A framework for management of chronic pain.

The management of chronic pain requires a physician who is motivated to provide care for patients with this difficult problem. A thorough search must be made to determine the cause of the pain, the extent of psychiatric overlay, the importance of the pain to the patient (litigation, secondary gain), the extent of illness behavior and the response to previous therapy. The physician must be part of the treatment rather than part of the problem. Narcotic analgesics should be avoided except in patients with cancer pain or terminal illness.