This
topic is for people with chronic pain caused by problems other than cancer. If
you are looking for information on pain caused by cancer, see the topic
Cancer Pain.
What is chronic pain?
Pain that lasts for 3 months
or longer is called chronic. Pain is your body's way of telling you that
something is wrong. It’s normal for you to have pain when you are injured or
ill. But pain that lasts for weeks, months, or years is not normal.
Chronic pain can occur anywhere in your body. It can range from being
mild and annoying to being so bad that it gets in the way of your daily
activities.
Anyone can get chronic pain. It’s more common in older
adults, but it’s not a normal part of aging. Older adults are more likely to
have long-term medical problems, such as
diabetes or
arthritis, which can lead to ongoing pain.
What causes chronic pain?
The cause of chronic
pain is not always clear. It may occur because brain chemicals that usually
stop pain after you get better from an illness or injury are not working right.
Or damaged nerves can cause the pain. Chronic pain can also occur without a
known cause.
What are the symptoms?
Common symptoms of chronic
pain include:
Mild to very bad pain that does not go away
as expected.
Pain that is shooting, burning, aching, or
electrical.
Soreness, tightness, or stiffness.
What other problems can chronic pain cause?
If you
have pain for a long time, it can make you feel very tired and may lead to
depression. It can get in the way of your usual social
and physical activities. You may have so much pain that you can't go to work or
school. The emotional upset may make your pain worse. Your body’s defense
system (immune system) may get weak, leading to lots of
infections and illnesses.
How is chronic pain diagnosed?
Your doctor can
find out if you have chronic pain by asking about your past illnesses and your
overall health. He or she will also do a physical exam.
You may
have tests to find out if a medical problem is causing the pain. Your doctor
may check for problems with your
nervous system and may order blood tests. He or she
may also ask you questions to check your mood and mental health and to see how
well you are able to think, reason, and remember. In most cases, test results
are normal. This can make it hard to know the exact cause of the pain. But this
doesn't mean that your pain isn't real.
How is it treated?
You can use home treatment for
mild pain or pain that you have now and then. Exercising, getting enough sleep,
and eating healthy foods may help reduce chronic pain. Using
over-the-counter pain medicines such as acetaminophen,
aspirin, or ibuprofen may also help. You may want to try
complementary therapies such as massage and
yoga.
Talk to your doctor if your pain does not go away or if it
gets worse. You may need to try different treatments to find what works for
you. Medicines you take by mouth, shots of numbing medicine,
acupuncture,
nerve stimulation, and surgery are used for some types
of chronic pain. It is important to make a clear treatment plan with your
doctor. The best plan may include combining treatments.
Living
with chronic pain can be hard.
Counseling may help you cope. It can also help you
deal with frustration, fear, anger, depression, and anxiety. Chronic pain often
can be managed so that you can get on with your life and do your daily
activities.
The cause of
chronic pain is not clear. When you have an injury or
illness, certain nerves send pain signals to your brain. With chronic pain,
these pain signals continue for weeks, months, or even years after you recover.
Chronic pain can develop after a major injury or illness, such as a back injury
or
shingles, or it can develop without a known cause. It
is also possible that certain brain chemicals that usually suppress pain may
not work properly. The pain may be:
Neurogenic pain, or neuropathic pain, which
occurs when the
peripheral nerves or
central nervous system are somehow damaged. The nerves
themselves cause the pain, and this kind of pain may not respond well to
treatment.
Psychogenic pain, which is pain that may be caused by an
emotional or mental health issue. This pain is not caused by a disease, injury,
or damage to the nervous system. Psychogenic pain is not common, but stress,
depression, and other mental health factors can make the pain worse.
Unidentifiable pain. It may be impossible to find or identify the
cause of your pain. Tests may not reveal any injury, illness, or tissue change
that could have triggered the pain.
In some cases,
chronic pain develops after an injury or illness. The
pain continues even after you have recovered from the injury or illness. For
example, many people who have had a limb amputated report feeling chronic pain
in the missing limb (phantom limb pain). Chronic pain can also develop even
though you have not had an injury or illness. But the result is often the
same—a cycle of sleeplessness, inactivity, irritability,
depression, and more pain.
Chronic pain
may be mild to severe. You may have pain that comes back from time to time over
several weeks, months, or years. Occasional, mild to moderate pain can usually
be managed at home. Exercise, good nutrition, regular massages, and
pain-relieving drugs—such as
acetaminophen or
nonsteroidal anti-inflammatory drugs (NSAIDs), for
example, ibuprofen or aspirin—may be enough to manage your symptoms.
On the other hand, you may have constant chronic pain that is severe. You
may be unable to work, and physical activity may be too painful or exhausting.
Sleeping at night may be difficult, resulting in fatigue and irritability. Your
outlook on life may change and strain your relationships with family and
friends. Prolonged pain may restrict your daily activities and eventually lead
to disability. Without specialized treatment,
chronic pain syndrome can become disabling.
After treatment begins, many things can interfere with your recovery,
such as dependency on drugs or alcohol, overwhelming
stress, lack of motivation, depression or other mental
health problems, or ongoing litigation because of a workers' compensation
claim. If your pain is disabling, you may want to seek an evaluation at a
pain management clinic, where a team of doctors work together to treat your
pain.
The lives of your family members, friends, or caregivers can
also be affected. The people you count on to help you may also need some
support.
Family therapy or involvement in a caregiver support
program may help.
Factors that may increase the
risk of
chronic pain include:
Aging. Older adults are more likely to suffer
from chronic conditions such as
arthritis,
diabetes,
shingles, and other causes of nerve problems
(neuropathy). But chronic pain is not a normal part of growing
older.
Smoking. Nicotine use can increase pain and decrease the
effectiveness of medicines.
Past health problems, such as joint injuries.
Also, previous surgery may cause new pain or may not work to relieve pain (such
as back surgery that does not relieve pain).
Overall general health
condition. You may have a
weakened immune system, which can lead to frequent
infections or illness.
Conditions that are difficult to treat, such
as nerve pain from shingles (postherpetic neuralgia).
Lifestyle, such as not eating healthy foods, not exercising
regularly, smoking, or having a
substance abuse or
alcohol dependency problem.
Other factors that may increase your risk for chronic pain
include injury, stress, inactivity, relationship problems, or a history of
physical, sexual, or emotional abuse.
Your pain has lasted more than 3 months without
a clear reason.
You are feeling down or blue or are not enjoying
the activities or hobbies that you have enjoyed in the past. You may be
experiencing
depression, which is common with chronic
pain.
You are unable to sleep because of the pain.
You
had an illness or injury that healed, but the pain has not gone
away.
You have a family member or friend who appears to be
suffering from chronic pain, and you would like information about
treatment.
Watchful Waiting
Watchful waiting is a period of time during
which you and your doctor observe your symptoms or condition without using
medical treatment. If you are able to control occasional, mild to moderate pain
with exercise, healthy eating, massage, and pain relievers—such as
acetaminophen or
nonsteroidal anti-inflammatory drugs (NSAIDs), for
example, ibuprofen or aspirin—you may not need further treatment from a doctor.
But watchful waiting is not appropriate if your pain is severe or if persistent
pain interferes with your life. If you delay treatment, the pain may get
worse.
Who To See
If you have mild to moderate recurring pain that
cannot be managed at home, you may need to consult one of the following health
professionals:
If your chronic pain is moderate to severe and constant,
or if treatment does not control the pain, your primary health professional may
recommend that you see a specialist, such as one or more of the
following:
Often more than one specialist will treat your chronic
pain. For example, a primary physician may manage your medicines, and a
physical therapist may help you restore function through exercise or other
therapies. A professional counselor may help you with coping and depression,
and a
complementary medicine practitioner may provide
alternative therapies such as
acupuncture or
yoga.
If chronic pain persists and
interferes with your daily life despite treatment, you may want to seek an
evaluation at a
pain management clinic. A pain management clinic is a setting where you
receive treatment and learn to cope with chronic pain. Treatment is usually
provided by a team of doctors who work together to address all the possible
causes of your chronic pain.
Many exams and tests are used to
evaluate
chronic pain. The first assessment includes:
A detailed
medical history. Your doctor will ask you about your
general medical history, past illnesses, and overall health. He or she will ask
you questions about your pain, previous pain episodes, how they were treated,
and whether treatment was successful. Also, your doctor will note any family
history of chronic pain. In order to identify activities that cause pain, how
you treat pain when it occurs, and whether the treatment relieves the pain,
your doctor may ask you to start keeping a
pain diary(What is a PDF document?)
.
A
physical exam. Your physical well-being will be
evaluated, which will help your doctor identify areas of pain. You may be asked
to move your limbs to help identify painful areas. A physical exam may uncover
health conditions that contribute to chronic pain. As part of your physical
exam, you may also have:
A neurologic exam to identify possible
nervous system problems. You may be asked to complete
a few physical tasks, such as walking up and down a hall or getting up from a
chair. By checking your reflexes and your ability to feel light touch, the exam
can help determine whether you have a nerve problem. The doctor may also ask
you to repeat a series of numbers or to answer simple questions about dates,
places, and current events.
A
mental health assessment. This test evaluates your
emotional functioning and ability to think, reason, and remember. You will be
asked questions to determine whether such conditions as
depression,
insomnia, or
stress are contributing to or happening as a result of
your chronic pain. These conditions often occur with chronic pain. You may also
be asked about your use of alcohol and drugs. Answering these questions fully
and honestly may help your doctor and you identify the sources of your chronic
pain.
Diagnostic tests. These tests are often used to
rule out other health conditions that can cause chronic pain. Tests may
include:
Blood tests or
other laboratory tests. A small sample of your blood is taken and then
evaluated to see if you have an infection or other condition that could be
causing your pain.
X-rays or other imaging tests (such as
CT scans,
MRIs, or
ultrasounds). These tests take pictures of the inside
structures of your body to look for disease and injury.
Electromyogram (EMG) and nerve conduction studies or
other nerve tests. These tests measure muscle and nerve function to determine
whether your chronic pain is related to muscle or nerve problems.
Angiogram or other vascular studies.
This test injects a dye and inserts a small tube into your arteries to trace
the movement of blood within your body.
Diagnostic
nerve blocks. One example is an injection of a
local anesthetic into or around a nerve to identify
whether that nerve is causing the pain.
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. But over time treatment should
reduce 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:
Making exercise (such as walking or swimming)
a routine part of your life.
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.
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.
If the above treatments do not relieve or reduce your
pain, your doctor 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.
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 build a clear
treatment plan for
chronic pain with your doctor. 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 doctor 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 that
are linked to chronic pain. The medicines and other treatments most often used
to treat chronic pain include:
Acetaminophen, such as Tylenol.
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.
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.
Cooling spray. This involves using a cooling
spray (such as Biofreeze) directly on the skin. This may be repeated several
times.
Creams or gels containing medicines or combinations of
medicines. These 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:
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 nerve
pain or pain and inflammation.
For some people,
complementary therapies can help reduce chronic pain.
These therapies include:
Acupuncture, a treatment based on
traditional Chinese medicine. Acupuncture involves putting very thin needles into the skin at certain points on the body.
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; 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,
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 help reduce 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 plenty of
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 want to think about going to a
pain management clinic. Treatment is provided by a team of doctors who work
together to address all the factors that may cause your 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.
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.
Intrathecal drug delivery. An
intrathecal pain pump is a small tube inserted in the spinal canal where the
pain signals go to the brain. This tube is connected to a small reservoir of
medicine inserted under the skin of your belly. The medicine is regularly
delivered to the area of pain through the tube.
Spinal cord stimulation. Spinal cord stimulation (SCS)
is a procedure that uses an electrical current to treat chronic pain. An
electrical generator is put under the skin. This generator sends electrical
pulses to a certain area of the spinal cord through electrodes placed in the
spinal cord by a specialist.
Radiofrequency ablation (also called radiofrequency
lesioning) 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
doctor find 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 doctors can help you set realistic
expectations and identify treatment choices.
Staying in good physical and mental
health may be the best way to prevent chronic pain or help you cope with the
constant pain. Get enough sleep every night. Treat your health problems early,
learn to alternate activity with rest throughout each day, exercise, eat a
balanced diet, and try to reduce
stress in your life to prevent chronic pain from
developing.
The following ideas can help you manage
your
chronic pain.
Take your medicines as
prescribed.
Eat a
balanced diet, and consider taking a daily
multivitamin that contains vitamin B and vitamin D.
Participate in
a physical therapy or exercise program that includes stretching several times a
day.
Keep your appointments with your doctor, especially if you
have moderate to severe or constant chronic pain.
Make lifestyle changes, such as:
Get enough sleep every night. If you are tired
during the day and have trouble sleeping, try to:
Set a bedtime and a wake-up time—and stay
with these times, even on weekends. This helps your body get used to a regular
sleep time.
Get some exercise during the day.
Avoid
taking naps, especially in the evening.
Avoid drinking or eating
caffeine after 3 p.m. This includes coffee, tea, cola drinks, and
chocolate.
Treat medical conditions and mental health
concerns early, before they get worse and become harder to treat. Untreated
health conditions (such as
shingles) or mental health problems (such as
depression or
anxiety) can make chronic pain harder to
treat.
Exercise regularly with aerobic exercise—such as swimming,
stationary cycling, and walking—to build your strength and health. Water
exercise may be especially helpful in reducing pain that gets worse during
weight-bearing activities, such as walking. Talk to your doctor before you
begin an exercise program. Start slowly and increase your efforts bit by bit.
If your joints are stiff, try taking a warm bath or shower first to loosen up.
Also, do some stretching exercises each day.
Schedule your day so
that you are most active when you have the most energy. Learn to move in ways
that are less likely to make your pain worse.
Eat a
balanced diet. Good nutrition will help you stay
healthy and strong.
Stop smoking. Smoking may affect your level of
pain and may reduce how well your chronic pain treatment
works.
Trying
assistive devices, if recommended by your doctor, that
help you do your daily activities. These devices can help you to be more mobile
and independent. For example, use a cane or crutch, braces, splints, or devices
such as doorknob extenders or an elevated toilet seat.
Joining a
support group. A support group is made up of people with similar experiences
who can understand your feelings and provide comfort. A support group can keep
you from feeling isolated and alone. Being around others who share your problem
can help you and your family learn how to accept and manage chronic pain. To
find a group near you, contact the American Chronic Pain Association at
1-800-533-3231 or online at www.theacpa.org.
Doing
self-massage or trigger point massage therapy.
If you are a caregiver for a person who has chronic pain,
your own stress and worry can also cause you to have symptoms of depression,
vague body pains, digestive disorders, or headaches. Experts say that it is
important to take care of yourself, too, and not to feel guilty about it. For
more information, see the topic
Caregiver Tips.
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:
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 Norco),
or acetaminophen with codeine (such as Tylenol with codeine). Opioids are
sometimes combined with other medicine, such as gabapentin, for nerve
pain.
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 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.
In addition to medicine or
surgery, other treatments can be helpful in reducing
chronic pain.
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.
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. Acupuncture involves putting very thin needles into the skin at certain points on the body.
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.
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.
National Institute of Neurological Disorders and
Stroke
P.O. Box 5801
Bethesda, MD 20824
Phone:
1-800-352-9424 (301) 496-5751
TDD:
(301) 468-5981
Web Address:
www.ninds.nih.gov
The National Institute of Neurological Disorders and
Stroke (NINDS), a part of the National Institutes of Health, is the leading
U.S. federal government agency supporting research on brain and nervous system
disorders. It provides the public with educational materials and information
about these disorders.
American Chronic Pain Association
(ACPA)
P.O. Box 850
Rocklin, CA 95677
Phone:
1-800-533-3231
Fax:
(916) 632-3208
E-mail:
ACPA@pacbell.net
Web Address:
www.theacpa.org
American Chronic Pain Association (ACPA) is a not-for-profit
organization that provides information and support to help people live more
fully in spite of their pain. ACPA groups across the U.S. are open to anyone
who is living with an ongoing pain problem. These groups provide support,
validation, and education in basic pain management and life skills.
American Pain Society
4700 W. Lake Avenue
Glenview, IL 60025
Phone:
(847) 375-4715
Fax:
1-866-574-2654 toll-free
E-mail:
info@ampainsoc.org
Web Address:
www.ampainsoc.org
The American Pain Society is a group of scientists,
clinicians, and others. This group seeks to advance pain-related research,
educate people about pain, and change public policy and clinical practice to
reduce pain-related suffering.
National Pain Foundation
300 East Hampden Avenue
Suite 100
Englewood, CO 80113
Web Address:
www.nationalpainfoundation.org
Through information, education, and support, the
National Pain Foundation (NPF) promotes the recovery of persons in pain. The
NPF Web site provides information and resources in an interactive way that
encourages patients to take an active role in managing their chronic pain. The
My Pain section of the Web site includes a Personal Inventory section to help
pain patients identify the information they need to manage their pain. The NPF
has information about pain conditions such as arthritis, back and neck pain,
and cancer pain. The NPF addresses the many approaches to pain management, such
as medicines, injections, surgery, acupuncture, biofeedback, chiropractic, and
physical therapy. The NPF also provides support for the special needs of
children in pain and information about psychological factors related to pain.
The Web site also provides information on clinical trials that are studying
pain management and treatment.
Brodie EE, et al. (2007). Analgesia through the
looking-glass? A randomized controlled trial investigating the effect of
viewing a 'virtual' limb upon phantom limb pain, sensation and movement.
European Journal of Pain, 11(4): 428–436.
Davies PS, Galer BS (2004). Review of lidocaine patch
5% studies in the treatment of postherpetic neuralgia. Drugs, 64(9): 937–947.
Gabapentin (Neurontin) for chronic pain (2004).
Medical Letter on Drugs and Therapeutics, 46(1180):
29–31.
Mailis-Gagnon A, et al. (2004). Spinal cord
stimulation for chronic pain. Cochrane Database of Systematic Reviews (3).
Taylor RS, et al. (2005). Spinal cord stimulation for
chronic back and leg pain and failed back surgery syndrome: A systematic review
and analysis of prognostic factors. Spine, 30(1):
152–160.
Woolf CJ (2004). Pain: Moving from symptom control
toward mechanism-specific pharmacologic management. Annals of Internal Medicine, 140: 441–451.
Ziconotide (Prialt) for chronic pain (2005).
Medical Letter on Drugs and Therapeutics, 47(1223/1224):
103–104.
This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.
This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.
