pain treatment

AVAILABLE PAIN TREATMENT OPTIONS

The following areas of pain treatment should be considered:
• Pharmacotherapy (drug options)
• Psychosocial Interventions (coping, counseling, etc.)
• Rehabilitation Techniques (re-conditioning, re-training and lifestyle changes)
• Complementary and Alternative Medicine (CAM)
• Injection and Infusion Therapies
• Implantable Devices and Surgical Interventions

Drug Options

Medications play an important role in the treatment of pain. Many different medicines can be used to help relieve pain. A few, such as aspirin, ibuprofen and acetaminophen, can be purchased in a pharmacy or supermarket without a prescription(OTC), but most pain relievers are only available with a prescription from your healthcare provider. Some medications used to treat pain are not usually thought of as pain medicines, but they have been shown to relieve specific types of pain. For example:

• Some drugs used to manage depression or seizures can be used to treat neuropathic or nerve pain.
• Some steroid medications, such as prednisone and dexamethasone, may be used to treat pain caused by inflammation or bone disease.
• Some medications used to relax muscles or treat insomnia or anxiety may be used in the overall management of pain.

CLASSES OF ANALGESICS FOR PAIN CONTROL
There are three major classes of medications for pain control:

• Non-opioids: non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen
• Opioids (may also be called narcotics): codeine and morphine are examples
• Adjuvant analgesics: a loose term referring to the many medications originally used to treat conditions other than pain, but now also used to help relieve specific pain problems; examples include some antidepressants and anticonvulsants. Some of these drugs have been shown to work well for specific types of pain.

The Pain Treatment Continuum is a step-by-step plan (algorithm) for the appropriate use of possible pain management therapies. These therapies are listed in order of increasing invasiveness. These therapies can be used one at a time or in combination.

Pain management is complex and often requires several attempts with different combinations of medications to find the best treatment plan for an individual. Medications are often one part of a person’s pain management plan and can be quite effective when used properly

Psychosocial Interventions

When you are in pain, you may have feelings of anger, sadness, hopelessness, and/or despair. Pain can alter your personality, disrupt your sleep, and interfere with your work and relationships. In turn, depression and anxiety, lack of sleep, and feelings of stress can all make pain worse. Psychological treatment provides safe, nondrug methods that can treat your pain directly by reducing high levels of physiological stress that often aggravate pain. Psychological treatment also helps improve the indirect consequences of pain by helping you learn how to cope with the many problems associated with pain.

A large part of psychological treatment for pain is education, helping patients acquire skills to manage a very difficult problem.

Rehabilitation Techniques

The simplest — yet often the most challenging — strategy for pain relief involves eating right, sleeping enough, exercising, and managing stress. “If you look at pain management skills, they are nothing more than good living skills,” says Cowan. “If we don’t live our life and really pay attention, the pain overcomes us.”

Complementary and Alternative Medicine (CAM)

The terms “complementary medicine” and “alternative medicine” often are used interchangeably, but the two are different.  Complementary therapies are used together with traditional Western medicine.  For example, you may take opioids to manage your day-to-day pain and use guided imagery to help manage a breakthrough pain episode.  Alternative medicine is used in place of conventional medicine.  For example, using a special diet to treat your arthritis instead of using medications recommended by a physician is using alternative medicine.

Injection and Infusion Therapies

Trigger point injection is a procedure used to treat painful areas of muscle that contain trigger points, or knots of muscle that form when muscles do not relax. During this procedure, a health care professional, using a small needle, injects a local anesthetic that sometimes includes a steroid into a trigger point. With the injection, the trigger point is made inactive and the pain is alleviated. Usually, a brief course of treatment will result in sustained relief. Trigger point injection is used to treat muscle pain in the arms, legs, lower back, and neck. In addition, this approach has been used to treat fibromyalgia, tension headaches, and myofascial pain syndrome (chronic pain involving tissue that surrounds muscle) that does not respond to other treatment.

Implantable Devices and Surgical Interventions

When standard medicines and physical therapy fail to offer adequate pain relief, you may be a candidate for a surgical implant to help you control pain. There are two main types of implants to control pain:

• Intrathecal Drug Delivery. Also called infusion pain pumps or spinal drug delivery systems. The surgeon makes a pocket under the skin that’s large enough to hold a medicine pump. The pump is usually about one inch thick and three inches wide. The surgeon also inserts a catheter, which carries pain medicine from the pump to the intrathecal space around the spinal cord. The implants deliver medicines directly to the spinal cord, where pain signals travel. For this reason, intrathecal drug delivery can provide significant pain control with a fraction of the dose that would be required with pills. In addition, the system can cause fewer side effects than oral medications because less medicine is required to control pain.
• Spinal Cord Stimulation Implants. In spinal cord stimulation, low-level electrical signals are transmitted to the spinal cord or to specific nerves to block pain signals from reaching the brain. In this procedure, a device that delivers the electrical signals is surgically implanted in the body. A remote control is used by the patient to turn the current off and on or to adjust the intensity of the signals. Most people describe the feelings from the simulator as being pleasant and tingling.

Two kinds of spinal cord stimulation systems are available. The unit that is more commonly used is fully implanted and has a pulse generator and a non-rechargeable battery. The other system includes an antenna, transmitter, and a receiver that relies upon radio frequency. The latter system’s antenna and transmitter are carried outside the body, while the receiver is implanted inside the body.

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