Archive for the ‘Chronic Pain’ Category

Chronic Pain – What Happens

Wednesday, June 24th, 2009

What Happens

In some cases, chronic pain develops after an injury or illness. The pain continues even after you have recovered from the injury or illness. For example, many people who have had a limb amputated report feeling chronic pain in the missing limb (phantom limb pain). Chronic pain can also develop even though you have not had an injury or illness. The result, however, is often the same—a cycle of sleeplessness, inactivity, irritability, depression, and more pain.

Chronic pain may be mild to severe. You may develop pain that comes back from time to time over several weeks, months, or years. Occasional, mild to moderate pain can usually be managed at home. Exercise, good nutrition, regular massages, and pain-relieving drugs—such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin—may be enough to manage your symptoms.

On the other hand, you may develop constant chronic pain that is severe. You may be unable to work, and physical activity may be too painful or exhausting. Sleeping at night may be difficult, resulting in fatigue and irritability. Your outlook on life may change and strain your relationships with family and friends. Prolonged pain may restrict your daily activities and eventually lead to disability.

After treatment begins, many things can interfere with your recovery, such as dependency on drugs or alcohol, overwhelming stress, lack of motivation, depression or other mental health problems, or ongoing litigation because of a workers’ compensation claim. If your pain is disabling, you may want to seek an evaluation at a pain management clinic, where a team of health professionals works together to treat your pain.

The lives of your family members, friends, or caregivers can also be affected. The people you count on to help you may also need some support. Family therapy or involvement in a caregiver support program may help.

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Chronic Pain – Other Treatment

Saturday, June 13th, 2009

Other Treatment

In addition to medicine or surgery, other treatments can be helpful in reducing chronic pain.

Other Treatment Choices

Additional treatments for chronic pain may include:

  • Physical therapy. This may include hot and cold therapy to relieve painful areas of the body. It may also include stretching and range-of-motion exercises to maintain strength, flexibility, and mobility.
  • Transcutaneous electrical nerve stimulation (TENS). TENS applies brief pulses of electricity to nerve endings in the skin to relieve chronic pain.
  • Professional counseling (such as cognitive-behavioral therapy). This treatment focuses on your mental health and conditions such as stress and depression, which can accompany chronic pain and make it worse. It is important to be healthy emotionally as well as physically, to recover from chronic pain.

Your health professional may refer you to a pain management clinic to receive these treatments. These clinics provide a setting where you can receive treatment and learn to cope with chronic pain. Treatment is usually provided by a team of health professionals who work together to address the many possible causes of your chronic pain. You may also receive these treatments from your own health professional or from specialists who treat chronic pain.

Complementary therapies

Complementary therapies may reduce pain, help you cope with stress, and improve your emotional and physical well-being. These include:

  • Acupuncture, a treatment based on traditional Chinese medicine, where very thin needles are inserted into the skin at certain points on the body to produce energy flow.
  • Aromatherapy, or essential oils therapy, which uses a plant’s aroma-producing oils (essential oils) to treat disease.
  • Biofeedback, a method of consciously controlling a body function that is normally regulated automatically by the body, such as skin temperature.
  • Chiropractic therapy, a hands-on therapy based on the theory that many medical disorders (especially disorders of the nervous system) may be caused by subluxations in the spine.
  • Guided imagery, a series of thoughts and suggestions that direct a person’s imagination toward a relaxed, focused state.
  • Healing touch, which influences a person’s physical or emotional health without physically touching the person.
  • Homeopathy, or homeopathic medicine, which is a medical philosophy and practice based on the idea that the body has the ability to heal itself.
  • Hydrotherapy, which uses water, in any form, to treat a disease or to maintain health.
  • Hypnosis, which is a state of focused concentration during which a person becomes less aware of his or her surroundings. Some people learn to manage pain through concentrating in this special way.
  • Magnet field therapy, a treatment that uses magnets to stimulate areas of the body to try to maintain health and treat illness.
  • Massage, which is rubbing the soft tissues of the body, such as the muscles, to help reduce tension and pain, improve blood flow, and encourage relaxation.
  • Meditation, which is the practice of focusing your attention to help you feel calm and give you a clear awareness about your life.
  • Naturopathy, which promotes using organic foods and exercise; maintaining a healthy, balanced lifestyle; and applying concepts from other areas of complementary medicine (such as ayurveda, homeopathy, and herbal therapies) to try to improve health, prevent disease, and treat illness.
  • Yoga, which uses meditation and exercises to help you improve flexibility and breathing, decrease stress, and maintain health.

What To Think About

If you decide to try one or more of these complementary therapies to treat your chronic pain, find a health professional who has special training and, whenever possible, certification in the particular therapy. You may get a referral from someone you trust such as your health professional, family, or friends. Make sure all of your health professionals know every type of treatment you are using to reduce chronic pain.

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Chronic Pain – When To Call a Doctor

Saturday, May 23rd, 2009

When To Call a Doctor

Call a doctor about chronic pain if:

  • Your pain has lasted more than 3 months without a clear reason.
  • You are feeling down or blue or are not enjoying the activities or hobbies that you have enjoyed in the past. You may be experiencing depression, which is common with chronic pain.
  • You are unable to sleep because of the pain.
  • You had an illness or injury that healed, but the pain has not gone away.
  • You have a family member or friend who appears to be suffering from chronic pain, and you would like information about treatment.

Watchful Waiting

Watchful waiting is a period of time during which you and your health professional observe your symptoms or condition without using medical treatment. If you are able to control occasional, mild to moderate pain with exercise, healthy eating, massage, and pain relievers—such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin—you may not need further treatment from a health professional. However, watchful waiting is not appropriate if your pain is severe or if persistent pain interferes with your life. If you delay treatment, the pain may get worse.

Who To See

If you have mild to moderate recurring pain that cannot be managed at home, you may need to consult one of the following health professionals:

  • Family medicine doctor
  • Internist
  • Nurse practitioner
  • Physician assistant
  • Doctor of osteopathy

If your chronic pain is moderate to severe and constant, or if treatment does not control the pain, your primary health professional may recommend that you see a specialist, such as one or more of the following:

  • Pain management specialist
  • Physiatrist
  • Physical therapist
  • Neurologist
  • Obstetrician or gynecologist (for chronic pelvic pain)
  • Anesthesiologist
  • Psychiatrist, psychologist, or a licensed mental health counselor
  • Orthopedic surgeon
  • Rheumatologist
  • Chiropractor

Often more than one specialist will treat your chronic pain. For example, a primary physician may manage your medicines, and a physical therapist may help you restore function through exercise or other therapies. A professional counselor may help you with coping and depression, and a complementary medicine practitioner may provide alternative therapies such as acupuncture or yoga.

If chronic pain persists and interferes with your daily life despite treatment, you may want to seek an evaluation at a pain management clinic. A pain management clinic is a setting where you receive treatment and learn to cope with chronic pain. Treatment is usually provided by a team of health professionals who work together to address all the possible causes of your chronic pain.

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Chronic Pain – Medications

Sunday, February 8th, 2009

Medications

Medicines can often help control chronic pain. Many different drugs, both prescription and nonprescription, are used to treat chronic pain. All these medicines can cause side effects and should be taken exactly as they are prescribed. In some cases, it may take several weeks before medicines work to reduce pain. It is important to let your health professional know all medicines you are taking (including herbal and other complementary medicines) to avoid dangerous drug interactions.

Medication Choices

You will likely be given medicines that cause the least significant side effects first (such as acetaminophen) to treat chronic pain. The dose will be increased or the medicines will be changed as needed. Older adults are more likely to experience adverse side effects, so medicines may be started at even lower doses and increased more slowly. Medicines used to treat chronic pain include the following:

  • Pain relievers (analgesics)—such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen (for example, Motrin)—which may be prescribed for mild to moderate pain and to reduce inflammation. Always take these medicines exactly as prescribed or according to the label. Do not take a nonprescription NSAID for longer than 10 days without talking to your doctor.
  • Antidepressants, such as tricyclic antidepressants (for example amitriptyline), which may be used to treat chronic pain, although not all antidepressants are effective at reducing pain. Duloxetine (Cymbalta) is another type of antidepressant that is approved by the U.S. Food and Drug Administration to treat pain from peripheral neuropathy.
  • Corticosteroids, such as prednisone, which are used to reduce inflammation and pain.
  • Oral medicines, such as mexiletine (Mexitil), that act like a local anesthetic to dull pain.
  • Anticonvulsants, which may ease pain that starts in the nerves (neuropathic pain). Examples are:
    • Gabapentin (Neurontin) for postherpetic neuralgia (nerve pain from shingles).
    • Pregabalin (Lyrica) for postherpetic neuralgia and diabetic neuropathy (nerve pain from diabetes).
    • Carbamazepine (Tegretol) to help control the episodes of facial pain in trigeminal neuralgia. If you take carbamazepine daily, you should be checked periodically to be sure you don’t develop serious side effects (such as an allergic reaction or liver problems).
  • Pain relievers that are applied directly to the skin (topical analgesics), such as EMLA cream or a lidocaine patch (Lidoderm), which can numb the skin and decrease pain.
  • Capsaicin, a naturally occurring substance that is found in chili peppers and is used to make certain topical analgesic creams. Capsaicin changes the pain signals in the skin, blocking pain without blocking other sensations. Capsaicin may cause a burning sensation when it is first applied. Always wear gloves when applying capsaicin and do not touch or rub your eyes until you have washed your hands.
  • Opioid analgesics, which may relieve moderate to severe pain. Examples of opioids include morphine, oxycodone (such as OxyContin), hydrocodone with acetaminophen (such as Vicodin, Lortab, or Norco), or acetaminophen with codeine (such as Tylenol with codeine). Opioids are sometimes combined with other medicine, such as gabapentin, for nerve pain.

Other therapies that may be used to treat chronic pain include:

  • Nerve block injections. An anesthetic is injected into the affected nerve to relieve pain. The anesthetic may relieve pain for several days, but the pain often returns. Although nerve blocks do not normally cure chronic pain, they may allow you to begin physical therapy and improve your range of motion.
  • Epidural steroid injections (injecting steroids around the spine). Although these injections have been used for many years and may provide relief for low back or neck pain caused by disc disease or pinched nerves, they may not be effective for everyone.
  • Trigger point injections. These may relieve pain by injecting a local anesthetic into trigger points (or specific tender areas) associated with chronic facial pain or fibromyalgia. For many people, nerve blocks or other injections can relieve chronic pain for good. However, it is not completely clear how this type of treatment works. These injections do not relieve chronic pain in everyone.

What To Think About

Medicine may work best when it is used in combination with other types of treatment, such as physical therapy and counseling, to address the different causes of chronic pain. Each person tolerates and responds to medicines differently.

Medicines can reduce or provide temporary relief of chronic pain. At first, you may be given medicines that cause the fewest side effects. Then, if needed, the dose will slowly be increased or you will be switched to a different medicine.

In general, avoid drinking alcohol while taking pain medicines, and do not take higher doses of any medicine than your doctor prescribed.

Daily medicines can be an effective part of long-term treatment for chronic pain. However, sometimes a medicine loses some or all of its effectiveness when it is used daily over a long period of time, because your body develops a tolerance to it.

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