There are many different treatment options for chronic pain management. A person may use a variety of different treatments for chronic pain.

Medications for Chronic Pain

There are many medications available to treat chronic pain. Finding the right medication may take several tries. It is not uncommon for a medication to lose effectiveness over time. Medications options include:

  • Acetaminophen (Tylenol)
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin (Bayer) and ibuprofen (Advil)
  • Anticonvulsants, such as pregabalin (Lyrica)
  • Antidepressants, such as duloxetine (Cymbalta, Irenka)
  • Muscle relaxants, such as baclofen (Gablofen, Lioresal) for long-term use, and diazepam (Valium, Diastat) for short-term
  • Naltrexone (Revia, Vivitrol)
  • Opioids, such as morphine or hydrocodone (Vicodin)

See Types of Opioids

Some of these medications, such as acetaminophen and NSAIDs, are available over the counter, while others require a prescription.

Opioid prescriptions are carefully monitored

There is an opioid epidemic in the United States. Opioids have a place in chronic pain management; however, these medications must be used with caution and with appropriate monitoring. They should only be used when they provide demonstrable benefit, such as decreased pain perception and increased daily function.

See When Are Opioids Appropriate?

Doctors will also look for problems, including:

  • Dose acceleration
  • Pill diversion
  • Addiction

This is done for the benefit and safety of the person being prescribed opioids.

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Topical Options for Chronic Pain

There are also topical medications that can be applied directly to the skin, including:

  • Capsaicin (Capzasin)
  • Counterirritants (Icy Hot, Gold Bond)
  • Lidocaine/lidocaine patches (Lidoderm, Xylocaine)
  • Trolamine salicylate (Aspercream, Myoflex)

See Non-opioid and Topical Medications for Chronic Pain

Topical medications are available over-the-counter, with a prescription, and some can be made at home. They should be tested on a small area of the skin before applying to a larger area.

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Interventional Pain Management for Chronic Pain

Interventional pain management is the broad term for treatments that are generally more invasive and include:

  • Injections, which deliver steroid medication, pain numbing medication, or a saline solution directly to the source of pain.
  • Spinal cord stimulation surgery, which involves the implantation of a device in the body. The device delivers a mild electric current to the spinal cord to stop pain signals from reaching the brain.

See Interventional Pain Management for Chronic Pain

Injections and spinal cord stimulation surgery do not eliminate the source of pain, which means the degree of relief achieved will vary from person to person. These treatments may not work for everyone.

Complementary Health Approaches for Chronic Pain

Complementary health approaches generally take in to consideration physical and mental components of a person. Some of the most common approaches include:

  • Chiropractic
  • Acupuncture
  • Yoga
  • Tai Chi
  • Massage Therapy

See Treating Chronic Pain with Acupuncture

As with all approaches, complementary health may not work for everyone; however, there are few, if any, side effects or risks.

Pain Management Psychology

A pain management psychologist, or similar mental health professional, uses a number of techniques to help a person develop strategies for decreasing suffering and improving quality of life, even with chronic pain. Techniques may include the following:

  • Biofeedback
  • Cognitive behavioral therapy (CBT)
  • Self-hypnosis
  • Deep breathing exercises
  • Guided imagery
  • Mindful meditation
  • Progressive muscle relaxation

See Treating Chronic Pain with Mind-Body Medicine

Seeing a pain management psychologist does not mean the pain is not “real.” All pain is experienced in the brain, and how a person perceives it is impacted by thoughts and emotions. Pain management psychologists help a person decrease the perception of pain signals in the brain, leading to less suffering and improved quality of life.

Medical Marijuana and CBD May Help with Chronic Pain

Marijuana, also called cannabis, is considered by many in the medical community as a treatment for chronic pain.1 While it has not been approved by the Food and Drug Administration (FDA) for this purpose, it has been legalized by numerous states. States’ legalization laws have led to an increase in the number of doctors who are familiar and willing to consider it as a treatment option.

See Complementary Health Approaches and Marijuana for Chronic Pain

Many patients are reluctant to investigate marijuana as a pain-reliever due to the “high” and stigma associated with it. There are two natural compounds found in marijuana (cannabis): cannabidiol (CBD) and tetrahydrocannabinol (THC). THC causes the “high” whereas CBD does not. Research is just now beginning to explore the potential pain-relieving properties of CBD alone without the “high” associated with THC compounds.2-4

Diet and Exercise Play a Role in Chronic Pain

Ample exercise and eating a plant-based diet are good habits for everyone, especially people with chronic pain.

See Using Diet and Exercise to Treat Chronic Pain

Exercise can prompt weight loss, improve sleep, and reduce stress. Generally, people with chronic pain will focus on low-impact exercises, such as walking and swimming.

A plant-based diet that emphasizes leafy greens, whole grain, fish and fruit can help decrease inflammation, which is often associated with chronic pain. Avoiding processed food and red meat can also help fight inflammation.

Chronic pain is challenging to live with. The right health care provider, mindset, and treatment can help manage it.

References:

  1. National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division, Board on Population Health and Public Health Practice, Committee on the Health Effects of Marijuana: An Evidence Review and Research Agenda.
  2. Xiong et al. (2012). Cannabinoids suppress inflammatory and neuropathic pain by targeting a3 glycine receptors. Journal of Experimental Medicine, 209, 1121-1134.
  3. Russo, E.B. (2008). Cannabinoids in the management of difficult to treat pain. Therapeutics and Clinical Risk Management, 4, 245-259.
  4. Hammell et al. (2016). Transdermal cannabidiol reduces inflammation and pain-related behaviours in a rat model of arthritis. European Journal of Pain, 20, 936-948.
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