How Is Chronic Pain Treated?

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Chronic pain is treated in numerous different ways with numerous modalities. Here is 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 shot gun approach to see what works best for you.

In most cases your doctor probably will start with a complete history in physical and try to evaluate, when did the pain start, what is it better, what makes it worse. The doctor is also going to try to get you to quantify the pain. So, in a scale of one to 10, with 10 being child birth how does this pain compare? And many cases people have pain that's worse than child birth and that's going to get a lot more attention than pain that a patient says is it 2 or 3.

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 the [xx] medicine or non steroidal anti inflammatory drugs that's Ibuprofen,[xx] etcetera.

But then we may go to prescription pain medications in the steroidal anti-inflammatory category. We have Celecoxib or Celebrex which is a cox chew inhibitor. The advantage of that medication is that it doesn't cause as much of the gastrointestinal side effects, as over the counter non descriptory[sp?] inflammatory drugs.

Steroids can be very useful. And then of course, we've 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 that 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 medications I want to address is the whole issue of antidepressants. I do not want people to feel that if your doctor recommends antidepressant for pain management but that's because he thinks it's all in your head. Alright. It just happens that antidepressant medications also work very well for the treatment of chronic pain, usually in 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're drugs that are specifically approved to treat that condition.

Many people with chronic pain also have problems with sleep. So if you have distracted sleep, that can also exacerbate a 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're 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 it 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 etcetera and many of these modalities are very helpful, usually not alone as stand alone therapies but it's part of a comprehensive pain management program.