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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Article Home Adult and Senior Health Management of chronic pain

Management of chronic pain

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Management of chronic pain involves 2 important steps, first one being diagnosis and next is the treatment.

 

Diagnosis

  • Medical history: Regarding pain in terms of duration, severity, frequency, type, location, aggravating and relieving factors.
  • Physical examination to diagnose physical abnormalities/conditions.
  • Mental health assessment to rule out psychologican and/or psychiatric conditions.
  • Blood tests to detect infection, inflammation and conditions like Rheumatoid arthritis.
  • X-rays and other imaging tests like ultrasound, CT scan and MRI.
  • Electromyogram and nerve conduction studies.
  • Angiogram and other vascular studies.
  • Diagnostic nerve blocks: For eg. injecton of a local anesthetic into or around a nerve to identify whether that nerve is causing the pain.

 

Treatment

Goals of the treatment is to reduce the severity of the pain and increase the functional ability. Some of the measures followed is to improve the sleep and decreasing stress level.


Care at home:


Starting an aerobic exercise like walking, jogging, cycling and swimming. Take a balanced diet which includes vitamins B and D.

 

Avoid drinking or eating caffeine after 3 p.m. This includes coffee, tea, cola drinks, and chocolate.

 

Medications

Medicines often help to control chronic pain. Both prescription and nonprescription drugs are used to treat chronic pain. It can cause side effects and should be taken exactly as they are prescribed. In some cases, it may take several weeks to reduce pain. Some of the common drugs used are


  • NSAIDS(Non Steroidal Anti-inflammatory Drugs): Prescribed for mild to moderate pain eg. Aspirin, Ibuprofen, Paracetamol, etc.
  • Antidepressants eg.amitriptyline. Duloxetine (Cymbalta) is another type of antidepressant that is approved by the U.S. Food and Drug Administration (FDA) to treat pain from peripheral neuropathy and fibromyalgia.
  • Corticosteroids such as prednisolone.
  • Oral local anesthetics like mexiletine (Mexitil).
  • Anticonvulsants like Gabapentin, Pregabalin, carbamazepine, etc .
  • Topical analgesics like Lidocaine patch which can numb the skin.
  • Opioid analgesics like morphine, hydrocodone, oxycodone, etc.
  • Nerve block injections: Anesthetic is injected to the nerve
  • Epidural steroid injections: Injecting steroids around the spine.
  • Trigger point injections: TInjecting a local anesthetic into trigger points. Used mainly in  chronic facial pain or fibromyalgia.

 

Surgical approach

 

  • Surgically implanted pain control devices are considered in cases of severe chronic pain. These devices deliver drugs or a mild electrical current to the spinal cord and thereby reducing the pain. The most commong procedures employed are
  • Intrathecal drug delivery: Injecting medicines such as morphine or ziconotide into the spine.
  • Spinal cord stimulation: Sends a small electrical current to the spinal cord.
  • Chemical or surgical sympathectomy: Here the malfunctioning nerve/s are cut.
  • Radiofrequency ablation: Done to disrupt the flow of pain signals from specific nerves. Employed after confirmation with diagnostic nerve block.

 

 

Other treatment choices

 

  • TENS(Transcutaneous electrical nerve stimulation ): Electrical impulses are applied to nerve endings in the skin to relieve pain.
  • Cognitive behavioral therapy: To correct stress and depression.
  • Physiotherapy: Includes hot and cold therapies.
  • Complimentary therapies like Acupuncture, Biofeedback, massage, chiroptactic therapy, hydrotherapy, hypnosis, naturopathy, yoga and meditation.