The Multiply Operated Spine: Chronic Pain Medical Management

The medical management of chronic pain, especially in the multiply operated lumbar spine, is complex and largely empiric. Medications include opioids and nonopioids, which are reviewed and discussed. Recently, multimodal analgesic therapy has gained a wider application to many acute and chronic pain syndromes and disorders. This approach combines drugs to maximize the pain or analgesic effect by minimizing the dosing and lowers the side effects for expected physiologic response to each drug taken individually. The theory and practice of the medical management including medication and its use is reviewed and discussed.