Patients with chronic idiopathic pain need to be carefully assessed which includes eliciting their treatment goals and beliefs about treatments. In line with other chronic pain, unnecessary investigations and treatments make pain intractable and results in depressed patients. Clinicians often feel less optimistic about their ability to successfully manage these patients. A biopsychosocial approach to treatment is needed and CBT should be used alongside drug therapy in those who are found to have a high index of disability. The selective serotonin reuptake inhibitors (SSRI), especially fluoxetine and escitalopram or others such as venlafaxine, are often used as they cause fewer side effects than tricyclics, they do not interact with alcohol, do not result in weight gain and are safe in overdose but they may be less effective in pain relief. Written information is important and some patients may find it useful to talk to other patients with similar problems.
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