pressor test</a></li> <li><a href="/wiki/Dolorimeter" title="Dolorimeter">Dolorimeter</a></li> <li><a href="/wiki/Grimace_scale" title="Grimace scale">Grimace scale</a></li> <li><a href="/wiki/Hot_plate_test" title="Hot plate test">Hot plate test</a></li> <li><a href="/wiki/Tail_flick_test" title="Tail flick test">Tail flick test</a></li> <li><a href="/wiki/Visual_analogue_scale" title="Visual analogue scale">Visual analogue scale</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Pathophysiology" title="Pathophysiology">Pathophysiology</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Nociception" title="Nociception">Nociception</a></li> <li><a href="/wiki/Anterolateral_system" class="mw-redirect" title="Anterolateral system">Anterolateral system</a></li> <li><a href="/wiki/Marginal_nucleus_of_spinal_cord" title="Marginal nucleus of spinal cord">Posteromarginal nucleus</a></li> <li><a href="/wiki/Substance_P" title="Substance P">Substance P</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a class="mw-selflink selflink">Management</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Analgesia" class="mw-redirect" title="Analgesia">Analgesia</a></li> <li><a href="/wiki/Anesthesia" title="Anesthesia">Anesthesia</a></li> <li><a href="/wiki/Cordotomy" title="Cordotomy">Cordotomy</a></li> <li><a href="/wiki/Eradication_of_suffering" title="Eradication of suffering">Pain eradication</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Related concepts</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Threshold_of_pain" title="Threshold of pain">Pain threshold</a></li> <li><a href="/wiki/Pain_tolerance" title="Pain tolerance">Pain tolerance</a></li> <li><a href="/wiki/Suffering" title="Suffering">Suffering</a></li> <li><a href="/wiki/SOCRATES_(pain_assessment)" title="SOCRATES (pain assessment)">SOCRATES</a></li> <li><a href="/wiki/Pain_(philosophy)" title="Pain (philosophy)">Philosophy of pain</a></li> <li><a href="/wiki/Cancer_pain" title="Cancer pain">Cancer pain</a></li> <li><a href="/wiki/Drug-seeking_behavior" class="mw-redirect" title="Drug-seeking behavior">Drug-seeking behavior</a></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374" /><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235" /></div><div role="navigation" class="navbox" aria-labelledby="Medicine685" style="padding:3px"><table class="nowraplinks hlist mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" 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title="Subspecialty">subspecialties</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Surgery" title="Surgery">Surgery</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Cardiac_surgery" title="Cardiac surgery">Cardiac surgery</a></li> <li><a href="/wiki/Cardiothoracic_surgery" title="Cardiothoracic surgery">Cardiothoracic surgery</a></li> <li><a href="/wiki/Endocrine_surgery" title="Endocrine surgery">Endocrine surgery</a></li> <li><a href="/wiki/Eye_surgery" title="Eye surgery">Eye surgery</a></li> <li><a href="/wiki/General_surgery" title="General surgery">General surgery</a> <ul><li><a href="/wiki/Colorectal_surgery" title="Colorectal surgery">Colorectal 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title="Obstetrics and gynaecology">Obstetrics and gynaecology</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Gynaecology" title="Gynaecology">Gynaecology</a></li> <li><a href="/wiki/Gynecologic_oncology" title="Gynecologic oncology">Gynecologic oncology</a></li> <li><a href="/wiki/Maternal%E2%80%93fetal_medicine" title="Maternal–fetal medicine">Maternal–fetal medicine</a></li> <li><a href="/wiki/Obstetrics" title="Obstetrics">Obstetrics</a></li> <li><a href="/wiki/Reproductive_endocrinology_and_infertility" title="Reproductive endocrinology and infertility">Reproductive endocrinology and infertility</a></li> <li><a href="/wiki/Urogynecology" title="Urogynecology">Urogynecology</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Medical_diagnosis" title="Medical diagnosis">Diagnostic</a></th><td class="navbox-list-with-group navbox-list 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title="Disaster medicine">Disaster medicine</a></li> <li><a href="/wiki/Diving_medicine" title="Diving medicine">Diving medicine</a></li> <li><a href="/wiki/Emergency_medicine" title="Emergency medicine">Emergency medicine</a> <ul><li><a href="/wiki/Mass_gathering_medicine" title="Mass gathering medicine">Mass gathering medicine</a></li></ul></li> <li><a href="/wiki/Evolutionary_medicine" title="Evolutionary medicine">Evolutionary medicine</a></li> <li><a href="/wiki/Family_medicine" title="Family medicine">Family medicine</a> / <a href="/wiki/General_practice" title="General practice">General practice</a></li> <li><a href="/wiki/Hospital_medicine" title="Hospital medicine">Hospital medicine</a></li> <li><a href="/wiki/Intensive_care_medicine" title="Intensive care medicine">Intensive care medicine</a></li> <li><a href="/wiki/Medical_genetics" title="Medical genetics">Medical genetics</a></li> <li><a href="/wiki/Narcology" title="Narcology">Narcology</a></li> <li><a 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