Treating chronic pain is as diverse as the methods used to diagnose it. As chronic pain is subjective and resistive to traditional treatment options, quality pain management includes a variety of alternative options that are gaining ground in acceptance. The new approach is a whole body, holistic way of thinking, and the goal is to utilize the best combination for the specific needs of the patient.
Pain is an unpleasant sensation arising from injury or illness and is classified in to acute pain and chronic pain. Acute pain is a short-term sensation to alert the body of an injury or illness and is expected to fade as the cause heals. Chronic pain is persistent and long-lasting. Some forms of chronic pain occur even when the body has not received any trauma, such chronic pain associated with fibromyalgia or headaches.
Typical causes of chronic pain are low back pain, cervical pain(spinal stenosis), headaches(tension, migraines, chronic daily), muscular pain conditions (fibromyalgia, myofascial pain syndrome), lower extremity peripheral neuropathies (arthritis and joint pain), and cancer pain.
Before treatment can begin for chronic pain disorders, a correct diagnosis must be determined. Generally, physicians will not begin the diagnosis process until the pain symptoms have persisted for at least three to six months. This will give the body enough time to heal from any injury or illness. The location of the pain and description of the pain sensations will aid in determining what diagnostic procedures will be performed.
These tests include blood tests, urinalysis, imaging tests such as MRI, CAT, and bone scans, and spinal taps, and electrodiagnostic testing.
Blood tests are used to pinpoint or rule out conditions such as rheumatoid arthritis, lupus, and thyroid disorders. Imaging tests, such as MRI's, CT scans and X-rays are used to study the structure of bone and muscle tissues for injury or disease. EMG, or electromyography, is helpful to diagnose a specific area for the pain by testing the electrical signals in muscle tissue and the response to stimulation.
Sometimes, once the source of the pain is identified, surgery can be performed to lessen pain symptoms. Post-surgical treatment can include traditional medications and physical or occupational therapy. However, not all forms of chronic pain can be addressed in this manner. When surgery is not an option, other strategies must be employed.
Medication treatment will depend not only on the nature of the pain and how the patient responds to the drug, but how long they will be treated. In addition to NSAIDs and narcotic pain relievers, newer medications, such as pregabalin, have proved to be effective in treating nerve pain. Injections can be performed at the pain site to lessen symptoms. Alternative medications, such as serotonin and norepinephrine re-uptake inhibitors have shown promise in treating pain. While traditionally used in the treatment of depression, many patients feel a reduction in pain symptoms with use.
When medications are not enough, or the patient desires alternative methods of treatment, the patient can try massage therapy, acupuncture, or mind-body approaches such as meditation, journaling and breathing techniques. These can reduce pain and improve the mental well-being of the patient.
Cognitive Behavior Therapy (CBT) is a three-prong approach to pain management. The first step is teaching the patient that pain perception is influenced by cognition and behavior. Then, the patient is trained in coping skills, such as relaxation techniques. Lastly, the training is applied and monitored.
With research showing a lower level of endorphins in the spinal fluid, alternative treatments are being investigated. One cutting edge method being explored is electroacupuncture where the acupuncture needles provide electrical stimulation to the nerve endings thereby releasing endorphins into the system.
Chronic pain is complex in nature and its effect varies from patient to patient. Once the patient is properly diagnosed, treatment options that work best for the individual must be explored. New discoveries in pain management make this possible.