Pain management specialists use a range of techniques and treatments to address pain. These techniques can be generally grouped as:
- Nonsurgical, non-drug pain management
- Pain management using medications
- Interventional pain management
Examples of each type of pain management are provided below.
Nonsurgical, Non-drug Pain Management
Many pain management programs begin with noninvasive and non-drug treatments. Programs may include:
- Physical therapy to increase strength and flexibility through exercise, posture awareness, and improved body mechanics, thereby correcting secondary problems caused by pain.
- Spinal and/or extremity joint manipulation to increase range of motion and improve function of the involved joint. This is often performed by healthcare providers with special training such as doctors of chiropractic (DC), doctors of osteopathy (DO), as well as some medical providers and physical therapists.
- Transcutaneous electric nerve stimulation (TENS) therapy, which can interfere with the body’s pain signals by transmitting a mild, painless electrical current through the skin to the source of pain.
- Behavioral modification, which teaches certain techniques to distract from or change how the body perceives pain.
- Biofeedback to help an individual control physiological responses to pain.1
- Superficial heating or cooling of skin, such as using heating pads or ice massage.
- Massage therapy to manipulate soft tissue. 2
- Acupuncture, which uses extremely thin needles inserted into specific points of the body.3
- Mindful meditation, particularly when used in tandem with other pain management treatments.4
- Movement therapy, such as yoga and tai chi.
Patients are advised to consult with a pain management specialist or other health care provider before beginning any of the techniques.
Pain Management Using Medications
A pain management specialist can prescribe a range of medication for the treatment of pain, such as:
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, block the chemical cascade that leads to pain and inflammation in the body.
- Muscle relaxants act as central nervous system depressants. Certain muscle relaxants serve specific purposes, and a pain management specialist is prepared to prescribe the best fit.
- Antidepressants have proven effective in managing certain types of chronic pain, whether an individual has depression or not. Exactly how antidepressants work in the management of pain is unknown.5
- Antiseizure medications can treat nerve damage (neuropathic) pain by interfering with overactive transmission of pain signals to the brain.
- Topical medications can address focal superficial sources of pain.
- Opioids change the perception of pain by weakening pain signals in the brain. Opioids are very effective in controlling severe acute pain and can be used in the management of chronic pain, usually as part of polypharmacy regimen.
In general, opioid use is carefully monitored to avoid development of addiction disorder.
Interventional Pain Management
Interventional pain management refers to the use of injectables (often called nerve blocks) and devices placed into the body for pain relief. Examples are described below.
- Joint, muscle/tendon and peripheral nerve injections are often performed in the office with different medications under ultrasound guidance.
- Epidural steroid injections are used to reduce nerve inflammation and pain in the spine. This is an outpatient procedure with minimal recovery time.
- Radiofrequency ablation uses electrical current (radiofrequency waves) to heat up nerve tissue in the area where pain is experienced. Heating will destroy the nerve and disrupt pain signals coming from that area. This is an outpatient procedure using a fluoroscope and needle electrode.
- Intrathecal pain pumps are devices implanted under the skin that deliver small amounts of pain medication via catheter into a spinal fluid. A pain management specialist will program the device specific to a person’s needs.
- Electrostimulation implants are small devices that produce mild electrical pulses to interfere with pain messages reaching the brain. These devices are implanted inside the body, along the nerve pathways to bypass the source of pain. Most implants can be turned on and off with an external controller.
Which interventional treatment, if any, is recommended depends on the type, severity, and location of pain. For some people, interventional treatments can offer long-term pain relief without having to regularly take medication.