Treatment and Prevention
Treatment for chronic pain blocks pain anywhere in the pathway from the
skin to the spinal cord nerves and in the nerves in the thalamus and cortex
leading to the spinal cord. Treatments range from traditional medications
to alternative therapies.
Painkillers, also called analgesic medications, are often used to lessen
chronic pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) such
as aspirin*, ibuprofen, and naproxen can provide some relief.
Acetominophen is also commonly used. Opiates (also referred to as narcotics)
such as morphine and codeine, relieve pain. Opiates carry the stigma of concern
regarding dependence and addiction. They are the strongest analgesics available
and have significant potential for habituation, drowsiness, nausea, constipation,
and itch.
Although many people fear becoming addicted to opiates, addiction is extremely
rare when the medication is being used to treat pain. Addiction involves
a psychological need to abuse drugs that is different from tolerance (needing
higher doses of medication to keep the same level of pain control) and dependence
(experiencing withdrawal symptoms if the medication is stopped suddenly).
Anesthetics such as lidocaine and mexiletene (given as ointments, patches,
or oral medications) can relieve severe chronic pain if they're taken slowly
and steadily in very small amounts.
Corticosteroids reduce the pain of bone cancer, and anticonvulsant medications
such as carbamazepine relieve the pain of damaged nerves. Some types of antidepressants
are also helpful for nerve-related pain.
Transcutaneous electrical nerve stimulation (TENS) directs electrical
energy to the painful sites on the body. The energy starts a natural reaction
in the spinal cord that relieves the pain. Not all people respond to TENS, but
it takes away the pain completely for some individuals.
If someone suffers from chronic pain that's carried by one or more specific
nerves, they can have a nerve block. An injected anesthetic blocks the nerve
from carrying the pain signals. 50% of people are cured of the pain, and the
remaining 50% have the pain return within a year. People can also have the nerves
destroyed by surgery or by hot or cold treatments. The pain can return, however,
and some people may lose feeling or movement in the part of the body controlled
by the destroyed nerve.
In extreme cases, implantable nerve stimulators can be placed in the spinal
cord and be used to change the sensation from pain to parasthesia (tingling).
Acupuncture is used to treat many painful conditions, including migraine
and back pain. In acupuncture, the acupuncturist will insert thin needles just
under the skin at specific points on the body. Acupuncture probably stimulates
natural anti-pain chemicals in the spinal cord. Relaxation and meditation techniques
can help relax muscles, relieve anxiety, and stop the cycle of pain.
Biofeedback relieves chronic pain very well. In biofeedback,
an instrument measures breathing, heart rate, and other specific bodily responses
and feeds them back in the form of light or sound. People can then learn to
control these bodily responses through relaxation and cognitive techniques.
Various forms of psychological treatments have been used to help relieve chronic
pain. Cognitive behavior therapy can help people substitute positive thoughts
for negative ones. behavior therapy tries to change the attitudes of people
with chronic pain.
*All medications have both common (generic) and brand names. The brand name
is what a specific manufacturer calls the product (e.g., Tylenol®).
The common name is the medical name for the medication (e.g., acetaminophen).
A medication may have many brand names, but only one common name. This article
lists medications by their common names. For more information on brand names,
speak with your doctor or pharmacist.