Treating Chronic Pain

Pain Treatment Team

Developing the right treatment for your diagnosis is often the work of a multidisciplinary team of medical professionals. This team may include pain specialists, clinical psychologists, physical therapists, spine surgeons, neurosurgeons, oncologists, clinical nurse specialists, and various consultants (for example, specialists in general surgery or internal medicine). This team develops a care plan and then works together to deliver treatments appropriate to your needs.

Steps To Relieving Your Pain

Pain relief is personal, and treatments vary from one individual to the next. The choice of treatment depends on the type and severity of pain, and how you respond to your pain therapy. The following are explanations of therapies your doctors may consider when treating chronic pain.

Drug therapy is often the first therapy doctors use in managing chronic pain. Initially, patients usually try common oral pain relievers (pills) such as aspirin, acetaminophen, and non-steroidal anti-inflammatory drugs (NSAIDs). Some of these medications are available without a prescription, while others require a prescription from your doctor.

If these medications do not control your pain, your doctor may try opioids. Opioids either replace or combine with what you have been taking. Weak opioids such as codeine are usually given orally (as pills). Strong opioids such as morphine or fentanyl are commonly given orally, but they can also be given through skin patches (fentanyl only), suppositories, or via an external infusion system. Some people with chronic pain may worry about becoming addicted to these medications. However, studies show that addiction is rare for chronic pain patients who take these medications.

Doctors combine other types of drugs with pain relievers. These drugs include anti-inflammatory steroids, anticonvulsants, and antidepressants. While pain relief may not be the primary purpose of these drugs, they are still effective treatments for specific types of pain. For example, your doctor may prescibe antidepressants to help relieve certain types of neuropathic pain. Your presciption is for pain and doesn't necessarily mean your doctor thinks you are depressed. Similarly, steroids often are effective in relieving pain associated with inflammation.

Because each person is unique and responds to medication differently, doctors may try a variety of doses and drug combinations to determine what is most effective. The exact choice of treatments depends on the type of pain, how bad it is, and how your pain responds to that treatment method.

Physical therapy can be passive or active. Passive therapies such as massage and applying heat and cold are typically effective in relieving pain only in the first two to four weeks after an injury. Patients typically do active physical therapies such as exercise and posture/gait correction for up to 12 weeks. These active physical therapies help people with chronic pain build or recondition muscles so they can function more normally.

Psychological therapy. Chronic pain can be stressful in that it strains relationships and affects your ability to work or take part in other daily activities. In addition, you, your family members, and significant others bring a unique mix of feelings, expectations, beliefs, personality traits, experiences, support systems, and skills to treatment. Psychological therapy can help you sort through this unique mix and reduce the stress of chronic pain. Often psychologists work with people on relaxation techniques, coping mechanisms, and self-monitoring skills.

Corrective surgery is appropriate for certain people with chronic pain. A doctor can do diagnostic tests, such as an MRI or a CT scan, to find out if structural problems such as herniated discs or pinched nerves are causing pain. If surgeons find a problem, they may then perform the appropriate procedure to relieve the pain.

Therapeutic nerve blocks are injections at the site of pain of a local anesthetic and/or steroids. These injections affect the nerve that serves the painful area. Nerve blocks typically achieve temporary pain relief. Some people may benefit from a single nerve block, while other people with more complex pain conditions may require several blocks. If nerve blocks do not manage your pain within four to six months, your doctor often considers other pain treatments.

Medtronic Pain Therapies include two types of pain relief therapies:

• Neurostimulation uses a small neurostimulation system that doctors surgically place under the skin to send mild electrical impulses to the spinal cord. The electrical impulses travel through a lead (a special medical wire) that is also surgically placed. These electrical impulses block the signal of pain from reaching the brain. Peripheral nerve stimulation works in a similar way, except doctors place the lead on the specific nerve that is causing pain rather than near the spinal cord.
  
  
• Intrathecal drug delivery uses a small pump that doctors surgically place under the skin of the abdomen. The pump delivers morphine directly to the fluid around the spinal cord (this fluid is in the intrathecal space). The medication travels through a small tube called a catheter that is also surgically placed.

Neuroablation. When other treatments fail, doctors may use heat or chemicals to sever the nerves that serve as pathways for the pain. Neuroablation is the destruction of these nerves. Neuroablation may be permanent, or the nerves may grow back in time. Doctors usually use neuroablation only as a last resort.

1. Lamer TJ. Treatment of cancer-related pain: when orally administered medications fail. Mayo Clin Proc, Vol69, May 1994.