Type of pain | First-line therapy | Considerations for opioid use |
Nociceptive | NSAIDs | When other treatment options are inadequate, for pain severe enough to require potentially daily, round-the-clock, long-term treatment. Limit dose and duration whenever possible. Encourage as-needed use linked to meeting specific activity goals. |
Neuropathic | Antidepressants (TCAs or SNRIs) or Antiseizure medications | |
Central sensitization | Antidepressants (TCAs or SNRIs) or Antiseizure medications | Avoid whenever other multidisciplinary treatment options have not been systematically, sufficiently, and consistently trialed. Opioids often worsen central sensitization treatment outcomes. |
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