Treatment for chronic pain blocks the pain signal anywhere in the pathway from the skin to the spinal cord nerves and from the spinal cord to the thalamus and cortex. Treatment ranges from traditional medications to complementary therapies.
Painkillers, also called analgesic medications, are often used to lessen chronic pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen can provide some relief.
Acetaminophen is also commonly used. These medications are usually tried first. If they are ineffective, stronger medications such as opioids might be added.
Opioids (also referred to as narcotics) such as morphine and codeine reduce certain types of pain. Opioids have caused concerns because they have been linked to dependence and addiction. They are strong analgesics and have significant potential to become habit-forming, and they can cause drowsiness, nausea, constipation, dizziness, and itching.
Although many people are afraid of becoming addicted to opioids, addiction is uncommon when the medication is used appropriately. Addiction involves a psychological need to abuse drugs that is different from tolerance (needing higher doses of medication to keep the same level of pain control) and dependence (experiencing withdrawal symptoms if the medication is stopped suddenly).
Other medications such as corticosteroids reduce the pain of bone cancer and anticonvulsant medications relieve the pain of damaged nerves. Some types of antidepressants are also helpful for nerve-related pain.
A number of complementary therapies are used in addition to medications in the management of chronic pain, including an individualized physical therapy program. Stretching and exercises to improve range of motion can allow for gradual improvements in physical functioning. An exercise program should be tailored specifically to a person’s needs and limitations.
Transcutaneous electrical nerve stimulation (TENS) directs electrical energy through the skin using electrodes. Though it is not know exactly how TENS helps with pain, it is thought that the energy starts a natural reaction in the spinal cord that relieves the pain. Not all people respond to TENS, but it does provide some pain relief for certain individuals.
If someone suffers from chronic pain that's carried by one or more specific nerves, they can have a nerve block, which temporarily or permanently stops the pain signal from traveling along that particular nerve. An injected anesthetic blocks the nerve from carrying the pain signals. People can also have the nerves destroyed by surgery or by hot or cold treatments. The pain can return, however, and some people may lose feeling or movement in the part of the body controlled by the destroyed nerve.
In extreme cases, implantable nerve stimulators can be placed in the spinal cord to change the sensation from pain to parasthesia (tingling).
Acupuncture is used to treat many painful conditions, including migraine and back pain. In acupuncture, the acupuncturist will insert thin needles just under the skin at specific points on the body. Acupuncture probably stimulates natural anti-pain chemicals in the spinal cord. Relaxation and meditation techniques can help relax muscles, relieve anxiety, and help reduce pain.
Biofeedback may relieve chronic pain. In biofeedback, an instrument measures breathing, heart rate, and other specific bodily responses and feeds them back in the form of light or sound. People can then learn to control these bodily responses through relaxation and cognitive techniques.
Various forms of psychological treatments have been used to help relieve chronic pain. Cognitive therapy can help people substitute positive thoughts for negative ones. Behaviour therapy tries to change the activity level of people with chronic pain.
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