Overview of Pain Management Treatment
Overview of Pain Management Treatment
What Are the Treatments for Chronic Pain?
Chronic pain treatments are as varied as its causes. There are numerous approaches available, ranging from over-the-counter and prescription drugs to mind/body techniques and acupuncture. However, when it comes to treating chronic pain, no single technique can guarantee complete pain relief. A combination of treatment options may provide relief.
Drug Therapy: Nonprescription and Prescription
Over-the-counter medications such as Tylenol (acetaminophen) or nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and naproxen can help with milder forms of pain. Acetaminophen and NSAIDs both relieve pain caused by muscle aches and stiffness, and NSAIDs also reduce inflammation (swelling and irritation). Topical pain relievers, such as creams, lotions, or sprays, are also available to relieve pain and inflammation caused by sore muscles and arthritis.
If over-the-counter medications do not relieve your symptoms, your doctor may prescribe stronger medications such as muscle relaxants and anti-anxiety medications. (such as diazepam [Valium]), antidepressants (like duloxetine [Cymbalta] for musculoskeletal pain), prescription NSAIDs such as celecoxib (Celebrex), or a short course of stronger painkillers (such as codeine, fentanyl [Duragesic, Actiq], oxycodone and acetaminophen (Percocet, Roxicet, Tylox) or hydrocodone and acetaminophen (Lorcet, Lortab, and Vicodin). . A limited number of steroid injections at the site of a joint problem can reduce swelling and inflammation. An epidural might be given for spinal stenosis or lower back pain.
In July 2015, the FDA requested that the warning labels on both prescription and over-the-counter NSAIDs be strengthened to indicate the potential risk of heart attacks and strokes. The risk increases as the drug doses are increased. There is also the possibility of developing bleeding stomach ulcers.
Sometimes, a group of nerves that causes pain to a specific organ or body region can be blocked with local medication. The injection of this nerve-numbing substance is called a nerve block. Although many kinds of nerve blocks exist, this treatment cannot always be used. Often blocks are not possible, are too dangerous, or are not the best treatment for the problem. You doctor can advise you as to whether this treatment is appropriate for you.
Patient-controlled analgesia (PCA)
Patient-controlled analgesia (PCA) is another method of pain control. By pushing a button on a computerized pump, the patient is able to self-administer a premeasured dose of pain medicine infused with opiods. The pump is connected to a small tube that allows medicine to be injected intravenously (into a vein), subcutaneously (just under the skin), or into the spinal area. This is often used in the hospital to treat pain in post-traumatic or post-surgical pain as well as terminal cancer pain.
When standard pain medications and physical therapy are ineffective. You may be a candidate for a surgical implant to help you control pain. When they are used, which is uncommon, there are two main types of pain-controlling implants:
- 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 such as morphine or a muscle relaxant 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. This method being especially used for back and limb pain. 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. Some devices cause what’s described as a pleasant, tingling sensation while others do not.
- 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 goes outside the body, while we implants the receiver inside the body.
Trigger Point Injections
Trigger point injection is a procedure we use to treat painful areas of muscle. These areas contains trigger points, or knots of muscle that form when muscles do not relax. During this procedure, a healthcare professional, using a small needle injects a local anesthetic. Sometimes includes a steroid into a trigger point (sterile salt water injections). With the injection, the trigger point becomes inactive and alleviates the pain. Usually, a brief course of treatment will result in sustained relief.
We use the Trigger point injection 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.