Topical review
Where Do We Go from Here? Future Treatment Strategies for Chronic Pain

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Many of the tools that can be used to alleviate chronic pain in our patients are readily available to all practitioners, but they are not used with appropriate frequency. Thus, the immediate future of chronic pain therapy is simply to do more of what we are already doing. There are also drugs and techniques currently used in human medicine that may be available to us in the near future and many drugs and techniques on the research bench that might make it to our patients in the more distant future. Because of the magnitude of the chronic pain problem in human medicine, research on the treatment of chronic pain is intense, and the hope is that both human and veterinary patients will eventually benefit.

Section snippets

The Immediate Future

We could make a big impact on the quality of life of our patients in the immediate future simply by doing more of what we are already doing. Approaches that could be implemented immediately in our practices include 1) more consistent recognition of chronic pain; 2) more precise definition of the type of pain with treatment strategies designed to match the diagnosis; 3) increased use of current analgesic drugs and nonpharmacologic therapy with a focus on the use of multimodal protocols; 4)

More Consistent Recognition of Chronic Pain

Chronic pain is grossly underdiagnosed and undertreated in both human1 and veterinary patients.2 As is stressed in human medicine, we should strive to use pain as the fifth vital sign in every physical examination. Our entire practice team should be trained to recognize patients in pain and should be well versed in the negative effects of untreated pain. Senior care programs with the inclusion of a pain assessment package (e.g., an owner questionnaire + a pain-specific physical examination)

Where Do We Go from Here? The More Distant (But Perhaps Not Too Distant) Future

With so much research focused on chronic pain, our ability to treat chronic pain may rapidly improve. Both new drugs and new techniques are available in human medicine and may be useful in veterinary medicine as well.

Future Pharmacologic and Nonpharmacologic Therapies

There are many, many treatment opportunities for chronic pain currently on the research bench or in clinical trials. The pain pathway is extremely complex, which makes treatment of chronic pain difficult but provides many targets (e.g., receptors, genes, ion channels, etc) for treatment. See Table 2 (adapted from Mao11) for a list of potential new drug targets. More advanced interventional therapies like deep brain stimulation may also eventually become part of our pain management arsenal. Many

Conclusion

What does the future hold? Hopefully, more accurate diagnoses and more effective treatment of chronic pain. And the future starts tomorrow. We should strive to recognize and aggressively treat the patients in our practice that suffer from chronic pain, and we can do this by ramping up the pain management strategies that are already in place in our hospitals. We can use advanced techniques by referring to other pain management specialists. And we can continue to support ongoing research and

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