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Chronic Pain

Treatment Continuum

Introduction
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Low probability

Second Tier
Pain Therapies
First Tier
Pain Therapies

Diagnosis
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Third Tier
Pain
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NSAIDS Non-steroidal anti inflammatory drug

SCS Spinal Cord Stimulation

TENS

Transcutaneous electrical nerve stimulation

DBS Deep Brain Stimulation

PENS

Percutaneous electrical nerve stimulation

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