Commentary: Empower and educate patients diagnosed with chronic nonmalignant pain.

7 ullivan and Ferrell, in their provocative and interesting article, raise several important and relevant issues and provide the treating physician with ethial guidelines and a new paradigm to address individuals ith chronic nonmalignant pain (CNMP). This informaion should be of particular benefit to primary care proiders, who are becoming the major caregivers for those ith CNMP. Although emphasizing that untreated pain is recogized as a public health concern, the authors present a ase history and discuss ethical ways of addressing an ndividual’s pain and related problems. Although this case presentation is helpful for the disussion, the fact that the patient is elderly and has history f breast cancer clouds the issue. More typical for the rimary care physician is a relatively young individual in he 30s or 40s with complaints of musculoskeletal pain ocalized to the lumbosacral region, so-called “whiplash njuries,” or complaints of diffuse body ache usually dignosed as “fibromyalgia syndrome.” The authors clearly recognize the different approaches hysicians take to address individuals with “malignant ain”—that is, pain associated with cancer—and those ith CNMP. With regard to the majority of individuals ith CNMP, the authors cite studies and surveys indicatng that the pain is not proportional to objective disease, uch as back pain and headaches. However, these indiiduals describe significant limitations with regard to heir ability to function. The authors correctly note a significant shift in the past ecade toward recommendations to treat nonmalignant ain with opioids for analgesia. Select patients with hronic noncancer pain can have sustained analgesia and an function better with opioids, without becoming adicted. The authors identify several concerns in the use of opiids in patients with CNMP. These include the following: