Chronic pain is one of the most common conditions for which people seek medical attention.1 The goal of treatment should be to improve function and enable individuals to participate in daily activities and return to work without pain.2
Level 1 - Basic Pain Therapies: Basic therapies are the first step designed to lessen pain. The goal of these therapies is to reduce pain and improve mobility.
- Rest and Nutrition: Your doctor will usually recommend sufficient rest and proper nutrition as a first line of therapy for the treatment of chronic pain. A rested and well-nourished individual is better equipped to battle physical stress and recover from pain
- Exercise and Physical Therapy: In addition to rest and medication, your physician may recommend a program that includes physical conditioning to improve flexibility and strengthen your body for a greater chance of recovery. Your physical therapist will evaluate your baseline condition and tailor a plan specifically for you.
- Non-Steroidal Anti-Inflammatory Drugs (NSAIDS): The second line of therapy for chronic pain is often non-steroidal anti-inflammatory drugs (NSAIDs). These include common over-the-counter medications, such as ASPIRIN™, acetaminophen, and ibuprofen. These medications are often used to treat fever, swelling, arthritis, and other painful conditions. Physicians may prescribe stronger NSAIDs if rest and over-the-counter medications do not sufficiently relieve pain. Side effects of NSAIDs are usually mild, and may include nausea, heartburn, rashes, or upset stomach.
- Cognitive and Behavioural Modification: Because pain not only affects you physically, but also takes a toll on your mental and emotional well-being, physicians often prescribe cognitive and behavioural modification techniques. These techniques help you relax, reduce stress and cope with your pain. Forms of cognitive and behavioural modification include meditation and relaxation training, biofeedback and counselling
Level 2 - Mid Level Pain Therapies: A second line of therapy may be required if your pain does not respond to more conservative treatment. Many of these therapies may be used in conjunction with Level 1 treatments.
- Transcutaneous Electrical Nerve Stimulation (TENS): A TENS unit is an external stimulation device that sends electrical impulses through your skin to the painful area. Instead of feeling pain at the site, patients feel a tingling sensation. Unlike a Spinal Cord Stimulator, the TENS device does not apply energy directly to the nerve. The energy must be transmitted through the skin and muscle to reach the nerves. This results in tingling that is usually felt in a localised area. TENS can alleviate mild to moderate pain, but is often ineffective in treating more complex pain conditions
- Opioids: Opioids are prescription painkillers that block the ability of receptors in the brain to interpret pain signals. Physicians prescribe opioids for severe pain conditions that don't respond well to Level 1 treatment. Opioids can be very effective in relieving pain; however, they carry significant side effects, including drowsiness, constipation, dizziness and even potential addiction. These medications are most commonly administered orally or through skin patches
- Nerve Blocks: A nerve block is performed by injecting a combination of local anaesthetic, steroid and/or anti-inflammatory agents. It is applied directly into the area of pain to lessen the painful signals transmitted by nerves. Relief from nerve blocks may range anywhere from a few hours to several months. Nerve blocks may need to be repeated for sustained relief. Sometimes nerve blocks need to be performed in order to give patients enough relief to successfully complete physical or rehabilitation therapy
- Thermal Procedures: Signals traveling along nerves from painful areas to the brain can be disrupted using extreme heat or cold delivered through needles or probes. Cryo-analgesia applies extreme cold to nerves, while radio-frequency lesioning uses high-frequency energy to heat or coagulate specific nerves. Both processes may temporarily relieve pain, but pain may return as the nerve tissue regenerates. Repeated applications may be necessary for continued relief
Level 3 - Advanced Pain Therapies: When pain persists after Level 1 and 2 therapies have been tried, your Pain Management Specialist may recommend more complex treatment options. Relieving stubborn, chronic pain may take time and patience; your Pain Management Specialist may need to try multiple treatments to find the most effective solution for your unique pain condition.
- Spinal Cord Stimulation: Spinal Cord Stimulation (SCS) uses electrical signals to reduce the perception of pain traveling from the painful area to the brain. In place of pain, patients feel a mild tingling sensation called paraesthesia. SCS can provide long-lasting pain relief and can be used in conjunction with other therapies. Patients are able to control the intensity of the therapy, as well as turn it on and off using a remote control
- Surgery: Surgical procedures for pain can range from minor outpatient procedures to more invasive brain and spinal procedures. Surgery may be required when pain is caused by injury, structural problems or disease. Surgery may also be prescribed in conjunction with other treatments
- Implantable Drug Pumps: Drugs pumps, also known as intrathecal drug pumps, deliver pain medication directly to the cerebrospinal fluid in the space surrounding the spinal cord. Direct application reduces the amount of opioids needed to relieve painful symptoms. Pain pumps are often used to treat cancer pain and other conditions that involve both nociceptive and neuropathic pain
- Neuroablation: Neuroablation is a surgical technique that destroys nerves and tissue, permanently blocking nerve signals to the brain. There are several types of neuroablation: Cordotomy involves cutting a tract of the spinal cord. Rhizotomy destroys a nerve next to the spinal cord. Thalamotomy and pallidotomy use radio-frequency energy to destroy brain cells. Neuroablation is typically used as a last resort when other therapies fail to significantly relieve pain. There is risk of numbness or loss of muscle control with these procedures. The nerves may also regenerate and pain may develop in a different nerve pathway
- Galluzi. Management of neuropathic pain. Journal of the American Osteopathic Association. 2005;sup 4 (105):S12-S19
- Management of chronic pain syndromes: issues and interventions. Pain Med. 2005;6 Suppl 1:S1-S20