Chronic Pain Treatment A - Z Pain Diagnosis and Management Is Getting Easier

About 50 million Americans suffer from some type of chronic pain, according to the American Academy of Pain Management. Yet it remains a challenge to treat. Here’s what every woman should know about chronic pain treatment – from available medications to physical and psychological therapies... The goal of pain management is to improve function and enable work, attendance in school, or participation in day-to-day activities. Chronic pain patients and their physicians have a number of options for treatment; some are more effective than others. The following treatments are among the most common: Acetaminophen is the basic ingredient found in Tylenol and its many generic equivalents. It’s sold over the counter, in a prescription-strength preparation, and in combination with codeine (also by prescription). Acupuncture, part of a broad category of healing called traditional Chinese or Oriental medicine, dates back 2,500 years and involves the application of needles to precise points on the body. Acupuncture remains controversial, but is quite popular and may one day prove to be useful for a variety of conditions as it continues to be explored by practitioners, patients and investigators. Analgesic refers to the class of drugs that includes most painkillers, such as aspirin, acetaminophen and ibuprofen. Nonprescription or over-the-counter pain relievers are generally used for mild to moderate pain. Prescription pain relievers, sold through a pharmacy under the direction of a physician, are used for more moderate to severe pain. Anticonvulsants are used for the treatment of seizure disorders but are also sometimes prescribed for pain treatment. Carbamazepine, in particular, is used to treat many painful conditions, including trigeminal neuralgia, an excruciating painful nerve condition. Another antiepileptic drug, gabapentin, is being studied for its pain-relieving properties, especially as a treatment for neuropathic (nerve-related) pain. Antidepressants are sometimes used for the treatment of pain and, along with neuroleptics and lithium, belong to a category of drugs called psychotropic drugs. In addition, anti-anxiety drugs called benzodiazepines also act as muscle relaxants and are sometimes used as pain relievers. Aspirin may be the most widely used pain-relief agent and has been sold over the counter since 1905 as a treatment for fever, headache and muscle soreness. Biofeedback is used for the treatment of many common pain problems, most notably headache and back pain. Using a special electronic machine, the patient is trained to become aware of, to follow and to gain control over certain bodily functions, including muscle tension, heart rate and skin temperature. The person can then learn to effect a change in their responses to pain, for example, by using relaxation techniques. Biofeedback is often used in combination with other treatment methods, generally without side effects. Similarly, the use of relaxation techniques in the treatment of pain can increase the patient’s feeling of well-being. Capsaicin, a chemical found in chili peppers, is also a primary ingredient in pain-relieving creams. Chemonucleolysis is a treatment in which an enzyme, chymopapain, is injected directly into a herniated lumbar disc in an effort to dissolve material around the disc, thus reducing pressure and pain. The procedure’s use is extremely limited, in part because some patients may have a life-threatening allergic reaction to chymopapain. Chiropractic care may ease back pain, neck pain, headaches and musculoskeletal conditions. It involves “hands-on” therapy designed to adjust the relationship between the body’s structure (mainly the spine) and its functioning. Chiropractic spinal manipulation includes the adjustment and manipulation of the joints and adjacent tissues. Such care may also involve therapeutic and rehabilitative exercises. Cognitive-behavioral therapy involves a wide variety of coping skills and relaxation methods to help prepare for and cope with pain. It’s used for postoperative and cancer pain, and childbirth. Counseling can give a chronic pain patient needed support, whether through family, group or individual counseling. Support groups can provide an important adjunct to drug or surgical treatment. Psychological chronic pain treatment can also help patients learn about the physiological changes produced by pain. COX-2 inhibitors may be effective for people with arthritis. For many years scientists have wanted to develop a drug that works as well as morphine but without its negative and addictive side effects. Nonsteroidal anti-inflammatory drugs (NSAIDs) work by blocking two enzymes, cyclooxygenase-1 and cyclooxygenase-2, both of which promote production of hormones called prostaglandins, which, in turn, cause inflammation, fever and pain. Newer COX-2 inhibitors primarily block cyclooxygenase-2 and are less likely to have the gastrointestinal side effects sometimes produced by NSAIDs. In 1999, the Food and Drug Administration approved a COX-2 inhibitor – celecoxib – for chronic pain treatment. The long-term effects of all COX-2 inhibitors are still being evaluated, especially in light of new information suggesting that they may increase the risk of heart attack and stroke. Patients taking any COX-2 inhibitor should review their treatment with their doctors. Electrical stimulation, including transcutaneous electrical stimulation (TENS), implanted electric nerve stimulation, and deep brain or spinal cord stimulation, is the modern-day extension of age-old practices in which the nerves of muscles are subjected to a variety of stimuli, including heat or massage. Electrical stimulation, no matter what form, involves a major surgical procedure and is not for everyone. Nor is it 100% effective. The following techniques each require specialized equipment and personnel trained in the specific procedure being used: TENS uses tiny electrical pulses, delivered through the skin to nerve fibers, to cause changes in muscles such as numbness or contractions. This, in turn, produces temporary pain relief. There is also evidence that TENS can activate subsets of peripheral nerve fibers that can block pain transmission at the spinal cord level, the way that shaking your hand can reduce pain. Peripheral nerve stimulation uses electrodes surgically placed on a carefully selected area of the body. The patient is then able to deliver an electrical current as needed to the affected area, using an antenna and transmitter. Spinal cord stimulation uses electrodes surgically inserted within the epidural space of the spinal cord. The patient is able to deliver a pulse of electricity to the spinal cord using a small box-like receiver and an antenna taped to the skin. Deep brain or intracerebral stimulation is considered an extreme treatment and involves surgical stimulation of the brain, usually the thalamus. It’s used for a limited number of conditions, including severe pain, central pain syndrome, cancer pain, phantom limb pain and other neuropathic pains. Exercise for Chronic Pain Treatment Because there is a known link between many types of chronic pain and tense, weak muscles, exercise – even light to moderate exercise such as walking or swimming – can contribute to an overall sense of well-being by improving blood and oxygen flow to muscles. Just as we know that stress contributes to pain, we also know that exercise, sleep and relaxation can all help reduce stress, thereby helping to alleviate pain. Exercise has been proven to help many people with low back pain. It’s important, however, that patients carefully follow the routine laid out by their physicians. Hypnosis, first approved for medical use by the American Medical Association in 1958, continues to grow in popularity, especially as an adjunct to pain medication. In general, hypnosis is used to control physical function or response - that is, the amount of pain an individual can withstand. How hypnosis works isn’t fully understood. Some believe that hypnosis delivers the patient into a trance-like state, while others feel the individual is simply better able to concentrate and relax or is more responsive to suggestion. Hypnosis may result in relief of pain by acting on chemicals in the nervous system, slowing impulses. Whether and how hypnosis works involves greater insight – and research – into the mechanisms underlying human consciousness. Low-power lasers have been used occasionally by some physical therapists as a treatment for pain, but like many other treatments, this method is not without controversy. Magnets are increasingly popular with athletes who swear by their effectiveness for the control of sports-related pain and other painful conditions. Usually worn as a collar or wristwatch, the use of magnets as a treatment dates back to the ancient Egyptians and Greeks. While it’s often dismissed as quackery and pseudoscience by skeptics, proponents offer the theory that magnets may affect changes in cells or body chemistry, thus producing pain relief. Nerve blocks employ the use of drugs, chemical agents or surgical techniques to interrupt the relay of pain messages between specific areas of the body and the brain. There are many different names for the procedure, depending on the technique or agent used: neurectomy; spinal dorsal, cranial, and trigeminal rhizotomy; and sympathectomy, also called sympathetic blockade. Nonsteroidal anti-inflammatory drugs (NSAIDs) (including aspirin and ibuprofen) are widely prescribed and sometimes called non-narcotic or non-opioid analgesics. They work by reducing inflammatory responses in tissues. Many of these drugs irritate the stomach and for that reason are usually taken with food. Although acetaminophen may have some anti-inflammatory effects, it is generally distinguished from the traditional NSAIDs. Opioids are derived from the poppy plant and are among the oldest drugs known to humankind. They include codeine and perhaps the most well-known narcotic of all, morphine. Morphine can be administered in a variety of forms, including a pump for patient self-administration. Opioids have a narcotic effect, and induce sedation as well as pain relief; some patients may become physically dependent upon them. For these reasons, patients given opioids should be monitored carefully. In some cases stimulants may be prescribed to counteract the sedative side effects. Besides drowsiness, other common side effects include constipation, nausea and vomiting. Physical therapy and rehabilitation date back to the ancient practice of using physical techniques and methods, such as heat, cold, exercise, massage and manipulation, in the treatment of certain conditions. These may be applied to increase function, control pain and speed the patient toward full recovery. Placebos offer some individuals pain relief, although whether and how they work is mysterious and controversial. Placebos are inactive substances, such as sugar pills, or harmless procedures, such as saline injections or sham surgeries, generally used in clinical studies as control factors to help determine the efficacy of active treatments. Although placebos have no direct effect on the underlying causes of pain, evidence from clinical studies suggests that many pain conditions, such as migraine headache, back pain, post-surgical pain, rheumatoid arthritis, angina and depression, sometimes respond well to them. This positive response is known as the placebo effect, which is defined as the observable or measurable change that can occur in patients after administration of a placebo. Some experts believe the effect is psychological and that placebos work because the patients believe or expect them to work. Others say placebos relieve pain by stimulating the brain’s own analgesics and setting the body’s self-healing forces in motion. A third theory suggests that the act of taking placebos relieves stress and anxiety – which are known to aggravate some painful conditions – and, thus, cause the patients to feel better. Still, placebos are controversial because, by definition, they are inactive and have no actual curative value. R.I.C.E. – Rest, Ice, Compression and Elevation – are four components prescribed by many orthopedists, coaches, trainers, nurses and other professionals for temporary muscle or joint conditions, such as sprains or strains. While many common orthopedic problems can be controlled with these four simple steps, especially when combined with over-the-counter pain relievers, more serious conditions may require surgery or physical therapy, including exercise, joint movement or manipulation, and stimulation of muscles. Surgery, although not always an option, may be required to relieve pain, especially pain caused by back problems or serious musculoskeletal injuries. Surgery may take the form of a nerve block or it may involve an operation to relieve pain from a ruptured disc. Surgical procedures for back problems include: Discectomy in which the entire disc is removed. Microdiscectomy, when microsurgical techniques are used. Laminectomy, a procedure in which a surgeon removes only a disc fragment, gaining access by entering through the arched portion of a vertebra. Spinal fusion, a procedure where the entire disc is removed and replaced with a bone graft. In a spinal fusion, the two vertebrae are then fused together. Although the operation can cause the spine to stiffen, resulting in lost flexibility, the procedure serves one critical purpose: protection of the spinal cord. Rhizotomy, in which a nerve close to the spinal cord is cut. Cordotomy, where bundles of nerves within the spinal cord are severed. Cordotomy is generally used only for the pain of terminal cancer that does not respond to other therapies. Dorsal root entry zone operation, or DREZ, in which spinal neurons corresponding to the patient’s pain are destroyed surgically. Because surgery can result in scar tissue formation that may cause additional problems, patients should seek a second opinion before proceeding. Occasionally, surgery is carried out with electrodes that selectively damage neurons in a targeted area of the brain. These procedures rarely result in long-term pain relief, but both physician and patient may decide that the surgical procedure will be effective enough that it justifies the expense and risk. In some cases, the results of an operation are remarkable. For example, many individuals suffering from trigeminal neuralgia who are not responsive to drug treatment have had great success with a procedure called microvascular decompression, in which tiny blood vessels are surgically separated from surrounding nerves. For more information and expert advice, visit our Pain Management Health Center. How Bad Is Your Back Pain? So your back hurts? Take our back pain quiz to see how severe it really is. You may need to see a doctor but have just been avoiding it, thinking it will get better. On the other hand, your back pain may be more normal than you suspect.