How is chronic pain treated?

Depending on the source of your pain and the diagnosis for your pain and whether we can make a diagnosis, we may start with short term pain

management medicines. [MUSIC PLAYING]

Chronic pain is treated in numerous different ways with numerous modalities. Here's a case where we look at everything that's

in our little black bag and we put it on the table and see what works best for an individual patient

in an individual situation, ideally with a proper diagnosis. I can't overemphasize the importance

of a proper diagnosis. But many times chronic pain is idiopathic. That means we don't really know the cause of the pathology

or the cause of the problem. And then in many cases we're really doing a shotgun approach to see what works best for you.

In most cases, your doctor probably will start with a complete history and physical and try to evaluate when did the pain start, what makes

it better, what makes it worse. Your doctor is also going to try to get you to quantify the pain so on a scale of 1 to 10,

with 10 being childbirth. How does this pain compare? And in many cases, people have pain

that's worse than childbirth. And that's going to get a lot more attention than pain that a patient says is a two or a three.

Depending on the source of your pain and the diagnosis for your pain and whether we can make a diagnosis, we may start with short term pain

management medicines. This may include over-the-counter medicines, such as acetaminophen or non-steroidal anti-inflammatory

drugs. That's your ibuprofen, your naproxen, et cetera. But then we may go to prescription pain medications

in the non-steroidal anti-inflammatory category. We have celecoxib or Celebrex, which is a COX-2 inhibitor.

The advantage of that medication is that it does not cause as much of the gastrointestinal side effects as over-the-counter non-steroidal anti-inflammatory

drugs. Steroids can be very useful. And then, of course, we have much stronger pain medications,

which is the whole class of narcotics or opioids. And I don't want people to be afraid of them if they need them.

The irony is many doctors are afraid of patients getting addicted to pain medicines. But the truth is most patients with severe chronic pain

problems are not taking enough pain medication. Another class of medication I want to address is the whole issue of antidepressants.

I do not want people to feel that if your doctor recommends an antidepressant for pain management

that that's because he thinks it's all in your head, all right. It just happens that antidepressant medications also

work very well for the treatment of chronic pain, usually at much lower doses than you would require for the treatment of depression.

And that's because of the mechanisms and the neuronal pathways that these medications work on. Very similarly, anti-seizure medicines

may have some benefit in certain pain conditions. And then for some pain conditions such as fibromyalgia, there are drugs

that are specifically approved to treat that condition. Many people with chronic pain also have problems with sleep.

So if you have disrupted sleep, that can also exacerbate the problem and talk to your doctor about sleep medications, which may help you.

In some conditions, especially in women, we find that the level of chronic pain may vary according to the menstrual cycle.

If that's the case in your situation, we can stop your periods altogether. Or we can eliminate the hormonal variation

using hormonal products, particularly birth control pills, whether or not you need contraception.

And then finally for severe cases of spinal pain and other kinds of pain, there are all kinds of injections that pain management specialists can

offer with and without steroids to try to control the pain. In many cases, we turn to invasive therapies

such as surgery, which can be very helpful in some cases but can actually worsen the pain in some cases.

So we're very careful to do as little invasive surgery as possible.

In addition your doctor will talk to you about all kinds of complementary therapies from acupuncture to massage therapy, hydrotherapy, et cetera.

And many of these modalities are very helpful. Usually not alone as standalone therapies but as

part of a comprehensive pain management program. [AUDIO LOGO]