Medications
Medicines can often help control chronic pain. Many different drugs, both prescription and nonprescription, are used to treat chronic pain. All these medicines can cause side effects and should be taken exactly as they are prescribed. In some cases, it may take several weeks before medicines work to reduce pain. To avoid dangerous drug interactions, tell your doctor all the medicines you are taking (including herbal and other complementary medicines).
Medication Choices
You will likely be given medicines that cause the fewest side effects first (such as acetaminophen) to treat chronic pain. The dose will be increased or the medicines will be changed as needed. Older adults are more likely to experience adverse side effects, so medicines may be started at even lower doses and increased more slowly. Medicines used to treat chronic pain include the following:
Pain relievers (analgesics)-such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen (for example, Advil)-which may be prescribed for mild to moderate pain and to reduce inflammation. 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.
Antidepressants, such as tricyclic antidepressants (for example amitriptyline), which may be used to treat chronic pain, although not all antidepressants are effective at reducing pain. Duloxetine (Cymbalta) is another type of antidepressant that is approved by the U.S. Food and Drug Administration (FDA) to treat pain from peripheral neuropathy.
Corticosteroids, such as prednisone, which are used to reduce inflammation and pain.
Oral medicines, such as mexiletine (Mexitil), that act like a local anesthetic to dull pain.
Anticonvulsants, which may ease pain that starts in the nerves (neuropathic pain). Examples are:
Gabapentin (Neurontin) for postherpetic neuralgia (nerve pain from shingles).
Pregabalin (Lyrica) for postherpetic neuralgia and diabetic neuropathy (nerve pain from diabetes).
Carbamazepine (Tegretol), oxcarbazepine (Trileptal ), and lamotrigine (Lamictal) to help control the episodes of facial pain in trigeminal neuralgia. If you take carbamazepine daily, you should be checked regularly to be sure you don’t develop serious side effects (such as an allergic reaction or liver problems).
Pain relievers that are applied directly to the skin (topical analgesics), such as EMLA cream or a lidocaine patch (Lidoderm), which can numb the skin and reduce pain.
Capsaicin, a naturally occurring substance that is found in chili peppers and is used to make certain topical analgesic creams. Capsaicin changes the pain signals in the skin, blocking pain without blocking other sensations. Capsaicin may cause a burning sensation when it is first applied. Always wear gloves when applying capsaicin and do not touch or rub your eyes until you have washed your hands.
Cooling spray. This involves using a cooling spray (such as Biofreeze) directly on the skin. This may be repeated several times.
Opioid analgesics, which may relieve moderate to severe pain. Examples of opioids include morphine, oxycodone (such as OxyContin), hydrocodone with acetaminophen (such as Vicodin, Lortab, or
Other therapies that may be used to treat chronic pain include:
Nerve block injections. An anesthetic is injected into the affected nerve to relieve pain. The anesthetic may relieve pain for several days, but the pain often returns. Although nerve blocks do not normally cure chronic pain, they may allow you to begin physical therapy and improve your range of motion.
Epidural steroid injections (injecting steroids around the spine). Although these injections have been used for many years and may provide relief for low back or neck pain caused by disc disease or pinched nerves, they may not work for everyone.
Trigger point injections. These may relieve pain by injecting a local anesthetic into trigger points (or specific tender areas) linked to chronic facial pain or fibromyalgia. For many people, nerve blocks or other injections can relieve chronic pain for good. But it is not completely clear how this type of treatment works. These injections do not relieve chronic pain in everyone.
What To Think About
Medicine may work best when it is used in combination with other types of treatment, such as physical therapy and counseling, to address the different causes of chronic pain. Each person tolerates and responds to medicines differently.
Medicines can reduce or provide temporary relief of chronic pain. At first, you may be given medicines that cause the fewest side effects. Then, if needed, the dose will slowly be increased or you will be switched to a different medicine.
In general, avoid drinking alcohol while taking pain medicines, and do not take higher doses of any medicine than your doctor prescribed.
Daily medicines can be an effective part of long-term treatment for chronic pain. But sometimes a medicine loses some or all of its effectiveness when it is used daily over a long period of time, because your body develops a tolerance to it.
Surgery
Surgery is not often used to treat chronic pain. The decision to have surgery depends on your condition and the cause of your pain. Surgery is usually considered only after other treatments have failed or if it is considered medically necessary.
Surgery may provide pain relief, but it also may permanently damage your ability to perceive other sensations, such as light touch and temperature changes. It can also cause a different pain to occur.
Surgery Choices
Surgically implanted pain control devices may be an option if you have severe chronic pain. These devices deliver drugs or a mild electrical current to the spinal cord. But they are not effective or appropriate for everyone. Your doctor may recommend that you try a temporary device to see if it helps you.
The most common, effective implanted pain control systems include:
Intrathecal drug delivery, which injects a medicine such as morphine or ziconotide (Prialt) into the spinal fluid through a small, adjustable, implanted pump.
Spinal cord stimulation, which sends a small electrical current to the spinal cord from an implanted power source. The electrical current is adjusted with a controller.
A technique called chemical or surgical sympathectomy prevents the flow of pain signals. In surgical sympathectomy, the malfunctioning nerve or nerves are cut, usually stopping or reducing the pain. This procedure, though, may also destroy other sensations besides pain or create other sensations such as burning or numbness. This treatment may be used for a type of chronic pain called reflex sympathetic dystrophy, which is a condition that affects the nervous system. This procedure is not commonly done because it can cause side effects that include new pain and sweating. Your doctor may want to try a sympathetic nerve block first, in which local anesthetic is injected into the nerve to relieve pain.
Radiofrequency ablation (also called radiofrequency lesioning) is another 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 doctor locate the nerves that are causing your pain.
What To Think About
Surgically implanted devices are not commonly used to treat chronic pain. They may not always control chronic pain in the long run and can lead to other problems that can complicate chronic pain or sometimes make it worse.
Other Treatment
Other Treatment Choices
Additional treatments for chronic pain may include:
Physical therapy. This may include hot and cold therapy to relieve painful areas of the body. It may also include stretching and range-of-motion exercises to maintain strength, flexibility, and mobility.
Transcutaneous electrical nerve stimulation (TENS). TENS applies brief pulses of electricity to nerve endings in the skin to relieve chronic pain.
Professional counseling (such as cognitive-behavioral therapy). This treatment focuses on your mental health and conditions such as stress and depression, which can happen along with chronic pain and make the pain worse. To recover from chronic pain, it is important to be healthy emotionally and physically.
Your doctor may refer you to a pain management clinic to receive these treatments. These clinics provide a setting where you can receive treatment and learn to cope with chronic pain. Treatment is usually provided by a team of doctors who work together to address the many possible causes of your chronic pain. You may also receive these treatments from your own doctor or from specialists who treat chronic pain.
Complementary therapies
Complementary therapies may reduce pain, help you cope with stress, and improve your emotional and physical well-being. These 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 that uses magnets to stimulate areas of the body to try 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; having a healthy, balanced lifestyle; and applying concepts from other areas of complementary medicine (such as Ayurveda, homeopathy, and herbal therapies) to try to improve health, prevent disease, and treat illness.
Yoga, which uses meditation and exercises to help you improve flexibility and breathing, reduce stress, and maintain health.
Radiofrequency Ablation
Radiofrequency ablation of nerves is a procedure that may be used to reduce certain kinds of chronic pain by preventing transmission of pain signals. It is a safe procedure in which a portion of nerve tissue is heated to cause an interruption in pain signals and reduce pain in that area. This procedure is sometimes called radiofrequency lesioning.
Your doctor will first identify the nerve or nerves that are sending pain signals to your brain. You may have X-rays to pinpoint where to direct the radiofrequency probe. After you receive a local anesthetic, the doctor places an instrument under your skin through which electrical stimulation heats the surrounding tissue. This may cause you to feel a buzzing or tingling sensation. The heat “stuns” your nerves, blocking them from sending pain signals to your brain. But the nerve often tries to grow back. If it does, the results are only temporary and usually last for around 6 to 9 months.
This procedure is done in an operating room and takes between 20 minutes to 1 hour or longer depending on how many, and which, nerves are being blocked. If the nerve that is blocked is not the nerve that is causing the pain, your pain will not be reduced.
Radiofrequency ablation is not effective for everyone. If you have not responded well to other treatment, such as diagnostic local anesthesia nerve blocks, radiofrequency ablation will probably not work for you.
What To Think About
If you decide to try one or more of these complementary therapies to treat your chronic pain, find a health professional who has special training and, whenever possible, certification in the particular therapy. You may get a referral from someone you trust such as your doctor, family, or friends. Make sure all of your health professionals know every type of treatment you are using to reduce chronic pain.
Reference from Healthwise
Originally posted 2010-09-12 05:49:02.
