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The last several decades have seen a marked increase in both the recognition and treatment of chronic pain. Unfortunately, patients frequently misunderstand both the nature of pain and the best practices for its treatment. Because primary care physicians treat the majority of chronic pain, they are ideally situated to provide evidence-based pain care. The majority of the medical evidence supports a biopsychosocial model of pain that integrates physical, emotional, social, and cultural variables. The goal of this primer is to assist primary care physicians in their understanding of pain, evaluation of the chronic pain patient, and ability to direct evidence-based care. This article will discuss the role of physical rehabilitation, pain psychology, pharmacotherapy, and procedural interventions in the treatment of chronic pain. Given the current epidemic of drug-related deaths, particular emphasis is placed on the alternatives to opioid therapy. Unfortunately, death is not the only significant complication from opioid therapy, and this article discusses many of the most common side effects. This article provides general guidelines on the most appropriate utilization of opioids with emphasis on the recent Centers for Disease Control and Prevention guidelines, risk stratification, and patient monitoring. Finally, the article concludes with the critical role that a pain medicine specialist can play in the management of patients with chronic pain.

G tolerances of 102 women and 139 men subjected to Standard Medical Evaluation (Medeval) G Profiles were compared. Unpaired t-tests revealed no significant difference between the women and men in either relaxed or straining G tolerance. Covariance analysis controlling for differences in tolerance due to age, height, weight, and activity status revealed the women to have marginally lower tolerance; the analysis also identified height as a factor having a strong negative influence on G tolerance, and weight as having a positive influence. When the women were matched only by height to the men in the comparison group, the women's mean G tolerances were significantly lower than the men's. On Standard Training G Profiles 88% of 24 women and 80% of 213 men completed the runs, but this difference was not significant. G tolerances of 47 women were measured on the Medeval Profiles both during and between menses, but no significant differences related to menstruation were found. No important differences between women and men in signs or symptoms of G stress were observed, except for two instances of urinary stress incontinence in women during the Training Profiles. We conclude that women should not categorically be excluded from aircrew duties for reasons of G intolerance.