Pharmacologic Management of Chronic Pain

There are many available pharmacologic classes used in the treatment of chronic pain, including acetaminophen, oral NSAIDs, topical medications, muscle relaxers, anticon-vulsant medications, antidepressants, and opioids. Nonopioid medications result in small to moderate improvements in pain and function with limited differences in effi-cacy and outcomes between classes and doses of the drugs. Nonopioid medications are preferred to opioid medications in noncancer pain because of the high rates of adverse events as well as the risk of misuse and use disorder. Further research is needed to determine the specific efficacy of each medication for individual pain syn-dromes. Medications can be used as monotherapy or in combination and can be one component of a multimodal treatment plan. Unfortunately, there are no high-quality studies addressing the efficacy of specific combinations for the management of chronic pain. Pharmacologic management should be tailored based on patient prefer-ence, comorbid conditions, side-effect profile, cost, and access. Clinicians should engage their patients in shared decision making to tailor the treatment regimen for the best outcomes of the patient.