Managing the Many Presentations of Pain

Because pain is the primary reason for which most patients seek treatment in the primary care setting, it’s important not only to diagnose the etiology of their pain and treat its root cause over the long term, but also to relieve patients’ pain immediately if possible. Given the multitude of potential causes of pain, each with its own uniquely indicated and contraindicated approaches, this often is no easy task, as the cases and conditions presented here in this special Consultant pain management supplement demonstrate.

Gout is a good example of a common condition in which treatment that addresses the root cause (that is, allopurinol to lower the uric acid levels that lead to painful crystal deposition) traditionally has been withheld while the patient receives treatment for the pain of an acute attack (that is, nonsteroidal anti-inflammatory drugs, colchicine, and/or corticosteroids)—although, as Helen Paulson, MD, and Ellison L. Smith, MD, point out in their article offering practical tips for gout management, “This practice may have been a disservice to many patients, given that it may reduce the likelihood that they are started on proper treatment.  Uric acid-–lowering treatment should not be stopped during an attack.”

In addition to including the article on the top 10 treatment principles of gout management, this supplement also features case studies covering the management of painful osteomyelitis (in which the patient presented with chronic, debilitating hip pain) and disseminated cutaneous herpes zoster—shingles—in an immunocompetent woman.

For much more on pain management from Consultant, visit the Pain 360 specialty area at There you can access all of the latest news and clinical information on “the fifth vital sign,” from migraine to cancer pain to opioid therapy. While you’re there, I invite you to share your pain management experiences with Consultant and your colleagues by posting a comment. Or send a note to or call me at (800) 237-7285, ext. 4396.

Thanks for reading!

Michael Gerchufsky
Managing Editor, Consultant