Pain is defined by the International Association for the Study of Pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage.
Pain can be further classified into two basic categories:
i) Acute pain: This type of pain is believed to be a consequence of a disease, injury or inflammation. This type of pain is usually self-limiting and can be mostly diagnosed and treated easily.
ii) Chronic pain: This particular form of pain is said to be more related to the disease itself, and it can get further aggravated by environmental and psychological factors.
Research and Analysis
A study conducted at the Centers for Disease Control and Prevention points towards chronic pain as the leading cause of disability in the United States.
Another related study also concluded that out of the total number of patients reporting to primary care for pain, at least 38% of them presented a case of chronic pain.
Treatment Options
Available treatment will vary for the different forms of chronic pain according to the causative factors concerned. However, there are certain medications that are quite commonly prescribed for relief from most forms of chronic pain. The following sections provide a brief detail on each of such options.
A) Medications
a) Opioids
Generally used for severe chronic pain, such as acute post-surgical and cancer-induced pain, opioids are commonly available in various forms such as pills, patches and intravenous administration. The most common examples of opioids include oxycodone, hydromorphone, codeine, hydrocodone and fetanyl. At times, opioids are also used in combination with other medications such as acetaminophen.
b) NSAIDs
Used for mild to chronic pain, the nonsteroidal anti-inflammatory drugs (NSAIDs) are non-opioid analgesics and are mostly used for mild to moderate chronic pain.
NSAIDs basically work by altering the sensation of pain as they block certain enzymes which participate in the pain response. This category of drugs is also useful in reducing swelling that can often arise with chronic pain.
Some of the most common NSAIDs used include ibuprofen, naproxen, ketoprofen and aspirin.
c) Antidepressants
Also known as adjuvant analgesics, antidepressants can reduce chronic pain in two ways. First, they can effectively alter the way pain is perceived from the spinal cord to the brain. Alternatively, antidepressants can also help by decreasing anxiety and facilitate sleep.
Some of the most common forms of antidepressants used for chronic pain include amitriptyline, which is a tricyclic antidepressant (TCA) and other medications such as duloxetine and nefazodone.
d) Topical Analgesics
Available as creams, lotions and patches, topical analgesics can work by delivering the medicine through the skin (such as Apercreme). Alternatively, some of these can also contain a skin irritant that interferes with perception of pain.
B) Alternative Therapies
If conventional forms of treatment are not producing adequate results, there are many forms of alternative therapies that can be used to treat chronic pain. The main forms include:
i) Mind-Body Therapies – These include techniques such as relaxation methods, guided imagery, biofeedback and hypnosis.
ii) Acupuncture – This form of treatment is widely used to cure chronic pain related to conditions such as headache, lower back pain, fibromyalgia, osteoarthritis, carpal tunnel syndrome and many more.
In addition, chiropractic treatment and massage has often been found helpful in the treatment of chronic pain. However, alternative therapies do not have medical evidence to show that they work so they are sometimes marginalized. Even though science cannot prove some of these therapies work, many chronic pain patients report good results with these alternatives.
C) Lifestyle Alterations
Either as a complement to the existing medication or even as a stand-alone option, lifestyle alterations should not be overlooked as another way to control chronic pain. The most important measures include:
i) Smoking cessation
ii) Adequate sleep
iii) Proper diet
iv) Regular exercise
D) Surgical Intervention
Usually as a last option, surgery can be sometimes help where the medications and alternative therapies have failed to provide the desired results. For instance, in severe cases of lower body pain, Cordotomy is often performed in which the nerve fibers on one or both sides of the spinal cord are severed which leads to a total loss of sensation of pain and temperature. Other surgeries related to chronic pain are often related to spinal discs and other nerve related injuries. These options are typically recommended by your doctor if appropriate.
