Chronic Pain Treatment

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• QWhat kinds of specialists can help treat chronic pain?

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  A Jumo Health answered

  In addition to doctors and nurses, a number of different specialists can help treat chronic pain.

  Psychologists are experts in helping people cope with pain. They help people learn things like relaxation exercises. Relaxation exercises help the pain and help people to sleep better too.

  An occupational therapist will help people find different ways of looking after themselves, doing things around the house or doing hobbies. This might involve using equipment called assistive devices. There are many different types of devices. They help people do normal things, even when they're still in pain, like getting dressed. They can also help with eating and cleaning.

  A physiotherapist gets the body moving through exercise. The more active people are, the fitter and stronger their muscles and body will be.

• QWhat are other strategies besides medication for managing chronic pain?

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  A Dr. Travis M. Hendry, MD , Orthopedic Surgery, answered on behalf of Intermountain Healthcare

  Taking your medication as directed is an important part of your chronic pain management. But it's not a good idea to rely on medication alone to manage your pain. Your doctor will work with you to choose other strategies to try as well. Examples include:
  

  • Relaxation. This can include meditation, deep breathing, listening to music, or other strategies.
  • Physical or occupational therapy. Your doctor may refer you to a specialist for these therapies. Physical therapy can reduce pain and help you regain movement and strength. Occupational therapy can give you strategies to live better despite a certain amount of pain.
  • Exercise, healthy eating, and other lifestyle changes. Depending on your situation, your doctor may recommend some lifestyle changes that can reduce your pain over time.
  • Medical procedures, such as injections or surgery. Depending on your condition, your doctor may refer you to a specialist for evaluation.
  • Emotional or spiritual support. Talking with a counselor, friend, or support group can help you manage pain.
  • Psychological counseling. Your doctor may also refer you to a psychologist to build coping skills and deal with issues that can be caused by pain.
  • Alternative therapies. For some pain conditions, alternative therapies such as acupuncture can be helpful. If you try any of these therapies on your own, be sure to keep your doctor informed.

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• QWhat treatments are there for chronic pain?

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  A Jeanne Longbottom, MSN , Hospice Nursing, answered on behalf of Sigma Nursing

  Pain is the body’s warning system designed to alert the self to actual or potential damage to tissues. When you touch a hot stove, pain stimulates the body to pull away from that surface. Pain in a twisted ankle limits your ability to walk on that ankle until tissues are properly supported or healed. Pain is subjective, which means the experience is different for every person. The past experience with pain, emotional make-up, type of injury, and even social stressors or support affect the amount of discomfort each person experiences. It is important to share as much information with your doctor related to your pain experience as possible.  

  Chronic pain is defined as pain that lasts over six months in duration. Chronic pain outlasts the positive function of pain. For some patients the source of the original pain has been removed, while others have permanent damage that cannot be healed. In either case, combinations of different therapies can often be found to reduce suffering to more tolerable levels. Pain management doctors or clinics should assess your pain carefully to determine the cause and then offer potential treatments. Treatment should include non-drug approaches to relief.

  Medication combinations including opiates, anti-inflammatories, steroids, anti-depressants (depression), anxiolytics (anxiety), antiarrhythmics (heart arrhythmia), and anticonvulsants (seizure) can help provide relief for complex pain. Diet and hot and/or cold applications can provide pain relief. Exercise can be hard to start with significant pain, but there are many exercise programs for chronic pain sufferers. Yoga, Feldenkrais, and programs for arthritic patients allow for limitations caused by pain. Many find relief with warm water therapy pool exercises. Keeping joints mobile and strong can improve function and reduce pain.

  Alternative therapies such as electrical stimulation, acupuncture, meditation, mindfulness, cogitative behavior to learn coping skills, stress management, relaxation, biofeedback, and self-hypnosis are all helpful to people with chronic pain. The ability to learn to live with chronic pain takes time and practice. There is no magic key or instant relief. Believe in yourself and keep working to find comfort in an uncomfortable world. Good luck.

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• QWhy is it difficult to treat chronic shoulder and elbow pain?

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  A Intermountain Healthcare answered

  Chronic shoulder and elbow pain can be difficult to treat because of the nature of the underlying cause. Most commonly, this is caused by a type of tendonosis. Tendonosis is different than tendonitis, which refers to tendon inflammation. When the tendon pain is chronic the inflammation has come and gone and left behind a tendon with areas of degeneration. This does not mean that the tendon is almost falling apart, but that some parts of the tendon have lost their normal collagen architecture and have filled in with areas of abnormal tissue that is similar to scar tissue. These areas are painful and do not respond well to anti-inflammatory medications. Many other treatments are helpful, but there is not one that is always successful. Relative rest is a good place to restart. Physical therapy is often helpful. Stretching, range of motion, and eccentric strengthening are mainstays. Another type of treatment that is helpful goes under trade names like Graston or ASTYM. These are types of deep massage using metal or plastic tools to break up scar tissue and incite inflammation. The theory is that this inflammation may start the body’s own repair process so that the degenerative tendon can be repaired. Some providers use slightly different techniques like ART. 

  Injections are sometimes used to either increase inflammation or add growth factors to injured tendon. Platelet Rich Plasma (PRP) is one of these techniques. In PRP blood is drawn from the patient and then the platelets and growth factors are removed and concentrated for injection into the injured tendon. A few providers are even harvesting a person’s own stem cells from their bone marrow and injecting them. Many patients have good results, but large, quality studies are lacking.

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• QWhat happens during a trigger point injection procedure?

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  A Intermountain Healthcare answered

  Trigger point injections can be done in a doctor's office. The actual injection takes only a few minutes, but plan on 30 to 60 minutes for the whole procedure. You will remain awake and able to communicate the entire time. These steps will be part of your procedure:

  • Position. Depending on where you will have the injection, you will be sitting or lying down.
  • Numbing the skin. You may be given a local anesthetic near the injection site so you don't feel the trigger point injection.
  • Injection. A small needle will be inserted into the trigger point. The injection will contain a local anesthetic that sometimes includes a corticosteroid to reduce inflammation. If you are allergic to the medication, a dry-needle technique (involving no medications) can be used.
  • Brief pain. The injection may cause some pain that can last from a few seconds to a few minutes.
  • Pain relief. The injection will allow the trigger point to relax, and the pain should go away.
  • Additional injections. Several sites may be injected in one visit.
• QHow effective are trigger point injections in relieving pain?

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  A Intermountain Healthcare answered

  Trigger point injections have been found to be very effective in relieving pain, especially when combined with exercise and medication. For many patients, the pain will go away and not return. For some, the pain will decrease but not go away entirely. In this case, your doctor may recommend another injection.
• QDo I have to suffer with chronic pain for the rest of my life?

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  A Dr. Philip S. Kim, MD , Pain Medicine, answered on behalf of Castle Connolly Top Doctors

  No, that is where advanced pain options such as spinal cord stimulation and intrathecal pain pumps may allow better pain control then systemic pain medications. Integrative medical options and lifestyle changes may also allow one to recover and return to a better quality of life.
• QHow can epidural injections relieve chronic pain?

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  A Debra Fulghum Bruce PhD , Healthcare, answered

  Injections around the spine (epidural injections of a cortisone derivative and anesthetic) can be used in some cases for constant, severe pain. These injections may give weeks of relief for women who suffer with chronic back pain, fibromyalgia, bursitis, and other related pain.

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• QHow can narcotics be used to manage chronic pain?

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  A National Fibromyalgia & Chronic Pain Association answered

  The use of opioid analgesics (narcotics) in the management of non-malignant pain has been a controversial issue for many doctors, with the usual reasons for concern: addiction, oversight by state medical boards, and criminal diversion of drugs. However, research has shown that addiction seldom occurs when these medications are used in chronic pain states.