This comprehensive guide will take you through pain management options and techniques for chronic pain, helping you make the best choices.
Chronic pain is defined as pain that lasts longer than three months, and the latest statistics show that it affects around 20.5% of the world's population – that’s around 1.5 billion people!
When we see medical professionals about our pain, typically this consists of brief appointments every few months. Meaning that the majority of managing your pain is done at home in your own time.
There is a wide range of ways that you can manage and reduce your pain, increasing your level of functioning and getting your quality of life back. This in-depth study explains that “With effective self-management, the patient can monitor his or her condition and make whatever cognitive, behavioral, and emotional changes are needed to maintain a satisfactory quality of life.”
If you haven’t had the opportunity to see a pain specialist or build a pain management plan, don’t despair – this guide is designed for you!
Pharmaceutical
Over-the-counter treatments
There are painkillers and non-steroidal anti-inflammatories (NSAIDS) which are available over the counter. Depending on your diagnosis and the severity of your symptoms, these may be able to reduce your pain. A wide range of topical creams and gels are available which produce a tingling, cooling, or warming sensation; these can be applied to painful areas and interrupt pain messages to bring short-term relief. Topical treatments can be particularly helpful to reduce pain enough to drift off to sleep.
Pros
- Easily accessible
- Reasonably priced
- Can ease symptoms
Cons
- Don’t work for everyone
- Only work in the short term
- NSAIDS can have side effects on the body
Prescribed Medications
Your doctor may prescribe you medications to help you deal with your pain. Your options could include:
- Painkillers - Your doctor may offer you stronger painkillers than you can access over the counter. These are often opioids, or you may have heard of them referred to as narcotics.
- Non-Steroidal Anti-Inflammatories (NSAIDS) - Stronger NSAIDS are available on prescription. These can help reduce pain as well as inflammation.
- Steroids - Corticosteroids may be offered in the form of tablets or injections directly into the painful area. Steroids work by preventing your body from producing the chemical which causes inflammation.
- Antidepressants - Three types of antidepressants are available which are thought to help with chronic pain. Tricyclic antidepressants (TCAs) raise levels of certain chemicals in your brain, which is thought to help with chronic pain. This study explains that TCAs, “inhibit the reuptake of serotonin and norepinephrine at the synapse”
Serotonin is a chemical in your body that contributes to your general sense of happiness and well-being, as well as playing a part in regulating various processes within your body. Serotonin and norepinephrine reuptake inhibitors (SNRIs) affect how your brain absorbs and processes neurotransmitters. Selective serotonin reuptake inhibitors (SSRIs) affect how your body absorbs serotonin as this study states: “(SSRIs) exert their efficacy predominantly through the reuptake inhibition of serotonin.”
- Anticonvulsants - You might also hear these described as anti-seizure medications. They are thought to help manage pain by suppressing pain messages. More research needs to be done into the science behind the use of both antidepressants and anticonvulsants to treat chronic pain, as this study discusses.
Pros
- May reduce pain
- Antidepressants can help treat the mental health issues that often come with chronic pain
Cons
- Many prescribed medications have side effects such as weight gain, heart problems, sexual dysfunction, nausea, dizziness, etc.
- Can be addictive
- Many require slow tapering over time to stop taking them
- Don’t work for everyone
- Don’t usually eliminate all symptoms, rather just reduce them
- Can be trial and error to find a medication that works for you
- Research is lacking on antidepressants and anticonvulsants
If you are offered prescribed medicines, be sure to ask questions and do your research, so you can understand why they are being prescribed and what side effects they have.
It’s important to take your prescribed medications regularly. It can be all too easy to forget to do so when you’re in pain or having cognitive difficulties, like fibro fog in my case. Asking a loved one to remind you to take medications or setting a reminder on your phone can prompt you to take them.
Manual and physical therapies
Massage
Before you begin massage therapy you will typically talk to the therapist about which areas of your body are painful and what you feel comfortable with. During the massage the therapist will use varied pressure on specific areas of your body to help your muscles to relax, providing relief from pain and stress.
Sometimes massage can feel a bit uncomfortable, particularly if your muscles are very tight. If you are worried, talk to your massage therapist. They will be able to reassure you and make the experience as comfortable as possible for you.
Pros
- Can help to relieve pain
- Provides relaxation/reduces stress
- Tailored to your individual needs
Cons
- Can be uncomfortable
- May not be offered readily through your doctor
- Must attend a therapist’s office (need transport)
Physiotherapy
You might have heard physiotherapy referred to as physical therapy. A physiotherapist will work with you to build up your range of movement. They will teach you how to strengthen your body in a way that prevents pain flares. Typically, physiotherapists will carry out passive treatments, meaning treatments in which they do the work. These might involve them manipulating and moving your body to strengthen it and target specific muscle groups.
You will also engage in active treatments, meaning you take an active role while being guided by your physiotherapist. These are often specific strengthening and flexibility exercises. You will usually be given exercises to practice at home, to continue building and maintaining strength.
Pros
- Reduces pain
- Increases range of movement
- Strengthens body
- Tackles fear avoidance
- Increases confidence
- Has long-term results
- Increases level of functioning
- Reasonably easy to access
- Active treatments can be carried out using an online pain therapy program
Cons
- Requires effort and dedication
- Can be uncomfortable at times
- Could cause flares during the learning period
Hydrotherapy
Exercising in water takes the weight off your joints, therefore making movement less painful. Often warm water will be used in hydrotherapy pools to aid relaxation and help with easing pain. You may attend hydrotherapy in a hospital pool or be referred to a specific hydrotherapy center.
If specific hydrotherapy pools are not available, you could use a local pool to join in with an aqua fit class, or use a local spa. Ensure that you are moving at your own pace and speak to instructors beforehand about your diagnosis.
Pros
- Allows you to practice movement with less weight on joints
- Strengthens muscles
- Aids in reducing pain
- Increases mobility
- A heated pool helps with pain reduction during exercise
- Can be relaxing
Cons
- Must travel to a hydrotherapy pool
- Depending on where you live, access to hydrotherapy pools may be limited.
Chiropractors
Often focusing on the back and spine, chiropractors will use firm movements and manipulation to apply pressure and release tension in specific areas. They might manually move your body into different positions and stretch your muscles. Sometimes this can feel uncomfortable, but shouldn’t feel painful.
Chiropractic treatment is thought of as an ‘alternative’ therapy, which means that it might not be offered readily through your doctor, so you may need to ask specifically about this type of treatment or seek it privately.
Pros
- Can help to ease pain
- Can improve mobility/flexibility
Cons
- Not readily available
- Less scientific evidence than many other treatments
- May be costly to seek privately
- Treatment can be uncomfortable
- Can cause aches, pains, and stiffness after treatment
- Must attend a therapist’s office
Osteopaths
Osteopaths physically manipulate areas of the body to promote healing, strengthen muscles, and relieve muscle tension. Osteopathy is based on the concept that all of the muscles and tissues within your body need to work together healthily, to bring optimal levels of functioning for the patient.
Pros
- Can help to relieve muscle tension
- Can increase mobility
- Thought to promote healing
Cons
- Less scientific evidence than many other treatments, especially for chronic pain
- Not readily available
- Costly to seek privately
- Can be painful during and after treatment
- Must attend a therapist’s office
Acupuncture
During acupuncture, very fine needles are inserted into specific areas of the body, typically while you lie still in a calm atmosphere. The needles stimulate the nerves just below the skin. Research suggests that this works by encouraging the body to produce pain-relieving chemicals.
Acupuncture shouldn’t feel painful; it should be a relaxing and pleasant experience. It’s thought of as an ‘alternative’ therapy, so it isn’t often prescribed by doctors. You can seek it privately or by asking your doctor or specialist specifically about acupuncture.
Pros
- Not painful
- Can reduce pain
- Regular treatment can provide long-lasting pain relief
- Can be relaxing
Cons
- Not readily available
- Can be costly to seek privately
- Must attend a therapist’s office
Precision Pain Care and Rehabilitation has two convenient locations in Richmond Hill – Queens and New Hyde Park – Long Island. Call the Queens office at (718) 215-1888, or (516) 419-4480 for the Long Island office, to arrange an appointment with our Interventional Pain Management Specialist, Dr. Jeffrey Chacko.
