geon. Basic pain management cases like lum-
bar epidurals, facet joint injections and lumbar
facets — the patient's pain is diagnosed and
located, an injection is administered — take
about 15 minutes apiece. Here's a look at how
our understanding of pain, and our strategies
for managing it, have evolved.
Multifaceted management
A major impetus behind an evolving pain man-
agement arsenal is the country's opioid epi-
demic. While these drugs used to be the go-to
defense, sobering statistics have disrupted
American health care's love affair with opi-
oids. Between 1999 and 2014, 165,000 people
died from prescription painkillers. So, what
does next-generation chronic pain manage-
ment look like? As multifaceted as the thing it
seeks to treat.
For years, opioids were the gold standard of
chronic pain management. But, increasingly,
comprehensive pain-management plans
include non-steroidal anti-inflammatories
(NSAIDs), as well as antidepressants or anti-
convulsants to reduce nerve pain. Serotonin-
norepinephrine reuptake inhibitors, such as
duloxetine (Cymbalta) and venlafaxine
(Effexor), are prescribed for pain at doses
lower than are effective for depression. The
most commonly used anticonvulsant used to
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