The primary care physician is ideally placed to screen for the likely causes of chronic pain. Deciding whether or not to refer depends upon the type and nature of the pain, and must follow ethical principles. Treatment in primary care involves assessment and diagnosis, managing pain, treating anxiety and/or depression, supporting the patient's self-management skills and regularly reviewing medication. In some cases the patient must be referred as early as possible, to allow early diagnosis and treatment of an underlying chronic condition, such as diabetic neuropathy. Neuropathic pain, caused by a lesion or disease of the somatosensory nervous system, has a major impact on primary care, but is suboptimally treated. The referral process could be improved by various measures, but particularly by better undergraduate and postgraduate medical education.
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