Box 3.

General principles for biopsychosocial management of chronic pain of uncertain etiology

The management approach is primarily nonpharmacological with pharmacological modalities if necessary. Unnecessary medication should be avoided. Assess pain and its impact on functioning. Assess and manage risk factors for chronic pain, including mood and sleep. Discuss realistic expectations of treatment outcomes (ie, improvement in function). Validate the patient’s experience and empower them to take responsibility for self-management. Involve other health professionals from the onset (eg, biokineticist, physiotherapist, psychologist). Avoid unnecessary additional special investigations. Assess and rationalize current medication, including an assessment for analgesic-induced pain (eg, rebound, withdrawal). Opioids (including codeine-containing formulations) should be tapered and preferably discontinued. Pharmacological management should be carefully considered and may require rational polypharmacy. Encourage increased movement, healthy nutrition and socialization. Encourage early return to normal daily activities and work.

Note: Data from references 7, 13, 15, 32, 33, 46, and 52–58.