Ouch that hurts chronic pain management
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Ouch! That Hurts—Chronic Pain Management. Paul Lyons, MD Senior Associate Dean for Education Chair, Family Medicine University of California Riverside School of Medicine. The two enemies of human happiness are pain and boredom—Arthur Schopenhauer. Just the Facts.

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Ouch that hurts chronic pain management

Ouch! That Hurts—Chronic Pain Management

Paul Lyons, MD

Senior Associate Dean for Education

Chair, Family Medicine

University of California Riverside School of Medicine



Just the facts
Just the Facts boredom—Arthur Schopenhauer

  • Pain that lasts longer than 3-6 months

  • 19-30% of all adults

  • 116 million Americans

  • associated with depression, anxiety, sleep disturbance, decreased activity


When I was young I thought money was the most important thing in life; now that I am old I know that it is—Oscar Wilde


It costs how much
It Costs thing in life; now that I am old I know that it is—Oscar WildeHow Much?

  • ~$600 Billion per year in US

    • $261-$300 billion per year direct health care cost

    • $4000-$7000 in extra health care cost per person per year

  • ~$300 billion per year in lost productivity

    • Work days missed

    • Annual work hours

    • Hourly wages



Types of pain
Types of Pain Hugo

  • Nociceptive

  • Neuropathic


It is easier to find men who will volunteer to die than to find those who are willing to endure pain with patience—Julius Caesar


1 set reasonable goals
#1—Set Reasonable Goals find those who are willing to endure pain with patience—Julius Caesar

If you don’t know where you’re going you’ll end up somewhere else—Yogi Berra



2 focus on function
# with it—Charlie Chaplin2—Focus on Function

Before we make love my husband takes a pain killer—Joan Rivers



Medication options
Medication Options nature cures the disease—Voltaire

  • Analgesia

  • Antiepileptics

    • Gabapentin

    • pregabalin

  • Antidepressants

    • Duloxetine

    • amitriptyline


One of the first duties of the physician is to educate the masses not to take medicine—William Osler


Non pharmacologic treatment
Non Pharmacologic Treatment masses not to take medicine—William Osler

  • Cryotherapy

  • Heat

  • Physical/Occupational Therapy

  • Exercise

  • TENS


You know what they call alternative medicine that’s been proved to work? Medicine—Tim Minchin


Additional therapies
Additional Therapies proved to work? Medicine—Tim Minchin

  • Hypnosis

  • Massage

  • Acupuncture

  • Chiropractic


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