Avoid excessive alcohol; it interacts with pain medications and worsens sleep
Return immediately to the emergency department for
New weakness, numbness, or difficulty walking
Especially if involving both legs
Loss of bowel or bladder control
Inability to urinate or urinary leakage
Fever or chills with worsening pain
Severe uncontrolled pain despite prescribed medications
Tearing or pulsating pain spreading to your chest, abdomen, or legs
Thoughts of self-harm or suicide
Call 988 Suicide and Crisis Lifeline or go to emergency
Follow-up appointments
See your family doctor or pain specialist within 1 to 2 weeks
For medication review and adjustment
For referrals to physical therapy or pain program
Physical therapy: start within 2 to 4 weeks
Psychology or CBT referral: contact your doctor about this option
Self-management strategies
Exercise is one of the best treatments for chronic pain
Engage with your pain management team and follow your treatment plan
Avoid escalating medications independently; contact your prescriber first
References
Guidelines and key sources
Primary guidelines
CDC Clinical Practice Guideline for Prescribing Opioids for Pain, United States 2022
Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. MMWR 2022
Non-opioid therapy preferred for chronic non-cancer pain
VA/DoD Clinical Practice Guideline for Low Back Pain, 2022
Anderson DPT et al. Department of Veterans Affairs 2022
Exercise and non-pharmacologic first-line recommendation
VA/DoD Clinical Practice Guideline for Use of Opioids in Chronic Pain, 2022
Brown DPT et al. Department of Veterans Affairs 2022
APA Clinical Practice Guideline for Nonpharmacological Treatment of Chronic Musculoskeletal Pain, 2024
Prasad R et al. American Psychological Association 2024
ACEP Policy Statement: Optimizing the Treatment of Acute Pain in the Emergency Department, 2018
American College of Emergency Physicians
ACR Appropriateness Criteria Cervical Pain or Cervical Radiculopathy, 2025 Update
Eldaya RW et al. Journal of the American College of Radiology 2025
Key evidence
Landmark studies and systematic reviews
Cohen SP, Vase L, Hooten WM. Chronic Pain: An Update on Burden, Best Practices, and New Advances. Lancet 2021. PMID 34062143
Lumanauw DD et al. Subdissociative-Dose Ketamine Is Effective for Treating Acute Exacerbations of Chronic Pain. Academic Emergency Medicine 2019. PMID 30901130
Beaudrie-Nunn AN et al. Efficacy of Analgesic and Sub-Dissociative Dose Ketamine for Acute Pain in the ED. American Journal of Emergency Medicine 2023. PMID 37290249
Fitzcharles MA, Cohen SP, Clauw DJ et al. Nociplastic Pain: Towards an Understanding of Prevalent Pain Conditions. Lancet 2021. PMID 34062144
Dunn M et al. Biopsychosocial Factors Associated With Development of Chronic Musculoskeletal Pain. PLoS One 2023. PMID 38557647
Chiarotto A, Koes BW. Nonspecific Low Back Pain. NEJM 2022
Sokol R, Grossman E, Bourgery R. Nonopioid Pharmacologic Management of Chronic Noncancer Pain. American Family Physician 2025. PMID 40834375
Steinman MA. Alternative Treatments to Selected Medications in the 2023 AGS Beers Criteria. Journal of the American Geriatrics Society 2025
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.