Chronic Pain - Treatment Overview

Treatment Overview

Treating chronic pain can be challenging. Often the reason for the pain is not clear, and it may take several types or combinations of treatments before you find relief. When treatment is started, some people may have increased pain because their chronic pain has caused them to be inactive and they have lost strength and flexibility. However, over time treatment should decrease the pain and increase your ability to function. You may learn new ways of doing ordinary tasks to reduce pain. Often chronic pain cannot be cured, but it can be managed well enough to significantly improve the quality of your life.

Be sure to seek treatment if your pain lasts longer than 2 to 3 months. Early treatment may prevent the pain from getting worse.

Some chronic pain is caused by specific conditions that can be treated. For example, there are treatments for headaches, arthritis, neck pain, low back pain, or depression.

Initial treatment

The goals of treatment are to reduce chronic pain and increase your ability to function. This includes improving your sleep and coping skills and reducing stress so you can return to your regular activities. Initial treatment depends on what kind of pain you have and how severe it is, as well as whether your pain is related to an illness, injury, or an unknown cause. Often, the best approach is a combination of therapies.

You may be able to control your pain at home by:

• Getting appropriate daily exercise, such as walking or swimming.
• Eating a balanced diet. This includes getting enough vitamins such as vitamin B and vitamin D. Talk to your doctor or a registered dietitian about a healthy diet for you.
• Getting enough sleep.
• Using pain relievers—such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, for example) or aspirin. Always take these medicines exactly as prescribed or according to the label. Do not take a nonprescription NSAID for longer than 10 days without talking to your doctor.
• Using complementary therapies, such as acupuncture or meditation.

A licensed mental health counselor, psychologist, or psychiatrist can help with your emotional well-being while you are dealing with chronic pain. It is common to respond to chronic pain with feelings of frustration, depression, anxiety, fear, and even anger. These feelings can make it tough to conquer chronic pain, especially if you use alcohol or drugs to manage your symptoms. Pain affects both your physical and emotional well-being. Untreated depression or anxiety can make your pain worse. A counselor may use treatments such as cognitive-behavioral therapy to help you cope with your pain.¹

If the above treatments do not relieve or reduce your pain, your health professional may:

• Treat existing health problems that may contribute to the pain.
• Recommend that you reduce stress with relaxation techniques, such as guided imagery, and exercise, such as yoga.
• Prescribe physical therapy to relieve pain and improve movement and function.
• Prescribe medicines, such as tricyclic antidepressants, anticonvulsants, or opioid analgesics. At first, you may be given medicines that cause the fewest side effects.
• Increase the strength of your medicines, change medicines, or add new ones as needed.
• Prescribe electrical stimulation therapies, such as transcutaneous electrical nerve stimulation (TENS), to alter pain signals as they travel to the brain. This treatment has had mixed results and may not work for everyone.

Ongoing treatment

It is important to develop a clear treatment plan for chronic pain with your health professional. Part of this plan includes identifying ways for you to manage your pain. Only you know the severity of your pain and how it affects your life. Be sure to ask your health professional if you are not clear about what steps you can take when pain occurs or gets worse.

For occasional flare-ups of chronic pain, making lifestyle changes (such as exercising, getting enough sleep, and eating a healthy diet) and taking pain relievers (such as acetaminophen or nonsteroidal anti-inflammatory drugs) may be all that is needed. If your pain is constant, severe, or interferes with your daily activities, your health professional may prescribe additional treatment.

Medicines or a combination of medicines and other therapies may be used to relieve pain, inflammation, depression, and sleeping problems associated with chronic pain. The medicines and other treatments most often used to treat chronic pain include:

• Acetaminophen, such as Tylenol, Panadol, or Tempra.
• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil, for example), ketoprofen, and naproxen (Aleve, for example). Always take NSAIDs exactly as prescribed or according to the label. Do not take a nonprescription NSAID for longer than 10 days without talking to your doctor.
• Tricyclic antidepressants, such as amitriptyline (Elavil).
• Corticosteroids, such as prednisone. Sometimes, steroids are injected around the base of the spine to relieve low back pain (epidural steroid injections).
• Oral medicines that act like a local anesthetic, such as mexiletine (Mexitil).
• Anticonvulsants, such as gabapentin (Neurontin) and pregabalin (Lyrica).
• Pain relievers that are applied directly to the skin (topical analgesics), such as EMLA cream or a lidocaine patch (Lidoderm).
• Capsaicin, a naturally occurring substance that is found in chili peppers and is used to make certain topical analgesic creams.
• Creams or gels containing medicines or combinations of medicines are being studied for pain control. The cream or gel is rubbed directly on the painful area. Nonsteroidal anti-inflammatory drugs such as ketoprofen, the antiseizure medicine called gabapentin, and tricyclic antidepressants such as amitriptyline are among the medicines being studied.
• Opioid analgesics, such as morphine, oxycodone (such as OxyContin), hydrocodone with acetaminophen (such as Vicodin, Lortab, or Norco), or acetaminophen with codeine (such as Tylenol with codeine).
• Nerve block therapy, which is an anesthetic that is injected into the affected nerve to relieve pain.
• Trigger point injections, which are injections of a local anesthetic into trigger points or specific tender areas.

If you continue to experience chronic pain, you may be:

• Referred to one or more health professionals who specialize in rehabilitation and pain management (such as an anesthesiologist, a neurologist, or a physiatrist).
• Offered electrical stimulation therapies (such as TENS), which seem to decrease the feeling of pain for some people.
• Given injection therapy (such as corticosteroids), which can sometimes reduce pain and inflammation, or nerve pain.

For some people, complementary therapies can help reduce chronic pain. These therapies include:

• Acupuncture, a treatment based on traditional Chinese medicine, where very thin needles are inserted into the skin at certain points on the body to produce energy flow.
• Aromatherapy, or essential oils therapy, which uses a plant's aroma-producing oils (essential oils) to treat disease.
• Biofeedback, a method of consciously controlling a body function that is normally regulated automatically by the body, such as skin temperature.
• Chiropractic therapy, a hands-on therapy based on the theory that many medical disorders (especially disorders of the nervous system) may be caused by subluxations in the spine.
• Guided imagery, a series of thoughts and suggestions that direct a person's imagination toward a relaxed, focused state.
• Healing touch, which influences a person's physical or emotional health without physically touching the person.
• Homeopathy, or homeopathic medicine, which is a medical philosophy and practice based on the idea that the body has the ability to heal itself.
• Hydrotherapy, which uses water, in any form, to treat a disease or to maintain health.
• Hypnosis, which is a state of focused concentration during which a person becomes less aware of his or her surroundings. Some people learn to manage pain through concentrating in this special way.
• Magnet field therapy, a treatment which uses magnets to stimulate areas of the body in an attempt to maintain health and treat illness.
• Massage, which is rubbing the soft tissues of the body, such as the muscles, to help reduce tension and pain, improve blood flow, and encourage relaxation.
• Meditation, which is the practice of focusing your attention to help you feel calm and give you a clear awareness about your life.
• Naturopathy, which promotes using organic foods and exercise; maintaining a healthy, balanced lifestyle; and applying concepts from other areas of complementary medicine (such as ayurveda, homeopathy, and herbal therapies) in an attempt to improve health, prevent disease, and treat illness.
• Yoga, which uses meditation and exercises to help you improve flexibility and breathing, decrease stress, and maintain health.

A licensed mental health counselor, psychologist, or psychiatrist can help you cope with chronic pain. Chronic pain may affect all aspects of your life, straining your relationships and making it difficult for you to keep up with work and home responsibilities. You may feel angry, fearful, depressed, anxious, or frustrated because of chronic pain. These feelings can make it tough to conquer chronic pain, especially if you use alcohol or illegal drugs to manage your symptoms.

The best approach is usually a combination of treatments. If one treatment has stopped working, another treatment or combination of treatments may improve your pain. Try to stay ahead of the pain: don't wait until your pain is severe to begin treatment. Lifestyle changes such as getting daily exercise, eating a healthy diet, getting enough sleep, and trying complementary therapies and cognitive-behavioral therapy may help you reduce the pain or prevent it from getting worse.

Treatment if the condition gets worse

If your chronic pain is not relieved after you have tried numerous treatments, you may wish to consider seeking an evaluation at a pain management clinic. Treatment is provided by a team of health professionals who work together to address the variety of factors that may contribute to chronic pain.

Treatments that are commonly used for prolonged chronic pain include:

• Physical therapy, which may include using hot and cold therapy to relieve painful areas of the body, and exercises to maintain strength, flexibility, and mobility.
• Transcutaneous electrical nerve stimulation (TENS), which uses a wire in a skin patch to apply brief pulses of electricity to nerve endings in the skin to relieve pain.
• Professional counseling, such as cognitive-behavioral therapy. Stress and depression may contribute to or occur as a result of chronic pain. It is important to be healthy emotionally as well as physically to recover from chronic pain.

You may also wish to consider surgical options for relieving chronic pain.

• One option is surgery to implant a small pump that continuously delivers pain-relieving medicine (for example, spinal drug delivery).
• Another option is to implant a device that controls pain through spinal cord stimulation. This device administers small electrical currents to the spinal cord. The electrical current can be adjusted with an external control device. This technique may be successful in treating chronic low back pain.
• Radiofrequency lesioning (also called radiofrequency ablation) is a procedure that can disrupt the flow of pain signals. First, you will need to have a test that uses a nerve block, which numbs specific nerves, to help your health professional locate the nerves that are causing your pain.

What To Think About

Your chronic pain may improve more if you have a combination of treatments at the same time.

It is important to find a doctor with whom you feel comfortable, and to keep in regular contact with this doctor. If your doctor is unable to provide effective treatment to reduce your pain, ask about a referral to a pain management clinic. There, a team of health professionals can help you set realistic expectations and identify potential treatments.