Accurate diagnosis and drug selection in chronic pain patients.

Chronic somatic pain patients often present more than one pain location with concomitant different pain complaints (pain qualities) which may need to be treated individually. Major attention should be given to the identification of opioid insensitive neurogenic pain qualities, and to a lesser degree the pain intensity. The following pain qualities are of interest: Diffuse deep located nagging pain which is treated with peripherally acting analgesics and/or long acting opioids. Dysaesthetic pain, described as a superficial burning sensation, is usually only partially responsive to opioids and may be treated with antidepressants, whereas neuralgic pain usually is unresponsive to opioids and may be treated with anticonvulsants. Other special pain qualities should be treated as specifically as possible. With this differentiated pharmacological therapy approximately 70-90% of somatic pain patients can be treated with satisfactory pain relief or freedom from pain, at least at rest.