Pain is an unpleasant sensory and emotional experience associated with actual or potential

1 Merskey H et al 1979 Pain terms: a list with definitions and notes on usage. Pain 6: 249.

2 Melzack R, Wall P 1982 The challenge of pain. Penguin, London.

3 Loeser J D, Melzack 1999 Pain: an overview. Lancet 353:1607.

depression),4 e.g. psychotropic drugs, or they may modify underlying causes, e.g. spasm of smooth or of voluntary muscle.

The general principle that the best treatment of a symptom is removal of its cause applies. But this is often impossible to achieve and symptom relief of pain by analgesic drug is required.

Pain is the most common symptom for which patients see a doctor. The complaint does not mean that an analgesic is needed. To manage the pain, the doctor needs to know what is happening to the patient in mind and body.

Optimal management of pain requires that the clinician should have a conceptual framework for what is happening to the patient in mind and body.

• Acute pain is managed primarily (but not invariably) by analgesic drugs.

• Chronic pain often requires adjuvant drugs in addition as well as nondrug measures.

Analgesics are chosen according to the cause of pain and its severity.

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