What Are the Treatment Options for Chronic Pain?
Chronic pain is classified as pain that lasts for longer than three months. In most cases, it has a well-defined organic cause, so doctors will make treating the source of the pain a priority.
However, many ailments involve intensely painful periods over the course of their development which require treatment. These include cancer, rheumatoid arthritis, fibromyalgia, ankylosing spondylitis, and many others.
We’ve prepared an article with the most important therapeutic measures that doctors utilize in treating these patients. We’ll cover medications, psychological therapies, physical therapy, and complementary treatments. Keep reading for all the details!
Treatment with medication
Pharmaceuticals are the first line of treatment for chronic pain. Doctors consider the underlying disease, the intensity of pain, economic factors, and a risk/benefit analysis when prescribing analgesics.
Doctors often prescribe analgesics in combination formulations to potentiate their effect. In most cases, patients also implement secondary treatments such as physical therapy. Ahead, we’ll give you an overview of the main medications patients use.
Nonsteroidal anti-inflammatory drugs
Also known as NSAIDs, they’re the most widely used analgesics on a global scale. They include ibuprofen, acetylsalicylic acid (aspirin), piroxicam, ketoprofen, and others. They stand out for their anti-inflammatory, analgesic, and antipyretic effects.
From a biochemical standpoint, these medications have a similar mechanism of action. They inhibit several intermediaries involving cyclooxygenase pathways. This is an important metabolic pathway that produces inflammatory substances, many of which are involved in chronic pain.
There are several cyclooxygenase pathways, and, depending on which is inhibited, NSAIDs will have different adverse reaction profiles. The most important adverse effects involve the gastrointestinal tract (like peptic ulcers or GI bleeding), as well as the kidneys.
Despite having certain functional similarities in common with NSAIDs, paracetamol (acetaminophen) doesn’t have anti-inflammatory effects. Even so, it’s widely used for both chronic and acute pain, so much so that it’s included on the list of essential medications published by the World Health Organization (WHO).
It’s generally considered to be a safe medication, but an overdose can cause liver toxicity. In some cases, it can even lead to organ failure. For this reason, if there’s any preexisting liver disease, there’s an increased risk of toxicity even at therapeutic doses. This was described in a case report published in 2019 in Medicina Interna in Mexico.
For the treatment of some ailments like migraines, it’s common to come across commercial formulations that combine it with other drugs. Caffeine is commonly combined with acetaminophen to potentiate the analgesic effect.
COX-2 selective inhibitors
This group includes rofecoxib, celecoxib, etoricoxib, and others. They differ from the rest of the NSAIDs in that they only inhibit the COX-2 metabolic pathway. This can be beneficial in the treatment of some disorders, above all because they have a good gastrointestinal safety profile.
However, these medications have been the source of some controversy within the medical community. For example, valdecoxib was pulled from the market because research revealed that prolonged use increases the risk of thrombosis.
This means that the occurrence of cardiovascular events can be increased with prolonged use of these medications. For this reason, their use should be limited in patients with known risk factors, despite their powerful analgesic effects.
For several years now, antidepressants have been shown to be effective for chronic pain, even in patients without depression. Experts believe this is due to changes in the concentration of certain neurotransmitters, although a definitive explanation hasn’t been found.
The most widely used antidepressants for chronic pain belong to the tricyclic antidepressants group. These include amitriptyline, nortriptyline, and desipramine. Occasionally, doctors will prescribe more modern medications, like selective serotonin-norepinephrine reuptake inhibitors (SSNRIs). This group includes venlafaxine and duloxetine.
In general, doctors prescribe them as a supplementary therapy, and they don’t provide short-term effects. Therefore, several weeks of continuous treatment are required to show clinical improvement.
Doctors also prescribe them as a complementary therapy for pain management, especially when the pain is lancinating or burning. Experts have found that they act on the complex process of nerve sensitivity, a mechanism associated with chronic illnesses.
Like antidepressants, they require several weeks before giving effects, and they’re not useful for acute pain. In fact, their efficacy is slightly lower, according to a 2005 study from the Cochrane group.
This study concluded that these medications are effective for neuropathic pain (where the anatomy of the nerves is damaged), particularly in some complications of diabetes mellitus and postherpetic neuralgia. Some anticonvulsants are useful as an alternative treatment for trigeminal neuralgia.
According to the WHO’s analgesic scale, patients can take opioids for moderate to severe pain. These medications are considered powerful analgesics. They include a variety of substances, such as morphine, oxycodone, methadone, fentanyl, and many others.
Unlike many of the previously mentioned medications, opioids require a prescription from a doctor. That’s because they have a large number of adverse effects. However, these effects are typically only experienced by patients who take high doses for prolonged periods.
Some of the issues involved with taking opioids are arrhythmias, orthostatic hypotension, seizures, and kidney failure. Patients frequently develop an addiction to these medications. However, in terminally ill patients this is usually not a deciding factor when considering whether to discontinue opioid administration.
In certain patients, suffering due to pain often improves with psychological therapy. This is more important in patients who experience constant fear or panic about the imminent arrival of pain, especially in chronic conditions that are difficult to manage.
To understand it better, we need to accept the fact that health is a reflection of the accepted biopsychosocial model, in which affective and emotional factors can play a role in the course of disease. Ahead, we’ll describe the most important psychology-based modalities for the treatment of chronic pain.
Through assertive communication, therapists are able to help patients identify negative thought patterns that might play a role in their perception of pain. These include exaggerated feelings of fight or flight when confronted with small painful stimuli, in the absence of an organic cause that explains the pain.
Patients work to acquire tools that help them replace these attitudes with positive affirmations with respect to the problem. This doesn’t mean that the goal is to avoid or underestimate an illness, but rather to change the negative response.
According to this 2014 article, several observational studies and experiments have found significant results in favor of cognitive-behavioral therapy for chronic pain.
This section refers to the practical application of psychological therapy on the part of the patient. It consists of adopting new habits that help reduce the sensation of pain, through acceptance and the ability to reestablish daily activities whenever possible.
Writing about emotions and mindfulness are becoming very popular methods. Emotional writing involves constantly writing about the emotions associated with pain and traumatic events. It’s not about aesthetic perfection, but rather as a means of personal relief.
Mindfulness, in turn, is based on optimizing one’s attention during daily activities, and has a notable effect on mental health. In fact, it has proven abilities to decrease symptoms of depression, and to increase work productivity.
It’s a vague term, and can be achieved using several methods. Meditation is a classic example, and there are several ways to practice it that are different from what’s portrayed on TV and in movies.
The goal is to induce a state of deep tranquility that decreases the activity of the sympathetic nervous system, which prepares the body for fight or flight situations by secreting substances such as adrenaline.
A decrease in muscular tension is also a desired effect, especially for patients who suffer from migraines and recurring tension headaches.
It’s considered to be a technique that incorporates elements of both meditation and relaxation techniques. During hypnosis sessions, the patient focuses their attention on an object or a thought, with the goal of moving pain sensations to the subconscious level.
Psychologists and psychiatrists are the right professionals to carry out this type of intervention. However, interest in hypnosis also involves other health specialties.
This is possible thanks to growing scientific evidence on its effectiveness, which is its most controversial aspect. According to the prestigious Mayo Clinic, it’s a valid therapy for controlling chronic pain in patients with fibromyalgia, joint problems, dental problems, and others.
It’s the only technique on this list that’s based on the active support of technology during therapy sessions. It’s based on the principle that knowing certain physiological parameters could allow for self-regulation of the processes related to the occurrence of pain.
Doctors use electronic devices to measure body temperature, heart rate, and electrical activity of muscle fibers. Experts believe that, in the long term, it could induce regulation of endogenous opioid levels, which are substances related to neuropathic pain.
Experts consider it to be a complementary option for patients who suffer from migraines and defects in the temporomandibular joint. However, there still isn’t enough evidence on its effectiveness for other ailments.
Experts widely accept the efficacy of physical therapy, and there are even professionals who dedicate themselves to it exclusively. It includes practicing light- to moderate-intensity physical exercises to promote a progressive decrease in pain.
In general, doctors recommend it for musculoskeletal disorders, in which the goal is to maintain the functionality of the limbs. It’s one of the most common therapies for fibromyalgia.
Fibromyalgia involves increased sensitivity to pain throughout the body, especially certain specific points of maximum intensity, known as tender points. Experts aren’t sure what causes it, but it can significantly lower quality of life if left untreated.
Most healthcare professionals recommend a variety of therapies for chronic pain. For this reason, patients tend to use the treatments mentioned above in combinations that they modify over time to get better results.
When they lose effectiveness and patients stop seeing results, doctors might recommend more invasive options to eliminate the anatomical source of the pain. This is the case with neurolysis, surgical blocks, and minimally invasive surgery.
In most cases, there are few major complications. In part, this is due to specialized training in the holistic treatment of pain. Nowadays, hospitals consist of many heterogeneous units that include anesthesiologists, surgeons, and physical therapists.
It’s possible to alleviate chronic pain
As a general rule, experts consider that there isn’t any justification for patients to suffer pain. The only exception occurs when the risks of a certain treatment outweigh its benefits. For this reason, access to effective analgesic treatment is one of the basic goals of public health.
There are several options, and if you have doubts or questions you should turn to a specialist in your area. The most indicated medical professional is an anesthesiologist, although many others are qualified to treat specific types of pain.