pain
brain, spinal cord, and nerve disorders
Chronic Pain
Drugs to relieve pain Physical methods (such as physical therapy) Psychologic and behavioral therapy If a cause of chronic pain is identified, it is treated. Treatment of chronic pain may include the following: Drugs to relieve pain (analgesics) Physical methods, such as Physical Therapy (PT) or Complementary and integrative pain-relieving techniques, such as Acupuncture , Psychologic and behavioral therapy If treatments are ineffective, doctors may refer people to a pain clinic. In most people taking pain relievers (analgesics) for chronic pain, the pain's intensity varies throughout the day. Intensity varies based on several factors, such as the following: Characteristics of the affected nerves (for example, how quickly they send signals and where the nerves are located) Activities that can cause pain (such as moving or touching the affected area) Stress Dose or schedule of pain relievers Depending on the severity of the pain, the following types of drugs may be used to treat chronic pain: Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) Acetaminophen None Drugs called Adjuvant Analgesics (such as Opioid Pain Relievers None Sometimes a combination of drugs may relieve pain more effectively than a single drug. or with Nonsteroidal Anti-Inflammatory Drugs , such as Adjuvant analgesicsare commonly used to treat chronic pain. These drugs are thought to work by changing the way nerves process pain (rather than directly stopping the sensation of pain). The adjuvant analgesics most commonly used for pain are Medications for Treatment of Depression (such as Antiseizure medications (such as Oral and topical local Anesthetics None Opioid Pain Relievers None Before prescribing opioids for any type of chronic pain, doctors consider the following: What the usual treatment approach is Whether there are other treatments that could be used Whether the person has a high risk of side effects from an opioid Whether the person is at risk of misuse or abuse of an opioid drug or is likely to use the drugs for other purposes (for example, to sell them) Doctors may refer people to a pain specialist or a mental health care practitioner who has expertise in substance misuse if the risk of having a problem is high. For example, people who have had an addiction usually need a referral. When opioids are prescribed for chronic pain, doctors explain the nature of the person's disorder (if known) and the risks and benefits of other possible treatments, including nonopioid drugs and no treatment. Doctors ask the person about their goals and expectations. They usually give the person written information that describes the risks of taking opioids. After the person discusses this information with the doctor and understand it, the person is asked to sign an Informed Consent document. When doctors prescribe an opioid for chronic pain, they explain the risks and side effects of opioids. People are advised Not to drink alcohol or take antianxiety drugs or sleep aids when taking the opioid To take the recommended dose at the recommended times and not to change the dose To store the opioid in a safe, secure place Not to share the opioid with anyone To contact their doctor if the drug makes them drowsy or they have any other side effects (such as confusion, constipation, or nausea) To dispose of unused pills as directed To keepnaloxone(an opioid antidote) on hand and to learn and teach family members how to administer it if an opioid overdose occurs If an opioid is prescribed, doctors have usual practices to ensure the person's safety. Doctors typically ask the persons to get opioid prescriptions only from one doctor and fill prescriptions at the same pharmacy every time. They see the person for follow-up visits frequently and monitor the use of the drug to make sure it is safe and effective. For example, doctors may periodically test the person's urine to determine whether the drug is being taken correctly. They also ask the person to sign an agreement that specifies conditions required for opioid use, including any monitoring that may be needed. For people with pain due to cancer or another terminal disorder, concerns about side effects should not limit the use of opioids because side effects can usually be prevented or managed, and addiction is less of a concern. Physical or occupational therapists use various techniques to try to relieve chronic pain and help people function better. If trigger points are present, practitioners may use a spray to cool the area, then stretch the muscle. This method (called stretch and spray) can help lessen pain. Wearing an orthosis (a device that supports damaged joints, ligaments, tendons, muscles, and bones) helps some people. Sometimes doing exercises or increasing activity level helps. For example, walking regularly can help relieve lower back pain more effectively than resting in bed. Physical Therapy (PT) and Overview of Integrative, Complementary, and Alternative Medicine may be used to treat chronic pain. For example, doctors may suggest one or more of the following: Acupuncture None Mind-body techniques (such as Meditation , yoga, and tai chi) Manipulation and body-based therapies (such as Chiropractic or osteopathic manipulation and Energy-based therapies (such as Therapeutic Touch and Various Relaxation Techniques (such as relaxation training, distraction techniques, hypnosis, and Counseling or psychotherapy can help people function better, even if it does not reduce pain. Doctors may recommend specific ways to gradually increase physical and social activities. People are advised not to let pain derail their commitment to better functioning. When this approach is used, many people report a decrease in pain. Doctors applaud progress, encourage people to continue improving, and continue to treat the pain as needed. Doctors may also talk with family members or fellow workers to discourage them from doing anything that keeps the person focused on the pain. For example, they should not constantly ask about the person's health or insist that the person do no chores. A nerve block is frequently used to treat pain caused by damage to a specific large nerve. For this procedure, a nerve pathway that transmits pain signals is disrupted by one of the following: Injecting the area around the nerves with a local anesthetic to prevent the nerves from sending pain signals (doctors commonly use ultrasonography to help them locate the nerves to be treated) Injecting the area around nearby collections of nerve cells called ganglia to help regulate the transmission of pain signals Injecting a caustic substance (such asphenol) into a nerve to destroy it Freezing the nerve (cryotherapy) Burning the nerve with a radiofrequency probe Nerve blocks are often used to treat low back pain caused by pressure on (compression of) spinal nerves (which connect the spinal cord with other parts of the body). Nerve blocks may also be used to treat severe cancer pain near the end of life and severe, persistent neuropathic pain when drugs cannot relieve the pain. Doctors may recommend a pain rehabilitation program for people with chronic pain. These programs are managed by an interdisciplinary team that includes psychologists, physical therapists, doctors, nurses, and sometimes occupational therapists and integrative medicine practitioners. The programs include education. cognitive behavioral therapy, physical therapy, simplification of the drug regimen, and sometimes gradually decreased use of a pain reliever. They focus on the following: Restoring function Improving quality of life Helping people control their own life, despite their chronic pain 