Pain Treatment Options
By Joseph W. Galassi, M.D.
Once again, pain treatment options are individualized to the patient. No two patients are exactly alike, and, as such, they will have variations in how their pain is managed.
There are a few broad categories of treatment that will be listed below. This list is by no means complete as new therapies – both natural or homeopathic as well as medical come along every day – nor does it endorse any particular treatment modality.
Medications fall into various classes of drugs and they are chosen based on the individual’s type of pain, his/her previous responses to other medications and his/her other medical conditions.
Nonopioid analgesics – Acetaminophen and NSAIDs – nonsteroidal anti-inflammatory pain medications such as ibuprofen (there are numerous medications that are similar to ibuprofen)
Opioids – vary from mild, such as proproxyphene (made with ibuprofen in Darvocet) to strong, such as morphine
Anti-depressants – there are a number of these drugs that have proven to be effective in treating chronic pain, particularly neuropathic pain
Anti-convulsants – originally studied to treat seizures have been found to be helpful in treating neuropathic pain as well
Anti-arrhythmics – limited evidence to their benefit, but they may be useful in individuals who have failed other medications
NMDA antagonists – these have a limited role in certain patients
Sympatholytic agents – drugs such as clonidine play a role in refractory pain patients
Corticosteroids – these can be used to decrease inflammation and play a helpful role in diminishing pain
Muscle relaxants – play an adjuvant role in helping diminish discomfort
Local anesthetics – available for topical use, local anesthetic creams and patches can provide temporary or long-term relief from certain painful conditions
Anti-anxiety drugs – in some instances, these drugs may be used to help treat the psychological aspects associated with chronic pain
Capsaicin – available as an over-the-counter cream, this can be used for temporary relief.
The role of physical therapy (PT) cannot be minimized. This plays a key component in the rehabilitation process. The goals of PT are:
To minimize the restrictions on one’s activities of daily living
To educate patients with regard to proper body mechanics; that is, to avoid inciting factors that will exacerbate their pain
To return the patient to work
To decrease pain
The same thing can be said for occupational therapy (OT) that was said for physical therapy. The goals are increasing function, diminishing pain, and returning the patient to work with minimal restrictions on activities of daily living
Oftentimes depression and chronic pain go hand in hand. It can be difficult at times to tell which came first, the pain or the depression. In any event, one’s overall mood must not be overlooked as it directly impacts on one’s perception of pain.
There are a number of ways to address the psychological component of pain that are beyond the scope of this article. In brief, they include the following modalities:
Hypnosis or relaxtion with imagery
Cognitive-Behavioral methods including:
Cognitive restructing or reframing
Suffice it to say that your pain specialist will address this with you and treat it or refer you to the appropriate psychologist or psychiatrist who has experience in treating chronic pain
Accupuncture has been shown to help certain conditions such as back and neck pain. If your doctor feels that you are a good candidate, or you wish to try it, then there are really few downsides to using this modality.
Chiropractic treatment has also been used particularly for back and neck pain. If the pain is primarily musculoskeletal in origin, this can often be helpful. Realize that individual responses will vary.
Interventional Pain Procedures
These can be as simple as a trigger point injection or as complicated as a neurodestructive procedure, an implanted pain management system or surgery. Once again, each individual is offered a plan based on his/her history, physical, imaging studies and previous treatments.
Trigger point injections – these may be offered for temporary relief of myofascial pain
Joint injections – again, these are good for temporary relief of joint pain
Epidural steroid injections – these are good for temporary relief of nerve pain such as sciatica; they are commonly performed with X-ray guidance to ensure that they go directly to the perceived source of pain
Nerve Blocks – these can be done to direct steroids and local anesthetics to nerves believed to be the source of pain
Discograms – these are done to diagnose the source of pain as coming from a disc in the back
Spinal Cord or Peripheral Nerve Stimulators – these are permanently implanted systems that are used when less invasive methods fail to provide adequate pain relief; they are most effective for neuropathic pain such as sciatica
Implanted drug delivery systems – these are permanently implanted pumps that deliver drugs directly into the spinal fluid to treat pain; again, they are used when other routes of drug delivery fail
Surgery – there are often pain syndromes such as spinal stenosis that respond quite well to surgical intervention. There are other conditions, such as an acute herniated disc, where the long-term outcome of surgical intervention is similar to conservative, non-surgical treatment. Always be sure to know all your options, benefits and risks before agreeing to a surgical intervention with the promise of a cure. Going in to surgery knowing that one’s goal is improvement in pain and symptoms rather than believing you will be “cured” will lead to better satisfaction with one’s outcome.
Chronic Refractory Pain
By Joseph W. Galassi, M.D.
If you are a sufferer of chronic pain and have not been satisfied with the results you have gotten with your primary care doctor or other specialists, then a pain medicine specialist is likely your next best option.
He or she can review your history and prior studies and treatments, examine you, and then recommend a treatment plan best suited for you. Oftentimes, you can be referred to a pain medicine physician by your primary care doctor. Otherwise, you can find a list of doctors near you in the phone book or on the Internet.