Treatment of Pain

 

There are many treatment options for pain, but treatment of pain needs to be customized for each individual because the effects of medications and therapies can vary widely from person to person. The following is a general list of treatment options that can eliminate or control acute and chronic pain:

 

1. Pharmacological Therapy (Medication) options include:

-Nonopioid pain relievers (e.g. aspirin and ibuprofen)

-Opioids (e.g. vicodin and morphine)

-Adjuvant medications (drugs whose primary purpose is not for pain but rather for

other conditions; e.g. antidepressants and anticonvulsants)

-Topical treatments (drugs that are applied directly to the skin)

 

2. Non-Pharmacological Treatment options include:

            Less invasive options:

-Physiatric Approaches

-Non-invasive Stimulatory Approaches

-Psychological Approaches

-Alternative Approaches

 

More invasive options:

-Anesthesiologic Approaches

-Invasive Stimulatory Approaches

-Surgical Approaches

 

Non-pharmacological treatments do not rely on medication(s) to alleviate pain. However, in most cases, these techniques should be used in addition to pharmacological approaches of pain relief.

 

Below is a more in-depth discussion of the non-pharmacological treatment options:

 

Physiatric Approaches:

1. Therapeutic Exercise options help:

- Strengthen weak muscles

- Mobilize stiff joints

- Restore coordination and balance

- Promote a sense of well-being

- Decrease anxiety and stress

- Maintain an appropriate weight

 

2. Heat Therapy

 

- Heat therapy reduces pain, especially pain from muscle tension or spasms. Heat helps with pain because heat increases the blood flow to the skin, dilates blood vessels, increasing oxygen and nutrient delivery to tissues, and decreases joint stiffness by increasing muscle elasticity.

 

3. Cold Therapy

 

- Cold therapy constricts blood vessels near the skin and helps relieve the pain of muscle tension or spasms. It also helps reduce the swelling of an injury.

 

Non-Invasive Stimulatory Approaches:

1. Transcutaneous Electrical Nerve Stimulation (TENS): a method of applying a gentle electric current to the skin to relieve pain. It is a small box-shaped device that patients can put in their pocket and it transmits electrical impulses through wires to electrodes taped to the skin in the painful area. However, TENS can become less effective at relieving pain over time.

 

 

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Psychological Approaches:

1. Cognitive Behavioral Techniques

-Deep breathing – the patient focuses on breathing deeply. This may shift

attention away from the pain.

-Progressive muscle relaxation – patients contract, then relax, muscles

throughout the body, group by group. This helps patients relax the muscles in their body.

-Imagery – patients focus on pleasant thoughts, such as waves crashing

onto a beach. The patient may also be told to think of an image that represents pain and then imagine it changing into an image representing a pain-free state.

-Meditation – the individual aims to empty the mind of thoughts and focus

on breathing and the rhythms of the body.

-Biofeedback Therapy – individuals learn to reduce their body’s

unproductive responses to stress which decreases their sensitivity to pain.

-Distraction – a pain management technique in which patients focus their

attention on something other than their pain and negative emotions,

by doing thing such as singing, listening to music, watching TV, or

talking to friends.

2. Psychotherapy and Social Support

-Psychotherapy: a one-on-one approach that may be useful for anyone whose pain is difficult to manage, who has developed clinical depression, or who has a history of psychiatric illnesses. The goals of psychotherapy include teaching new coping skills, establishing a bond to decrease patient’s sense of isolation, and fostering a sense of self-worth.

-Group Approaches: an approach where individuals with the same conditions get to together for support. This approach helps the patient maintain a social identity and shows the patient how others are coping.

 

Alternative Approaches:

1. Acupuncture: an ancient method for relieving pain and controlling disease. Thin metal needles that are gently twirled for ten to twenty minutes can be used to stimulate acupuncture points, which relieve pain in specific parts of the body. It is effective for some patients with chronic pain.

2. Massage: works by stimulating blood flow, relaxing muscles that are tight or in spasm, and promoting a feeling of well-being. Massage should not be used on swollen tissue.

 

 

The following three approaches are typically reserved for patients who don’t respond to the previously discussed conservative therapies.

 

Anesthesiologic Approaches:

1. Nerve Blocks: to achieve a block, the doctor usually injects a local anesthetic

in the nerve(s). Although this is called a temporary block, the pain relief can last for a long time. In specific cases, the doctor can inject a solution that damages the nerve and produces a more permanent block.

2. Epidural Steroid Injections: can relieve pain by inhibiting the impulses that travel along specific nerves in the body. Epidural Steroids are administered through an injection and can help interrupt the passage of painful impulses through nerves.

 

Invasive Stimulatory Approaches:

1. Invasive Nerve Stimulation: electrodes are implanted in the patient’s body to send a gentle electrical current to nerves in the spinal cord or the brain.

 

Surgical Approaches:

1. Surgery: used in cases where all other approaches have failed. A surgeon can cut a nerve close to the spinal cord or bundles of nerves in the spinal cord to interrupt the pathways that send pain signals to the brain. In most cases, surgery relieves pain and the need for pain medication.