What Are the Treatments for Chronic Pain?

The treatments for chronic pain are as diverse as the causes. From over-the-counter and prescription drugs to mind/body techniques to acupuncture, there are a lot of approaches. But when it comes to treating chronic pain, no single technique is guaranteed to produce complete pain relief. Relief may be found by using a combination of treatment options.

Types of Pain

Acute pain can last a moment; rarely does it become chronic pain. Chronic pain persists for long periods. It is resistant to most medical treatments and cause severe problems.

Pain Classifications

Even though the experience of pain varies from one person to the next, it is possible to categorize the different types of pain.

Chronic Pain

Learn about how chronic pain occurs, and why chronic pain sometimes lingers.

Nerve Pain

When nerve fibers get damaged, the result can be chronic pain. Read about the very common causes of neuropathic pain, like diabetes.

Psychogenic Pain

Depression, anxiety, and other emotional problems can cause pain — or make existing pain worse.

Musculoskeletal Pain

Musculoskeletal pain is pain that affects the muscles, ligaments and tendons, and bones. Learn about the causes, symptoms, and treatments.

Chronic Muscle Pain

Use your muscles incorrectly, too much, too little — and you’ve got muscle pain. Learn the subtle differences of muscle injuries and pain.

Abdominal Pain

Learn common causes of abdominal pain and when to contact your doctor.

Joint Pain

See the causes of joint pain and how to treat it with both home remedies and prescribed medication.

Central Pain Syndrome

A stroke, multiple sclerosis, or spinal cord injuries can result in chronic pain and burning syndromes from damage to brain regions. Read this brief overview.

Chronic pain: Medication decisions

Chronic pain: Medication decisions

Chronic pain can limit your quality of life and lead to additional, serious health problems. Finding effective treatment is important — as is balancing pain relief with your safety.

Chronic pain is a serious health condition. Like any long-term health problem, the condition often leads to complications beyond your physical symptoms, such as new or worsened depression, anxiety and difficulty sleeping. Chronic pain can make it more difficult to keep up at work, manage tasks at home and attend social gatherings, leading to problems in your relationships and financial instability. Some research suggests that the more severe your pain, the more serious these problems.

Working in partnership with your doctor, however, you can identify treatments that allow you to live an enjoyable, fulfilling life. The approach you choose should include more than just medication, but painkillers are likely to play a role. Learn about the risks and benefits of common pain medications so that you can make safe choices as you seek your solution.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs are most effective for mild to moderate pain that’s accompanied by swelling and inflammation. These drugs are commonly used for arthritis and pain resulting from muscle sprains, strains, back and neck injuries, or menstrual cramps.

• Generic (brand) names. Ibuprofen (Advil, Motrin IB, others); naproxen sodium (Aleve); others
• How they work. NSAIDs work by inhibiting certain enzymes in your body, called cyclooxygenase, that are released during tissue damage. By blocking the different types of cyclooxygenase (COX) — including COX-1 and COX-2 — NSAIDs can help reduce pain and inflammation that result from an injury.
• Benefits and risks. When taken as directed, NSAIDs are generally safe. But if you take more than the recommended dosage — and sometimes even just the recommended dosage — NSAIDs may cause nausea, stomach pain, stomach bleeding or ulcers. Large doses of NSAIDs can also lead to kidney problems, fluid retention and high blood pressure. Risk of these conditions increases with age and in the presence of other health problems, including diabetes, a history of stomach ulcers or reflux, and kidney disease.
• Bottom line. If you regularly take NSAIDs, talk to your doctor so that he or she can monitor you for possible side effects. Bear in mind that NSAIDs also have a ceiling effect — a limit as to how much pain they can control. This means that beyond a certain dosage, they don’t provide additional benefit. Exceeding the recommended dose may not relieve your pain and may increase your risk of serious side effects.

Acetaminophen

Acetaminophen is usually recommended as a first line treatment for mild to moderate pain, such as from a skin injury, headache or musculoskeletal condition. Acetaminophen is often prescribed to help manage osteoarthritis and back pain. It may also be combined with opioids to reduce the amount of opioid needed.

• Brand names. Acetaminophen (Tylenol, others)
• How it works. Doctors don’t know exactly how acetaminophen works. Some scientists believe there may be a third type of cyclooxygenase, COX-3, that acetaminophen blocks. Acetaminophen doesn’t affect the other two cyclooxygenase enzymes, and it doesn’t target inflammation — only pain. It may be less effective than NSAIDs.
• Benefits and risks. Acetaminophen is generally considered safer than other nonopioid pain relievers because it doesn’t cause side effects such as stomach pain and bleeding. However, taking more than the recommended dose — or taking acetaminophen with alcohol — increases your risk of kidney damage and liver failure over time.
• Bottom line. Acetaminophen is generally a safe option to try first for many types of pain, including chronic pain. Ask your doctor for guidance about other medications to avoid while taking acetaminophen. Acetaminophen is not as effective as NSAIDs for the treatment of knee and hip pain related to osteoarthritis.

COX-2 inhibitors

These medications were developed with the aim of reducing common side effects associated with traditional NSAIDs. COX-2 inhibitors are commonly used for arthritis and pain resulting from muscle sprains, strains, back and neck injuries, or menstrual cramps. They are as effective as NSAIDs and may be the right choice if you need long-term pain control without increased risk of stomach damage.

• Brand names. Celecoxib (Celebrex)
• How they work. COX-2 inhibitors, another type of NSAID, work slightly differently from traditional NSAIDs. A COX-2 inhibitor blocks only the COX-2 enzyme — the one that’s more likely to cause pain and inflammation.
• Benefits and risks. COX-1 enzymes help protect the lining of your stomach. NSAIDs, which block COX-1, can cause side effects such as stomach pain and bleeding. COX-2 inhibitors, on the other hand, help keep the stomach protected by acting only on COX-2 enzymes, allowing COX-1 to function normally.

• Although the risk of stomach bleeding is generally lower if you take a COX-2 inhibitor instead of an NSAID, bleeding can still occur, especially at higher doses. These medications may cause side effects, such as headache and dizziness, and can lead to kidney problems, fluid retention and high blood pressure.

• Bottom line. Older adults may be at higher risk of common COX-2 side effects compared with younger adults. If these medications help you manage chronic pain, aim to take the lowest effective dose for the shortest time possible, and follow up closely with your doctor.

What Are Corticosteroids?

Prescription corticosteroids provide relief for inflamed areas of the body by easing swelling, redness, itching and allergic reactions. Corticosteroids can be used to treat allergies, asthma and arthritis. When used to control pain, they are generally given in the form of pills or injections that target a certain joint. Examples include: prednisone, prednisolone, and methylprednisolone.

Prescription corticosteroids are strong medicines and may have serious side effects, including:

• Weight gain and salt retention
• Peptic ulcer disease
• Mood changes
• Trouble sleeping
• Weakened immune system
• Thinning of the bones and skin
• High sugar levels

To minimize these potential side effects, corticosteroids are prescribed in the lowest dose possible for as short of a length of time as needed to relieve the pain.

The impact of chronic pain

Chronic pain can have an enormous impact on people. It may interfere with a person’s sleep patterns, their sexual activity, their ability to work and conduct daily activities, and it can cause emotional distress and lead to serious mental health problems, including depression.

The goals of pain treatment are to enhance functioning and reduce suffering and distress, while minimising the risk of adverse effects. While it is rare to eliminate chronic pain completely, it should be possible to control pain to a tolerable level and allow people to function at an acceptable level.

While acute pain can usually be attributed to an identifiable disease or damage process, finding an identifiable process for chronic pain can be very difficult. Sometimes the cause of the pain cannot be determined. This does not make the pain any less real to the patient.