Pain is your body telling you that you have hurt it. This is a good thing, important when you are injured. It can also help diagnose problems with your body. Sometimes pain continues long after it's necessary. Amputees report phantom pain in the legs or arms they no longer have.

There are different kinds of pain, and describing the type is useful in diagnosis: recurring, constant, steady, knife-like, radiating, sharp, dull. Medicines that dull pain are analgesics. Those that kill all feeling are anesthetics.

Pain

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Your Mental Health Could Be Causing Physical Pain

To Manage Your Chronic Pain

Organize your pain management plan around these 7 pain relief strategies.

Chronic Pain 101

7-Step Chronic Pain Management Plan

When Back Pain Isn't Caused by Your Back 

More Symptom Information

What's Making You Hurt?

No matter what type of pain you suffer from, experts stress that relief is possible&mdash;and it&rsquo;s critical for your health and wellbeing to <a href="https://www.sharecare.com/health/chronic-pain-treatment">treat your pain</a>&nbsp;and not suffer in silence. We&rsquo;ve gathered the info that will put you in control.

The Three M's for Relieving Chronic Pain 

Feel Better!

An Anti-Inflammatory Diet Plan

Diana Meeks

Sigma Nursing

You are only at risk for postherpetic neuralgia if you have had shingles; having had chicken pox puts you at risk for shingles. However, age can further increase your risk of developing the condition. On average, only one in ten people who have had shingles develop postherpetic neuralgia following an outbreak. But that risk increases as high as 50 percent for those who are over the age of 50. If you are 50 or older, you can lower the risk by having the shingles vaccine for the varicella-zoster virus, even if you have had chicken pox or shingles in the past.

What increases my risk for postherpetic neuralgia?

JUMO ADMIN

Jumo Health

Chronic pain means the pain lasts longer. It doesn&rsquo;t go away, or it goes away for a while and then comes back. &quot;Chronic&quot; means something going on for a long time. Chronic pain starts the same way as any other pain, but if the injury doesn&rsquo;t heal, the danger receptors keep sending messages to the brain, and the brain keeps sending pain messages back. The nerves become sensitive to make sure the messages get through easily, but if this goes on for too long, the nerves can become hypersensitive. This means they send damage messages to the brain, even when the injury has healed. This fools the brain into sending pain messages. This means that you can feel pain even when the injury has healed. In chronic pain, the messages are delivered non-stop to the brain. This means the pain never lets up.

What causes chronic pain?

RealAge Admin

RealAge

Manage your chronic pain better by dispelling common misconceptions: 
 
Pain always has an underlying cause. 
Fact: Pain sometimes travels alone. 
Not all chronic pain can be linked to an identifiable physical condition or injury. Sure, that fender bender 3 months ago might have triggered your back pain, or maybe too many hours on the soccer field caused your knee pain. Or maybe not. Sometimes pain develops for no apparent reason. Still, the discomfort is very real. Although it&#39;s more difficult to relieve pain without an identifiable cause, you can effectively manage it. 
 
Medication is the only way to relieve chronic pain. 
Fact: Pain has many enemies. 
When we think pain relief, we often think pills&mdash;whether over-the-counter or prescription pain medication, or even stronger and potentially addictive opioids for more severe pain. But pills aren&#39;t the only way to manage pain. You can add an array of alternative weapons to your arsenal, including a healthier diet, exercise, sound sleep, and simple self-care remedies. 
 
Chronic pain is an inevitable part of aging. 
Fact: Pain can strike at any age. 
The notion that you should expect pain as you age&mdash;and learn to live with it&mdash;is an ongoing myth about growing older. One example: Back pain more commonly strikes middle-age (35- to 50-year-old) adults than any other age group. Whatever your age, talk to your doctor about any chronic aches, pains, or discomfort. 
 
Admitting you&#39;re in pain is a sign of weakness. 
Fact: Acknowledging your pain is a sign of courage and strength. 
It takes courage to accept chronic pain, but doing so is the best first step to treating it. Suffering in silence is no way to cope. 
 
Bed rest is best for reducing chronic pain. 
Fact: Moving through the pain helps improve it. 
When your knee arthritis, achy hip, or lower-back pain flares up, it&#39;s tempting to simply curl up in bed. While your doc may recommend bed rest when pain is especially severe, making it a daily habit will only intensify your discomfort. Even gentle movement or stretching is better for pain relief than grinding to a complete standstill. Plus, regular doctor-approved workouts boost the release of pain-relieving neurotransmitters, such as dopamine and serotonin. 
<a href="http://www.realage.com/landing/entry4?cbr=SHCR10001" target="_blank">Take the RealAge Test!</a>

What do I need to know about chronic pain?

Dr. Mehmet Oz, MD

Over 116 million Americans suffer from chronic pain -- which adds up to more people than those suffering from diabetes, heart disease and cancer combined. It&rsquo;s your number-one health complaint: pain. Four out of five Americans will report back pain at some point in their lives, and pain accounts for more than 20% of all doctor&rsquo;s visits in the United States. This content originally appeared on <a href="http://www.doctoroz.com/videos/7-day-pain-prescription" rel="nofollow" target="_blank">doctoroz.com</a>

How common is chronic pain?

Chronic pain is different than the sensation you feel when you burn your finger or scrape your knee. In contrast to short-lived forms of pain, chronic pain occurs when your nervous system continues to fire pain signals for months or even years after the initial injury. Chronic pain can become worse over time because nerve fibers, like well-trained muscles, learn to deliver pain signals to the brain more effectively. The intensity of the signal increases as your brain becomes more sensitive to the pain message. Some call this the "wind up phenomenon" of chronic pain. This content originally appeared on <a href="http://www.doctoroz.com/videos/understanding-chronic-pain" rel="nofollow" target="_blank">doctoroz.com</a>

How is chronic pain different than short-lived pain?

Phillip Garrison 

National Academy of Sports Medicine

If you have chronic ankle pain it should be evaluated by a medical professional to determine if there is not some type of damage or injury that may require medical attention that exists. Chronic discomfort and tightness can be caused by excessive tightness of certain muscles of the ankle complex, including stretching of the gastrocnemius and soleus complex, as well as foam rolling and self myofascial release of the peroneal complex of the out calf. Hold the soleus and gastrocnemius stretch for 30 seconds per side, and foam roll the Peroneals for 30 seconds to maximize benefits. &nbsp;

What stretches alleviate chronic ankle pain?

When you have chronic pain, it affects your health in other ways besides feeling pain. It stops you from sleeping and makes you tired. It makes it harder to do the things you normally like to do. All these things can make you feel fed up and angry.

How does chronic pain affect my health?

NATA Admin

National Athletic Trainers' Association

Chronic pain is pain that is of long duration and typically occurs from repetitive microtrauma. An example of chronic pain is low back pain. Chronic pain can last from months to years. A previous injury may have caused this lasting pain, or the pain may be undiagnosed. Chronic pain normally does not go away with rest and inactivity, and frequently requires further medical treatment to find the cause. (This answer provided for NATA by the Gustavus Adolphus College Athletic Training Education Program.)

What is chronic pain?

Chronic pain includes headaches, migraines, back pain, arthritis, fibromyalgia and other types of pain that last more than a few weeks. Learn how to manage chronic pain and improve your quality of life.

Chronic Pain

English

Hi, Dr. Oz here with a simple tip to help you beat pain. Stand tall with confidence, act like a peacock spreading its feathers, really take up more space. Assuming an expansive powerful position changes your hormone levels, it boosts testosterone which helps with pain tolerance and decreases cortisol. Standing tall also makes you feel powerful and in control of your pain. 

Here's what I mean, stand up straight, not hunched over like this with your head of your shoulders, hips and ankles. When you sit, choose a chair with arm rest, [xx] your arms wide till your chest opens up. Whether you sit or stand, keep your hand relaxed, don't hesitate to make old gestures, now you are in control of your pain instead of the other way around. 

For more ways to stay strong and live better, stay tuned to watch all of our smart health tips, right here.

Here's a quick tip to relieve pain: Stand taller. Assuming an expansive, powerful position changes your hormone levels, which can fight pain. In this video, Dr. Oz explains how standing taller helps with pain tolerance.

Stand Tall to Relieve Pain

We haven't been able to stop pain completely, but one of the challenges in research, is that we don't want to because there is something about pain that is protective. So people who have heart attacks who have chest pain, they actually survive better than people who don't have chest pains. We actually do want to keep the pain that's protective, but we want to try to minimize the chronic pain that's not protective.

Pain has a protective function in our body, which is why we don't want to stop it completely, says Devi Nampiaparampil, MD, chief of pain management at Veterans Affairs. In this video she explains why doctors don't want to stop pain altogether.

Why Can't We Stop Pain Completely?

All doctors treat pain. If you go to the emergency department because you have a broken bone, or you have stomach ache, or you have some other type of issue like appendicitis, then the doctors there, whether they are ER physicians or surgeons will try to treat that. The times that people go to a pain management specialists are when that type of pain is not responsive to the usual treatment. 

So if you have pain that's not responding to the usual therapies for it like physical therapy or medication or surgery, then you might go to the pain management specialist to see what else can be done.

A pain management specialist can help when your pain doesn't respond to the usual treatments: physical therapy, medication or surgery. In this video, Devi Nampiaparampil, MD, chief of pain management at U.S. Department of Veterans Affairs, explains.

What Can a Pain Management Specialist Do for Me?

Chronic pain is self reported so if the patient comes in saying that they've had pain for three months or more, then we consider them to have chronic pain if they've had the usual treatments for that condition. Somebody has chronic pain for three months but they never sort out treatment and never tried anything, then I wouldn't necessarily categorize it as chronic pain. 

People also often think about coexistence conditions. So if someone has a chronic condition for example arthritis, but it's not really disrupting their life, it's not causing them a problem we wouldn't necessarily say they have chronic pain, they might and then we would agree. But if they say that they have this painful condition that is preventing them from doing the things that they like to do, it's affecting them at work, it's affecting them at home, it's affecting their mood, then we would consider that chronic pain because it's creating distress on the person who has it and it's affecting their life.

Chronic pain is self-reported and lasts for 3 months or longer and hasn't responded to treatment, says Devi Nampiaparampil, MD, chief of pain management at Veterans Affairs. In this video, she explains how the condition affects lifestyle and mood.

How Do You Make a Chronic Pain Diagnosis?

We look primarily at what the characteristics of the pain are, and what the cause of the pain is and then aim the treatments towards that, but generally speaking there are guidelines. So we use the same guidelines for almost everybody but you tailor the therapy towards a particular person and what their goals are. 

If someone has chronic pain then there are different issues because they still have to be able to work, they still have to be able to function maybe they have to be able to drive. So the type of therapy is going to be different because there are a lot of other things that we want to prevent from happening as well.

Effective pain treatment for chronic pain is tailored to the characteristics of an individual patient's pain. In this video, Devi Nampiaparampil, MD, chief of pain management at the U.S. Department of Veterans Affairs, explains the approach.

How Do You Define Effective Chronic Pain Treatment?

Certain types of pain are affected by weight, arthritis is significantly affected by weight. One of the main causes of hip osteoarthritis is weight gain, it accelerates the wear and tear that's associated with arthritis. The second thing is that, if a person loses even one pound of weight it takes off about five pounds of weight during certain movements of the hip, because the hip is functioning as a lever. 

So weight is very important in terms of arthritis pain.

Being overweight significantly affects certain types of pain, especially arthritis pain. In this video, Devi Nampiaparampil, MD, chief of pain management at the U.S. Department of Veterans Affairs, explains the effect of losing just one pound.

If I'm Overweight, Can Losing Weight Help Relieve Pain?

A lot of the things that go along with obesity such as high blood pressure, high cholesterol and other health factors can also cause some of the conditions that cause pain, so they tend to go together. If people have high cholesterol, diabetes, if they smoke, if they have high blood pressure, then what happens is those blood vessels are not able to function as well, they're not as wide open and they're a little bit damaged. 

So the blood flow to the actual disc that brings the healing factors and nutrients, that blood flow is limited and then the amount of healing that takes place may be limited. So it's related in a sense that if somebody is obese and that obesity is causing them to have high blood pressure to release high cholesterol then it can affect their painful conditions as well such as back pain.

Obesity and pain are related. Conditions associated with obesity—high blood pressure and diabetes—can contribute to lower back pain. In this video, Devi Nampiaparampil, MD, chief of pain management at Veterans Affairs, explains why.

Are People Who Are Obese More Likely to Suffer With Pain?

The conditions that I see most of in our people have muscular skeletal pain, for example, arthritis or low back pain or chronic headaches, and what we usually do, is multidisciplinary treatments. So, we try physical therapies, whether it's exercise, formal physical therapy itself or other alternative types of that exercise. We try medication, sometimes we use procedures or surgeries to try to combat the problem from a different point of view. And then we usually use some type of behavioral therapy as well, because, of course, anybody who has chronic pain or pain that refractory to the usual measures will start to have some stress related to that pain, and sometimes stress can also influence the pain itself and make it worse.

A pain management specialist treats chronic forms of musculoskeletal pain, including arthtritis and lower back pain. In this video, Devi Nampiaparampil, MD, chief of pain management at U.S. Department of Veterans Affairs, discusses the specialty.

What Kind of Conditions Does a Pain Management Specialist Treat?

I think, overall people are becoming more knowledgeable about pain and trying to do more. I think there are three different issues with pain, there's under treatments of acute pain. A lot of times when someone comes to the ER with one condition, people will try to treat the cause, which is the appropriate route to take, but they may not give the person something to help them with their pain while they're looking for the cause. 

The second problem is, sometimes, I'm going to say, overtreatment, it's not exactly over treatment, but we have a problem with prescription drugs in this country also. So that sort of where somebody comes in with pain, and maybe it's being over medicalised or treatments that are causing the more harm are being used, and the treatment is sort of, or the third issue is where there's a mismatch between the pain and the appropriate treatment for that, or best type of way for prescribing medication or using a procedure.

Doctors and patients are becoming more knowledgeable about pain. But challenges like undertreatment, overtreatment and finding the appropriate treatment abound, explains Devi Nampiaparampil, MD, chief of pain management at Veterans Affairs.

Is It True That We Don't Manage Pain Very Well?

There's a lot of new technologies that can help with pain. But at the same time there's still a lot of work to be done. I personally think that most of work should be done to find out what causes acute pain to progress to chronic pain. If we can figure that out, then we'll a have better sense of how to preserve the acute pain that's protective but at the same time prevent that progression to chronic pain. 

Right now a lot of their research focuses on treatment, but they are generalized treatments for all types of pain, whereas really that progression of what's happening in the brain in the spinal cord maybe the area that we need to focus on the most.

New technologies are improving how well we can manage and treat pain, but more research is needed to better understand how acute pain becomes chronic, says Devi Nampiaparampil, MD, chief of pain management at the U.S. Department of Veterans Affairs.

What Are the Obstacles to Treatment Pain as Effectively as We Should?

I think generally speaking we all do get some injuries throughout the day. It's possible to get a lot of different muscle strains and sprains and most of the time the body is healing itself. So if you take an aspirin or don't take an aspirin maybe the next day you'll still feel a little bit better depending on the problem, I'm talking more about wear and tear and age really changes, but if it's something that's causing enough distress for a person to actually come to see me that means they've already tried a few things and they're not working and the body is having a hard time healing itself. 

So yes, so at that point we try things that are more aggressive.

Over-the-counter painkillers, such as aspirin, can be effective for everyday aches and pains. But chronic pain may require more aggressive treatment than OTC drugs can provide, says Devi Nampiaparampil, MD, chief of pain management at Veterans Affair

Are Over-The-Counter Painkillers Effective for Chronic Pain?

Turmeric and ginger can be helpful for pain. At the same time even though they are herbal supplements they actually can also interact with other medications, so it's important to let people know if you're taking prescribed medication that you're also using these. I also like omega-3 fatty acids just because they have some properties, antioxidant properties that can help people and also promote improved blood flow and healing.

Turmeric, ginger and omega-3 fatty acids may help relieve pain. In this video, Devi Nampiaparampil, MD, chief of pain management at U.S. Department of Veterans Affairs, says you should check with your doctor before taking any dietary supplements.

Are There Any Dietary Supplements That Can Help Relieve Pain?

For people who have let's say some flare of arthritis pain, that maybe an anti inflammatory that's over the counter, they have a flair of back pain first, acetaminophen should be helpful. Sometimes if you take those medications 1/2 and hour before you want want to do something, it allows you to do what you need to do whether it's work or go out on trips, just sitting in the car for a long car ride. 

So I think that's reasonable to do, but if it's not working, I don't think it makes sense to keep taking something that's not working because they still have side effects whether or not they are over the counter.

An over-the-counter anti-inflammatory painkiller can relieve occasional arthritis pain, but don't use OTC painkillers for chronic pain. In this video, Devi Nampiaparampil, MD, chief of pain management at U.S. Department of Veterans Affairs, explains.

What Types of Over-The-Counter Painkillers Do You Recommend?

Acupuncture is shown to be pretty effective for a certain types of chronic pain conditions also the risks are very low, so if people can afford it I usually do recommend it. I particularly like it in children who have chronic pain, because there are fewer side effects even though we think about the needle, they're actually not that pain for most children can't tolerate it pretty well, and it does release people's natural painkillers so it can be helpful in that sense. 

I would not necessarily use acupuncture by itself in someone who is having severe refractory chronic pain, but I do think that in combination with other types of therapies, they can be very helpful. Massage is usually helpful for all of us generally feel better with a massage, the area that there's more contention about is how long those effects can last. 

So if you had to pick one, it would be more effective probably to do strengthening exercises or flexibility exercises, or aerobic exercises, but if you can do those things in conjunction with massage that probably would be more satisfying.

Combined with other treatments, acupuncture can help relieve certain chronic pain, with few risks or side effects. In this video, Devi Nampiaparampil, MD, chief of pain management at Veterans Affairs, discusses other alternative pain treatments.

Are Complementary Bodywork Therapies, Such as Acupuncture And Massage, Safe And Effective to Relieve Pain?

Acetaminophen which is one of the most commonly used over-the-counter agents has risks especially towards the liver. In high doses that can affect the liver in any given time. So if you take more than 4 grams in one day, you might damage the liver. The same time someone has chronic pain and they're taking tylenol all the time then they may have an issue where even 2 grams a day can cause a problem, so it really depends. 

Over-the-counter anti-inflammatory medications have more risks associated with them, they can damage the kidneys, they can damage the stomach, or GI lining essentially just directly by damaging it, and affecting some of the lining that protects the stomach that can cause GI bleeding. The other thing that can cause sometimes for people to be more likely to form clots. 

All that sounds very intimidating at first and I don't want to minimize it, but at the same time, not taking any type of agent or not doing anything that can help with the pain also has its risks. I mean not doing anything and having the chronic pain can have risks in terms of your overall quality of life, your ability to function, and your relationships with other people.

High doses of the common OTC painkiller and anti-inflammatories can cause liver, kidney and stomach problems. In this video, Devi Nampiaparampil, MD, chief of pain management at U.S. Department of Veterans Affairs, explains these side effects.

What Are the Risks Associated With Over-The-Counter Painkillers?

Stem cells treatment is in the pipeline, there are three types of stem cells treatments. So, the treatments are aimed at reproducing what the body normally does to heal. So, for example, if you get a cut or gush on your arm, a couple of different things happened. First there are platelets which are clotting factors in the body that go right to that wound, and those platelets actually attract your body's natural stem cells to the area, and that causes healing. 

The other thing is that there're other chemicals or products in the body called Fibrin and Throm bin which go to that area where the gush is, and those form sort of like a matrix that basically allows everything else to build on them to heal. So, that's another thing that's in the pipeline and then the stem cells itself, people are trying now just to directly inject themselves into an area where there's a wound and see if it heal. 

The way to think about stem cells is that they are essentially the bodies kind of I guess kids, you know how we have kids or children who they could become anything, they could become a reporter, they could become doctors, they could become pilots, so it's the same thing in the bodies. 

Stem cells can become anything and there's an army of stem cells essentially in the bone marrow. So, when there's an injury to any part of the body the stem cells get sent to that area, and then take over the functions. If they go to the bone, they become bone. If they go the skin they become skin, and in this case they're using stem cells and the disc in the spine and elsewhere to try and replace the cells that have already damaged.

Stem cells mobilize to injured areas to help repair damage causing pain. Treatments reproduce the natural healing rocess. In this video, Devi Nampiaparampil, MD, chief of pain management at Veterans Affairs, discusses stem cell therapy.

How Can Stem Cell Research Advance Pain Treatment?

Constipation is one of those very tricky things with opioid pain medication, it doesn't really get better on it's own, so I usually give people a stool softener and a laxative and maybe some third agent also that they can use, as soon as they start taking opioids even if it's for acute pain like a broken bone because otherwise you're always playing catch-up with the constipation. 

There are other side effects too like nausea, sometimes sedation or tiredness itching can be another side effect, we can give them something that would help them with the side effects, but usually they would get better on their own after some time if the person just gets used to the medication the real thing that always is hard to treat is constipation.

Your doctor may prescribe a stool softener along with an opioid to prevent constipation. Other common side effects like nausea, fatigue and itching may improve on their own, says Devi Nampiaparampil, MD, chief of pain management at Veterans Affairs.

How Do You Treat Constipation And Other Common Side Effects of Taking Opioids?

Generally speaking diet affects weight, and so we promote a healthy diet so that people do not gain too much weight, or they can lose weight and take some of the strain off of the joints. There are specific foods that might help with pain or might affect pain. So for example caffeine that's kind of a mixed bag. 

For people who don't drink coffee or tea and they don't use caffeine, caffeine can be helpful for pain, essentially if someone has a migraine for example or some other type of headache. There's some research that shows that having caffeine actually speeds up the headache, or the resolution of the headache so it can be very helpful. 

On the other hand people who regularly drink caffeine or too much caffeine in those situations it can make things worse. It can actually cause headaches it can cause headaches if you forget to have your morning cup of coffee. It can cause stomach pain or gastrointestinal upsets, so caffeine is sort of a mixed bag. 

Similarly dairy is a mixed bag where for some people of course you want to have some dairy products, you don't want to have osteoporosis or bone loss. But at the same time people who have irritable bowel symptoms or problems with their bowel, dairy can be irritating. There are some food allergies that can cause issues, but in terms of other types of things generally speaking turmeric, ginger, omega 3 fatty acids which are found in salmon and tuna. 

These types of things are very helpful for pain.

A healthy diet helps with weight management, which in turn helps prevent or lessen pain. In this video, Devi Nampiaparampil, MD, chief of pain management at U.S. Department of Veterans Affairs, discusses the connection between pain relief and food.

How Does Diet Affect Pain?

There are two ways of looking at it, people are doing research right now to try to get FDA approval for these strategies. If they are effective, but at the same time some people are doing them already without the FDA approval. I personally think its better to actually do the studies, and to see how the actual treatment works first, because there are a lot of risks in terms of injecting these biologic therapies into your body, and not knowing what effect it will have.

Though no stem-cell therapy is currently approved by the FDA, research is underway to get FDA approval. In this video, Devi Nampiaparampil, MD, chief of pain management at Veterans Affairs, discusses the potential of stem cell therapy.

How Soon Can Stem-Cell Therapy Be Used to Treat My Pain?

A healthy diet can indirectly relieve pain. There is not a specific food that you could take that would necessarily improve pain immediately, but generally speaking if you have a healthy diet you may be in better health then that can promote healing.

A healthy diet indirectly relieves pain by promoting better health overall for better healing. In this video, Devi Nampiaparampil, MD, chief of pain management at U.S. Department of Veterans Affairs, explains.

Can a Healthy Diet Help Relieve Pain?

X-ray guided interventional therapies are basically different types of procedures that are supposed to fix or treat pain coming from a specific area. These are procedures that are really for a very focal or specific type of pain. If somebody has a pinched nerve in the spine, then there are different ways of targeting it. 

So, first of all you could wait for the body to heal and do physical therapy in the interim to preserve the strength. You could try medication that might help stabilize that nerve, or medications that might change your threshold or tolerance for pain. Then there are interventional therapies. For example, the idea behind them is that, we would put a needle right next to that nerve and inject steroids. 

Steroids is the most commonly used medication. But we'll use steroids are trying to calm down inflammation in that area, so it doesn't put the disc back where it was, it doesn't actually physically move the nerve, but it calms down inflammation. The way you think about it is for example if you have a mosquito bite, you may put on some hydroquinone[sp?] cream, and kind of bring it down, bring down the swelling, bring down the redness, and even if you still have that dot where you were bitten, still may not be a problem because now the inflammation and all the irritating symptoms are gone. It's the same theory with sciatica and Epidural steroid injections, for example that the steroids is calming down the inflammation, and the person feels some relief of their pain, and it gives the body some time to be able to heal itself. So, it's essentially a way of buying time. 

The other one that we do very commonly is called radio frequency oblation, it's for a low back pain. In that, we are literally burning the nerves that go to the joints of the back and preventing people from feeling that pain from arthritis. So that's a very effective treatment, it's not a first step, but for people who really have very refractory pain, it's not getting better, and we know that the cause is arthritis, it's a very effective treatment.

X-ray guided interventional injections are used to treat very specific localized pain, such as sciatica. In this video, Devi Nampiaparampil, MD, chief of pain management at Veterans Affairs, discusses this treatment.

What Are X-Ray Guided Interventional Injections for Pain Treatment?

People who are good candidates for any type of intervention procedure are people who have very focal [xx] we know where the pain is, we know what the cause of the pain is and we can treat it, someone who has fybromyalgia is not the ideal candidate for this type of procedure, of cause paint as important, but there it'snot ideal for a few reasons they have white spread paints. 

There is not one white nerve that can block the entire system. Sunkened becauses they have a lower threshold of feeling pain and sometimes having this procedure can itself cause more pain to them or more distress so, it's usually got to be somebody who has a sense of the procedure itself and wants to go forward, does not mind having an [xx] procedure [xx] risk and benefit and that they also have something that probably will benefit from having risk procedure, in terms of other things that we are concerned about, we worry about people who have bleeding dis order you don't want to have a needle in the spine and then have bleeding in the spine itself, you don't want to have somebody who is very likely to have an infection, so somebody who already has an infection at the moment or somebody is very pre disposed to having one, and we also consider people who have cognitive problems, you have to consider that very carefully for example I treat a lot of people with all timers disease and some other types of dementia. 

So of course if someone has all timers disease just because they can't remember the pain that they had yesterday, it doesn't mean that the pain is not important, we'll still want to treat it, but there is a fine line you want to treat peoples pain but you also want to make sure or the person is aware enough of whats happening that if they have a problem they can immediately alert someone. 

Because especially when you're doing this delicate work in the spine there is a potential for having a bleed or having an infection, and we need people to be able to respond to that pretty quickly.

Patients in whom the cause and location of pain have been identified are the best candidates for X-ray guided interventional therapy. In this video, Devi Nampiaparampil, MD, chief of pain management at Veterans Affairs, explains.

Who Is a Good Candidate for X-Ray Guided Interventional Therapy?

They do tell people when we first meet for chronic pain that, what are their goals in terms of relaxation what are they trying to do and the more specific the goals the better, because if people just say they want to have less pain, that's fair enough that's a valid goal, but it's very hard to measure, it's very hard to know if you are making progress and it may or may not be realistic. But if someone says that my goal is to be able to go unromantic walks with my wife but the sciatic is stopping me then we can kind of tailor the treatment so that the person might be able to do something that's is fun. 

And even if the pain itself doesn't change that much, at least if they can do the things that they want to do, and they can relax more and they can do those things, their overall quality of life make a lot.

Set specific goals for managing pain. In this video, Devi Nampiaparampil, MD, chief of pain management at U.S. Department of Veterans Affairs, explains why you should tailor pain-management strategies to achieve your goals.

What Steps Should I Take to Manage Chronic Pain Effectively?

I think looking at that progression between acute pain and chronic pain is the most exciting. There are some developments looking at how pain as process that I think are fascinating. So for example, even if we think about kids learning how to ride a bike, when you start you may make some mistakes you just kind of fall off, you can't really do it as easily. 

But as you practice it becomes like second nature, and people can do it very easily without even thinking. Unfortunately that is the same process that goes on in the body in terms of pain processing. So that's one of the things, one of the hallmarks of chronic pain that as people feel the same type of pain whether it's low back pain or arthritis relief pain, the more times they have that same episode of pain or that same sensational pain, the more efficient the body becomes at sending that message so it actually becomes more frequent and more severe, more quickly. So the fact that we know that makes it a little bit easier to figure out what can we do to stop the brain from learning or memorizing how to feel pain, and I think that opens the door to a lot of treatment opportunities.

Research into how acute pain becomes chronic may lead to more effective treatment for chronic pain. In this video, Devi Nampiaparampil, MD, chief of pain management at U.S. Department of Veterans Affairs, discusses the future of pain treatment.

What Is the Future of Pain Management?

Try to use the person's usual coping mechanism, so if somebody is funny and they look at things with a sense of humor, you want to try to bring that into whatever they're doing, whether it's their chronic pain, if they're people who can be distracted by different things. There's sometimes we think of stress as being, let's say work or other things, but those can actually be positive as well. 

So, if someone has pain, but they're very busy into their work, or they're taking care of their kids and doing other things and they can focus on something else very completely that might actually decrease the pain. It's not that the actual injury has changed, it's just that their perception of the pain or the severity of the pain changes, and finally, I do try to get people involved with their pain psychologist if they have chronic pain and it's really taking a toll on them. 

Pain psychologists have very specific strategies in terms of cognitive behavioural therapy, biofeedback, there are a variety of things that they can use, imagery to be able to help people to overcome stress, and in terms of cognitive behavioural therapy, I think that's very useful. What happens with a lot of people is that, they have chronic pain and they're kind of managing with it, and then at certain times the pain just builds up, and it accelerates, and they don't know what to do. 

They reach this point where they're in a state of panic, and that's when the cognitive behavioural therapy is useful because they can figure out how to get themselves out of that position, how to avoid that escalation, and those fears, and those thoughts that might make them more alarmed, and that makes a huge difference in terms of managing the entire situation.

Humor can help reduce stress to relieve pain. In this video, Devi Nampiaparampil, MD, chief of pain management at U.S. Department of Veterans Affairs, explains why focusing on other activities can ease stress associated with pain.

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