الفهرس 
Introduction and Aim of the workOnly 14 pages are availabe for public view
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Abstract
Chronic pain, typically defined as pain of at least 3 months’ duration, is a common cause of major disability. Chronic non-cancer pain afflicts a significant subset of chronic pain patients, causing personal suffering, reduced productivity, and substantial health care cost.
In this essay different types of pain was discussed, with pam pathways, modulation, and pathogenesis of Chronic pain.
Assessment of pain severety was dicussed in a separate chapter including unidimential scales as the visual analogue scale and graphic rating scale, the numeric rating scale, the verbal rating scale, Behavioral rating scale and Face scale . Multidimential scales as MCGill pain questionnaire, brief pain inventory and pain diary.
Common cause of chronic non cancer pain was discussed including arthritis, chronic’ headache, cervical and lumbar pain, fibromyalgia, myofascial pain and neuropathic pain which was discussed in some details
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as Neuropathic pain defined by the ”International Association for the study
of Pain” as pain ”initiated or caused by a primary lesion or dysfunction in the nervous system” is a challenging clinical problem because the pain is often sever and resistant to conventional analgesics.
In a separate chapter variety of pharmacologic and non pharmacologic methods used in management of patients with chronic noncancer pain were discussed. pharmacologic methods include Non steroidal anti-inflammatory drugs (NSAIDs), Opioid Analgesic, centrally acting drugs as (Anti convulsants, Antidepressants, Antiarrythmics and
English Summary
NMDA-Receptor Antagonists) and localized drugs as (Local anesthetics, Calcium channel modulators, adrenoceptor agonists, Counterirritants and Capsaicin).
Non pharmacologic methods include psychotherapy, rehabilitative physical therapy and interventional techniques as spinal cord stimulation, Implantable infusion pump, ablative procedures and epidural steroid injections.
The use of opioid for reducing non cancer pam, which is mostly neuropathic pain was controversial due to concerns about adverse effects, and the potential for addiction. Nowadays it has been used for a large scale for reducing non cancer pain, which is mostly neuropathic pain.
Opioid effectiveness can be improved by individualizing dosing, route of administration of the drug. Particularly in the treatment of chronic non-cancer pain, careful patient selection is essential. Improving opioid effectiveness can be achieved by increasing efficacy or reducing adverse effects by combining other drugs that modulate opioid receptor mediated effects. These pharmacological ”opioid adjuvants” include e.g. a22adrenergic agonists, non-steroidal anti-inflammatory analgesics, ND-Aspartate (NMDA) receptor antagonists, and gabapentinoids.
Special concern was given for evidece based medicine for treatment of neuropathic pain, and Future targets of Analgesics as the Use of cannabinoids receptor antagonists and endothelial receptor antagonists for treatment of neuropathic pain.