Opioid abuse is an epidemic, the U.S. Centers for Disease Control and Prevention reports, killing 40 a day and ensnaring millions more in a pattern of abuse and addiction. At the same time, chronic pain is hurting the quality of life of some 100 million Americans — more than heart disease, cancer, and diabetes combined, a study published in the Journal of Pain estimates. If you suffer from chronic pain, understanding how to recognize, treat, and manage your pain as early as possible may relieve not only the pain, but also the anxiety that goes along with it.
Like heart disease and diabetes, chronic pain is a complex disease that needs to be managed with medications, lifestyle changes, and often psychological help. And like many chronic diseases, the sooner you treat pain, the sooner you can reverse or manage the damage that’s already been done.
When it comes to treating pain with drugs, almost all pain experts agree that cancer pain and pain from severe acute injuries or surgeries are best treated by opioids, but there are so many factors that determine which patients are good candidates for which treatments.
It is estimated that 10 percent to 15 percent of people treated with opioids can get addicted, and many millions more without chronic pain misuse the drugs recreationally. Even people who don’t get addicted to drugs get physically dependent because the body becomes habituated. While opioids are effective in nearly everyone for acute inflammatory pain, for chronic pain, maybe a third of people will get long-term benefits, and not all of those people will get a functional benefit, meaning other medications might be more effective.
Picking a Chronic Pain Treatment Plan
Before a pain specialist can decide the best course of action for you, he or she needs to take a comprehensive history of when and how your pain started, how long it’s lasted, and how you’ve been treated it so far.
Here are some general treatment categories to know the next time you talk to your doctor:
Acetaminophen: The active ingredient in Tylenol, over-the-counter acetaminophen is one of the most commonly used pain relievers, and a first-line treatment recommended by the American College of Rheumatology.
Nonsteroidal anti-inflammatory drugs (NSAIDs): Another first-line treatment, NSAIDs are slightly more powerful than acetaminophen and available over-the-counter in lower doses and by prescription for higher doses. NSAIDs include anti-inflammatory drugs, such as naproxen (the active ingredient in Aleve), and ibuprofen. They can be used in conjuction with opioids, making opioids more effective and reducing the necessary opioid dosage. But NSAIDs are also not without risks. When you reach a certain age, people become much more likely to develop complications with NSAIDs. Organ toxicity, kidney or liver failure, ulcers. Opioids don't have those risks.
Serotonin and norephinephrine reuptake inhibitors: Anti-depressants that inhibit both serotonin and norephinephrine are first-line treatments for nerve pain, such as diabetic neuropathy, and muscular and skeletal pain. Anti-depressants that are also approved for anxiety can help also help people sleep, and they don't have the downsides of opioids.
Cortiosteroids: Steroids, such as prednisone, inhibit injured nerves, Cohen explains. The problem is, the pain returns once you stop taking them and they may actually accelerate joint destruction.
Topical medications: Lidocaine and capsicin are two examples of topical creams that can treat localized pain, either as a one-time treatment or part of a regular pain-soothing treatment plan. The downside is these drugs only work for pain in one area, not total-body pain.
Injections: There are lots of different kinds of injections, including nerve, epidural, trigger point, and radiofrequency injections, which work for regional or local pain. Steroids and other types of drugs can also be administered through injections. The conditions injection can treat are as varied as the injections themselves. Arthritis, acute injuries and muscle pain, myofascial pain syndrome, headaches, and more can all respond favorably to injections. However, they're not good for someone with the total-body pain that comes with conditions such as fibromyalgia or diabetic neuropathy.
Neurostimulators: An acute treatment that is FDA-approved for back, neck, arm, or leg pain, neurostimulation uses implanted electrodes to interrupt nerve signals and provide pain relief. However, this type of treatment is not a cure for what's causing the pain; instead, it simply masks pain signals before they reach the brain. Some types of stimulation, including sphenopalatine ganglion stimulation, are going through clinical trials to evaluate their effectiveness for treating headaches, including cluster headaches.
Massage, acupuncture, and other alternative therapies: Often combined with traditional drug therapy, acupuncture, acupressure, spinal manipulation, and more can be effective, safe, and side-effect free, particularly when more conventional treatments have not helped. Alternative therapy seems to be more effective than not having any treatment and in some cases, may work as well as medications.
Exercise and physical therapy: Study after study has shown that gentle exercise can improve functionality and mobility in people with many kinds of chronic pain. Gentle movements such as tai chi and yoga have been shown to improve chronic back and joint pain, arthritis, fibromyalgia, and other conditions.
On the whole you can't say clear-cut things about who should be treated with which drugs, or which alternative and complementary treatments. The key is talking to your doctor to find a plan that works for you.
For more information on pain management, contact Comprehensive Pain Management in Attleboro, MA.