Get Chronic Pain Treated

Chronic pain may develop after an injury or due to a medical issue. Healthcare professionals define pain as chronic if it lasts longer than 3 months, or beyond the normal healing time for the underlying condition or injury.

Chronic pain can affect every part of a person’s life, from work and social life to sleep and mental health.

What Are the Causes of Chronic Pain ?

Chronic pain can be caused by a wide range of factors and conditions. Identifying the underlying cause of chronic pain is crucial for developing an effective treatment plan. Some common causes of chronic pain include:

1. Injuries: Past injuries, such as fractures, dislocations, or soft tissue injuries, can lead to chronic pain, especially if they do not heal properly or if there are complications during the healing process.
2. Medical Conditions: Various medical conditions can result in chronic pain, including:
   • Arthritis: Conditions like osteoarthritis and rheumatoid arthritis can lead to chronic joint pain.
   • Fibromyalgia: This is a disorder characterized by widespread musculoskeletal pain, fatigue, and tender points.
   • Neuropathy: Nerve damage from conditions like diabetes or infections can cause persistent pain.
   • Cancer: Cancer and its treatments, such as chemotherapy, can cause chronic pain.
   • Inflammatory Bowel Disease (IBD): Conditions like Crohn’s disease and ulcerative colitis can lead to abdominal pain.
   • Endometriosis: A condition where tissue similar to the lining of the uterus grows outside of the uterus, often causing severe pelvic pain.
   • Chronic Headaches: Conditions like migraines, tension-type headaches, and cluster headaches can result in recurrent head pain.
3. Nerve Damage: Injuries or diseases that affect the nervous system, such as multiple sclerosis or trigeminal neuralgia, can cause chronic neuropathic pain.
4. Musculoskeletal Problems: Chronic pain may result from issues with the muscles, bones, or joints, including:
   • Chronic Back Pain: Conditions like herniated discs or spinal stenosis can lead to long-lasting back pain.
   • Osteoarthritis: A degenerative joint disease that can result in persistent joint pain.
5. Infections: Some infections can lead to chronic pain, such as post-herpetic neuralgia, a complication of shingles.
6. Autoimmune Diseases: Conditions like lupus or rheumatoid arthritis can lead to chronic pain due to inflammation and tissue damage.
7. Psychological Factors: Emotional stress, anxiety, and depression can exacerbate and sometimes even be the primary cause of chronic pain, as the mind and body are closely connected.
8. Unexplained or Idiopathic Pain: In some cases, the exact cause of chronic pain remains unclear, and it is categorized as idiopathic pain.
9. Chronic Overuse or Repetitive Stress: Activities or occupations that place repetitive stress on certain body parts, such as typing (carpal tunnel syndrome) or lifting (chronic low back pain), can lead to persistent pain.

How is Chronic Pain Diagnosed?

Diagnosing chronic pain involves a comprehensive evaluation by healthcare professionals to determine the underlying cause and to develop an appropriate treatment plan. The diagnostic process for chronic pain typically includes the following steps:

1. Medical History: The healthcare provider will begin by taking a detailed medical history, including the patient’s description of the pain, its location, duration, and any factors that exacerbate or alleviate it. They will also inquire about any previous injuries, medical conditions, or surgeries.
2. Physical Examination: A physical examination is often conducted to assess the patient’s range of motion, muscle strength, and any physical signs of the pain, such as swelling, tenderness, or deformities. This helps in identifying potential sources of pain.
3. Diagnostic Tests: Depending on the suspected cause of the pain, various diagnostic tests may be ordered, including:
   • Imaging: X-rays, CT scans, MRI scans, or ultrasound may be used to visualize the affected area and identify structural abnormalities.
   • Nerve Conduction Studies (NCS) and Electromyography (EMG): These tests assess nerve function and can help diagnose conditions like neuropathy.
   • Blood Tests: Blood work may be performed to check for signs of inflammation, infection, or autoimmune diseases.
   • Other Specialized Tests: Depending on the specific pain complaint, other tests, such as bone scans, arthroscopy, or discography, may be recommended.
4. Pain Assessment: Pain intensity and quality are often assessed using pain scales or questionnaires to help quantify and characterize the pain, which can assist in treatment planning.
5. Psychological Evaluation: Since chronic pain can be influenced by psychological factors, a psychological assessment may be conducted to identify any underlying issues, such as depression, anxiety, or stress, which can contribute to or exacerbate the pain.
6. Consultation with Specialists: In some cases, the patient may be referred to specialists such as a pain management physician, neurologist, rheumatologist, or orthopedic surgeon for a more in-depth evaluation and to determine the best course of treatment.
7. Diagnostic Procedures: In certain cases, minimally invasive diagnostic procedures such as nerve blocks or joint injections may be used to help pinpoint the source of the pain. If the patient experiences relief after such procedures, it can provide valuable diagnostic information.
8. Ongoing Monitoring: Chronic pain is often a long-term condition, and it may require ongoing monitoring and adjustments to the treatment plan to address changes in the pain and its impact on the patient’s life.

Once the underlying cause of chronic pain is identified, a personalized treatment plan can be developed, which may include medications, physical therapy, lifestyle modifications, and psychological interventions, among other approaches.

If you have long-lasting pain, see your healthcare provider. Your provider will want to know:

• Where your pain is.
• How intense it is, on a scale of 0 to 10.
• How often it occurs.
• How much it’s affecting your life and work.
• What makes it worse or better.
• Whether you have a lot of stress or anxiety in your life.
• Whether you’ve had any illnesses or surgeries.

What Tests Are Used to Diagnose Chronic Pain?

Diagnosing chronic pain typically involves a combination of medical history, physical examination, and various diagnostic tests to determine the underlying cause. The specific tests used may vary depending on the suspected cause of the pain. Here are some common diagnostic tests and procedures that healthcare providers may use to diagnose chronic pain:

1. Imaging Studies:
   • X-rays: X-rays can provide images of bones and can help identify fractures, degenerative changes, or structural abnormalities in the affected area.
   • Computed Tomography (CT) Scan: CT scans offer detailed cross-sectional images of the body and are particularly useful for visualizing bone and soft tissue structures.
   • Magnetic Resonance Imaging (MRI): MRI scans provide detailed images of soft tissues, nerves, and joints, making them valuable for detecting conditions such as herniated discs or ligament injuries.
2. Nerve Conduction Studies (NCS) and Electromyography (EMG):
   • NCS measures the electrical activity of nerves and can help diagnose nerve-related conditions like neuropathy.
   • EMG assesses muscle activity and can be used in conjunction with NCS to evaluate nerve and muscle function.
3. Blood Tests:
   • Blood tests may be ordered to check for signs of inflammation, infection, autoimmune diseases, or other underlying medical conditions that could be contributing to the pain.
4. Imaging-Guided Procedures:
   • Ultrasound: Ultrasound can be used to guide certain diagnostic and therapeutic procedures, such as joint injections or nerve blocks.
   • Discography: This procedure involves injecting contrast dye into the intervertebral discs to assess for disc-related pain.
5. Bone Scans: Bone scans can help identify areas of increased bone activity, which can be indicative of conditions like osteomyelitis, fractures, or tumors.
6. Arthroscopy: Arthroscopy is a minimally invasive surgical procedure that allows direct visualization of joint structures and can be used to diagnose joint-related issues.
7. Provocative Tests: These are tests or procedures designed to reproduce the patient’s pain to help identify its source. For example, provocative discography involves injecting a suspected painful disc to reproduce the pain.
8. Psychological Assessments: A psychological evaluation may be performed to assess the impact of emotional factors on the pain, as well as to identify any comorbid conditions like depression or anxiety.
9. Nerve Blocks and Injections: These diagnostic procedures involve injecting anesthetic or anti-inflammatory medications into specific nerves or joints to determine if the pain is originating from that area. If the injection provides temporary relief, it can help pinpoint the source of the pain.
10. Specialized Tests: Depending on the suspected cause of pain, specialized tests may be ordered. For instance, if a vascular cause is suspected, tests like vascular ultrasounds or angiography may be conducted.

How to Treat Chronic Pain ?

Treating chronic pain is a complex and often individualized process, as the approach depends on the underlying cause, the type of pain, and the patient’s unique circumstances. The following is an overview of the various treatment modalities commonly used to manage chronic pain. It’s important to consult with a healthcare provider to determine the most suitable treatment plan for your specific condition.

1. Medical Interventions:
   • Medications: Depending on the cause and type of chronic pain, healthcare providers may prescribe various medications, including:
     • Over-the-Counter (OTC) Pain Relievers: Non-prescription pain relievers such as acetaminophen, ibuprofen, and naproxen can be effective for mild to moderate pain.
     • Prescription Pain Medications: These may include opioids (for severe pain), muscle relaxants, or anticonvulsants for neuropathic pain.
     • Topical Analgesics: Creams, gels, or patches that can be applied directly to the painful area.
     • Antidepressants and Anticonvulsants: These can be used for certain types of chronic pain, including neuropathic pain.
   • Corticosteroids: Steroid medications can reduce inflammation and alleviate pain associated with conditions like arthritis or autoimmune diseases.
   • Nerve Blocks and Injections: These involve injecting local anesthetics or corticosteroids directly into nerves, joints, or trigger points to provide pain relief.
   • Intrathecal Drug Delivery Systems: In some cases, pain-relieving medications are delivered directly into the spinal fluid using a pump.
2. Physical Therapy:
   • Physical therapists can design personalized exercise and stretching routines to improve strength, flexibility, and mobility. They may also use techniques like massage, heat or cold therapy, and ultrasound to reduce pain and improve function.
3. Occupational Therapy:
   • Occupational therapists help patients learn how to perform daily tasks with less pain and strain. They may suggest adaptive equipment and techniques to make daily living more manageable.
4. Psychological Approaches:
   • Cognitive-Behavioral Therapy (CBT): CBT helps individuals change their thought patterns and behaviors related to pain, reducing the emotional impact of chronic pain and improving coping skills.
   • Mindfulness and Relaxation Techniques: Techniques such as meditation and deep breathing can help manage pain and reduce stress.
   • Biofeedback: This method teaches patients to control physiological responses to pain, such as muscle tension and heart rate.
5. Lifestyle Modifications:
   • Making changes to one’s lifestyle can help manage chronic pain, including maintaining a healthy diet, regular exercise, proper sleep, and stress management.
   • Weight management can be crucial, especially for conditions that worsen with excess weight, such as osteoarthritis.
   • Smoking cessation is important, as smoking can worsen some types of chronic pain conditions.
6. Interventional Procedures:
   • Certain interventional procedures can help manage chronic pain when other treatments are ineffective. Examples include epidural injections, facet joint injections, or radiofrequency ablation.
7. Alternative and Complementary Therapies:
   • Some individuals find relief through treatments such as acupuncture, chiropractic care, massage therapy, and herbal supplements. While these approaches may not work for everyone, they are worth exploring with the guidance of a healthcare professional.
8. Surgery:
   • In some cases, when other treatments are ineffective or the condition is causing severe disability, surgery may be recommended to correct structural issues or remove damaged tissue.
9. Pain Management Programs:
   • Comprehensive pain management programs often involve a multidisciplinary approach, including various therapies, education, and support to help individuals manage their chronic pain effectively.
10. Support and Self-Care:

• Support from healthcare professionals, family, and support groups can be invaluable in managing the emotional and psychological aspects of chronic pain.

It’s essential to work closely with a healthcare provider to create a personalized treatment plan for chronic pain. The goal is to reduce pain, improve function and quality of life, and provide the patient with tools and strategies to self-manage pain effectively. Treatment may involve a combination of approaches, and it may require ongoing adjustments to optimize pain management.

How to Prevent Chronic Pain ?

Preventing chronic pain can be challenging, as it often arises from a combination of factors, including genetics, past injuries, and underlying medical conditions. However, there are several strategies and lifestyle changes that can help reduce the risk of developing chronic pain or manage pain more effectively. Here are some ways to prevent chronic pain:

1. Maintain a Healthy Lifestyle:
   • Exercise Regularly: Engage in physical activity to maintain strong muscles and joints. Focus on exercises that promote flexibility, strength, and balance. Low-impact activities like swimming, walking, and yoga can be beneficial.
   • Eat a Balanced Diet: Proper nutrition can help manage weight and reduce the risk of conditions like obesity, which can exacerbate pain. A diet rich in fruits, vegetables, whole grains, and lean proteins can support overall health.
   • Stay Hydrated: Adequate hydration is important for joint and muscle health.
2. Manage Stress:
   • Stress can exacerbate chronic pain and contribute to its development. Practice stress management techniques such as meditation, deep breathing, and relaxation exercises.
3. Maintain Proper Posture:
   • Maintain good posture to reduce strain on your spine and muscles. Use ergonomically designed furniture and equipment, especially if you have a desk job.
4. Lift and Move Safely:
   • When lifting heavy objects, use proper lifting techniques, and avoid twisting while lifting. Also, take breaks to move and stretch if you have a job that requires prolonged sitting.
5. Avoid Repetitive Strain:
   • If your job or activities involve repetitive motions or heavy lifting, take steps to reduce the risk of overuse injuries. Ergonomic equipment and posture adjustments can help.
6. Protect Your Joints:
   • Use appropriate safety gear and techniques when participating in activities that carry a risk of injury, such as sports or recreational activities.
7. Manage Chronic Conditions:
   • If you have a medical condition that can lead to chronic pain, such as diabetes or arthritis, work closely with your healthcare provider to manage the condition effectively.
8. Get Adequate Sleep:
   • Quality sleep is essential for the body’s ability to recover and repair itself. Develop healthy sleep habits and aim for 7-9 hours of sleep per night.
9. Avoid Smoking and Limit Alcohol:
   • Smoking can exacerbate chronic pain, and alcohol can interfere with sleep quality. Quitting smoking and moderating alcohol consumption can have positive effects on your overall health.
10. Listen to Your Body:

• Pay attention to your body’s signals. If you experience acute pain or discomfort, take it seriously and seek medical attention promptly.

11. Stay Active After Injuries:
    • After an injury, engage in appropriate rehabilitation exercises and follow medical advice to prevent the development of chronic pain.
12. Regular Checkups:
    • Maintain regular checkups with your healthcare provider to monitor your overall health and address any emerging health issues promptly.
13. Maintain a Healthy Weight:
    • Maintaining a healthy weight can reduce stress on your joints, especially in conditions like osteoarthritis. A well-balanced diet and regular exercise can help manage weight effectively.

How to Live With Chronic Pain ?

Living with chronic pain can be challenging, but with the right strategies and support, it’s possible to improve your quality of life and manage the pain effectively. Here are some tips for living with chronic pain:

1. Seek Professional Help:
   • Consult with healthcare professionals, such as pain specialists, physical therapists, and psychologists, to develop a comprehensive pain management plan tailored to your specific condition.
2. Educate Yourself:
   • Learn about your condition, its causes, and available treatments. Understanding your pain can help you make informed decisions and actively participate in your care.
3. Medication Management:
   • Take prescribed medications as directed and communicate with your healthcare provider about their effectiveness and any side effects. Avoid self-medicating or overusing pain medications.
4. Physical Therapy:
   • Engage in physical therapy or rehabilitation exercises to improve strength, flexibility, and function. A physical therapist can help you learn safe and effective exercises.
5. Pacing and Rest:
   • Manage your activities by pacing yourself and taking breaks to avoid overexertion. Balance activity and rest to prevent flare-ups.
6. Mind-Body Techniques:
   • Practice relaxation techniques such as deep breathing, meditation, and mindfulness to reduce stress and improve pain management.
7. Supportive Social Network:
   • Seek support from friends, family, or support groups. Sharing your experiences and feelings can be emotionally comforting.
8. Accept Your Limitations:
   • It’s essential to recognize and accept your physical limitations. Adjust your expectations and focus on what you can do rather than what you can’t.
9. Healthy Lifestyle:
   • Maintain a balanced diet, stay hydrated, get regular exercise within your limitations, and aim for adequate sleep. These lifestyle factors can contribute to pain management.
10. Occupational Adjustments:
    • If your work contributes to your pain, consider discussing accommodations or modifications with your employer. Occupational therapists can provide guidance on managing your job with chronic pain.
11. Assistive Devices:
    • Depending on your condition, assistive devices like braces, canes, or ergonomic tools may help reduce pain and improve daily functioning.
12. Emotional Well-Being:
    • Address the emotional impact of chronic pain through counseling, support groups, and activities that bring joy and relaxation.
13. Pain Journal:
    • Keep a pain journal to track your pain levels, activities, and any triggers. This can help identify patterns and make adjustments to your pain management plan.
14. Maintain Regular Medical Checkups:
    • Stay in touch with your healthcare provider to monitor your condition, make necessary adjustments to your treatment plan, and address any complications or new developments.
15. Alternative Therapies:
    • Consider complementary therapies like acupuncture, chiropractic care, or massage therapy if they align with your pain management plan.
16. Stay Informed:
    • Keep up to date with advances in pain management and treatment options. New therapies and technologies may provide additional relief.
17. Advocate for Yourself:
    • Be an active advocate for your health. Communicate your needs and concerns to your healthcare team, and don’t hesitate to seek a second opinion if necessary.
18. Maintain a Positive Outlook:
    • Staying positive and focusing on your abilities, accomplishments, and things that bring you joy can help improve your overall well-being.

It’s important to remember that living with chronic pain is a journey, and there may be good and bad days. It’s normal to have moments of frustration and fatigue, but with a well-rounded pain management plan and a supportive network, you can better cope with and adapt to the challenges of chronic pain.

Whether your pain has just come on or you’ve lived with it for years, these tried-and-tested self-help steps can bring you relief.

1.Get some gentle exercise

Simple, everyday activities like walking, swimming, gardening and dancing can ease some of the pain directly by blocking pain signals to the brain.

Activity also helps lessen pain by stretching stiff and tense muscles, ligaments and joints.

It’s natural to be hesitant if exercise is painful and you’re worried about doing more damage. But if you become more active gradually, it’s unlikely you’ll cause any damage or harm. The pain you feel when you start gentle exercise is because the muscles and joints are getting fitter.

In the long term, the benefits of exercise far outweigh any increase in pain.

2.Breathe right to ease pain

Concentrating on your breathing when you’re in pain can help.

When the pain is intense it’s very easy to start taking shallow, rapid breaths, which can make you feel dizzy, anxious or panicked. Instead, breathe slowly and deeply.

This will help you to feel more in control and keep you relaxed and prevent any muscle tension or anxiety from making your pain worse.

3.Talking therapies can help with pain

Pain can make you tired, anxious, depressed and grumpy. This can make the pain even worse, making you fall into a downward spiral. Be kind to yourself.

Living with pain is not easy and you can be your own worst enemy by being stubborn, not pacing your activities every day and not accepting your limitations.

Some people find it useful to get help from a psychologist or hypnotherapist to discover how to deal with their emotions in relation to their pain.

You can also find out more about talking therapies, also known as psychological therapies.

4.Distract yourself

Shift your attention on to something else so the pain is not the only thing on your mind. Get stuck into an activity that you enjoy or find stimulating. Many hobbies, like photography, sewing or knitting, are possible even when your mobility is restricted.

5.Share your story about pain

It can help to talk to someone else who has experienced similar pain themselves and understands what you’re going through.

Pain Concern, Action on Pain and Versus Arthritis all have telephone helplines staffed by people with long-term pain, who can put you in touch with local patient support groups.

6.The sleep cure for pain

Many people with long-term pain find it difficult to sleep at night. But it’s important to try to stick to a normal sleep routine so you’ve got the best chance of sleeping through the night.

Sleep deprivation can also make pain worse. Go to bed at the same time each evening, and get up at a regular time in the morning and avoid taking naps in the day. If sleep problems persist, see a GP.

7.Keep in touch with friends and family

Do not let pain mean that you lose contact with people.

Keeping in touch with friends and family is good for your health and can help you feel much better. Try shorter visits, maybe more often, and if you cannot get out to visit people, phone a friend, invite a family member round for tea or have a chat with your neighbour.

Aim to talk about anything other than your pain, even if other people want to talk about it.

8. Relax to beat pain

Practising relaxation techniques regularly can help to reduce persistent pain.

There are many types of relaxation techniques, varying from breathing exercises to types of meditation.

Ask a GP for advice in the first instance. There may be classes available locally or at your local hospital’s pain clinic.

9.  Physical Techniques

Various physical methods can help relieve pain, including physical therapy, hot and cold therapy, massage, and acupuncture.

9.1 Hot and cold therapy

Hot and cold therapy is a common and safe technique to reduce pain.

Heat can help relax the muscles and dilate the blood vessels. It can also promote healing after an injury.

Cold therapy reduces blood flow and reduces inflammation that causes pain. It often involves applying an ice pack wrapped in a towel to the skin.

9.2 Massage

Massage is a type of soft-tissue manipulation. People may benefit from this technique when used with other pain management treatments, such as physical therapy and pain medication.

The benefits of massage include:

• relaxation
• increased flexibility
• reduced inflammation
• improved posture
• improved circulation
• reduced stiffness

A 2007 review on massage found that it may be effective for lower back pain. However, there is mixed evidence from examining its benefits for other chronic pain types.

9.3 Acupuncture

Acupuncture involves a practitioner applying thin needles to the skin at precise points in the body.

According to the National Center for Complementary and Integrative HealthTrusted Source, evidence suggests this technique could help people manage certain pain conditions.

This includes short-term relief from pain in the lower back, neck, knee, and osteoarthritis. However, there is little evidence to suggest it is effective over the long term.

The proposed benefits of acupuncture are:

• pain relief
• reduced inflammation
• relaxation
• reduced muscle spasms

Acupuncture is generally safe when performed by trained practitioners using sterile needles.

10. Mind-body Techniques

Methods that combine psychology and the body can help many people manage chronic pain.

10.1 Cognitive behavior therapy

Psychological treatments for chronic pain include talking therapies, such as cognitive behavioral therapy (CBT).

Psychological treatments aim to reduce the negative impact that chronic pain can have on a person’s mental health.

A 2013 review on the effectiveness of psychological pain management techniques concludes that CBT is effective at reducing pain immediately after treatment compared with using no strategies.

The review also found that there was no evidence that CBT can reduce long-term pain. However, the technique was useful for reducing anxiety around pain and for improving quality of life.

10.2 Yoga

Yoga aims to relax, strengthen, and keep the body flexible through stretching, with specific poses focusing on particular body areas.

A 2010 study into yoga’s effects on chronic pain found that it did not decrease participants’ pain, but it did help them cope, and they were more in control of how their pain affected their everyday life.

However, other studies have found yoga to be effective in reducing pain.

Yoga is a safe and accessible pain management technique that people can try at home, using online videos, or in a class with an instructor.

10.3 Tai chi

Tai chi is an exercise therapy involving slow, continuous, fluid body movements combined with breathing and relaxation techniques. The method is also gentle on the joints and muscles.

Tai chi can improve strength and joint stability, and the concentration it requires can improve a person’s mood.

11. Relaxation Techniques

Dealing with chronic pain can be stressful for many reasons, such as not feeling in control regarding a person’s discomfort.

Relaxation techniques can help ease muscle tension, muscle spasms, aches, and pains. They can also release endorphins, which are the body’s natural painkillers.

A person can help reduce stress through relaxation, which can ease some of the burden of chronic pain while promoting better sleep.

Relaxation methods for chronic pain include:

• Deep breathing techniques: Slow and relaxed breathing methods, such as box breathing, help relieve tension.
• Progressive muscle relaxation: Involves tensing and relaxing each muscle group in turn, for 10 seconds each, from the head to the toes. Focus on breathing and avoid muscles that feel painful.
• Thinking calmly: Spend 5 minutes imagining a calming scene, such as a sunny afternoon in nature, surrounded by green trees and birdsong.
• Calming activities: Set aside time for relaxing activities such as having a warm bath, reading a book, or crafting.

Medication Therapies

There is a wide range of medications to relieve pain. Each class and type of drug work differently, while some may be more suitable for certain people than others.

Acetaminophen

Acetaminophen helps many kinds of chronic pain. One brand name is Tylenol. It is also found in many over-the-counter and prescription pain medicines. If you’re not careful, you could take more acetaminophen than is good for you. Too much acetaminophen can cause liver damage, especially if you drink alcohol. Tell your doctor if you have to take more than 2 acetaminophen pills a day.

Nonsteroidal anti-inflammatory drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a group of medications that reduce inflammation and pain. They are available in capsules, tablets, or as creams or gels for the skin.

However, NSAIDs may cause issues with the stomach and the cardiovascular system in some people. Talk with a doctor before beginning treatment with NSAIDs.

Opioids

Opioids can treat moderate-to-severe pain and are generally only appropriate for short periods, as they can be addictive.

CDC guidelines recommend people should only use opioids when the benefits outweigh the risks.

There is a lack of evidence that this treatment works for chronic pain, as people typically use opioids for short periods.

Antidepressants

Some antidepressants, such as amitriptyline, can help with pain relief.

Amitriptyline is an antidepressant that, at lower doses, people also use for chronic pain, such as diabetic neuropathy and fibromyalgia.

It can take 2–4 weeks for a person to feel the effects of the medication.

Side effects of amitriptyline can include:

• dizziness
• dry mouth
• fatigue
• headaches

Anticonvulsants

Your doctor may want you to try an anticonvulsant medicine. It may help reduce some types of chronic pain, such as low back pain. Examples of anticonvulsants are:

• gabapentin (Neurontin)
• carbamazepine (Tegretol)
• phenytoin (Dilantin)
• pregabalin (Lyrica)
• topiramate (Topamax)

Like antidepressants, your doctor may start you on a low dose of anticonvulsants. This helps prevent or reduce side effects. The doctor may increase the amount over time. Contact your doctor right away if you have suicidal thoughts. Minor side effects may include:

• drowsiness
• nausea or vomiting
• restlessness
• dizziness
• loss of appetite
• weight gain
• itching or swelling

Anti-seizure medications

Medications for epilepsy interrupt pain messages to the brain.

Types include gabapentin (Gabarone®) and pregabalin (Lyrica®).

These medicines can ease nerve pain and fibromyalgia.

Muscle Relaxant

Healthcare providers in the United States can currently prescribe the following antispasmodic skeletal muscle relaxants:

• Carisoprodol (Soma®, Vanadom®).
• Chlorzoxazone (Lorzone®, Parafon Forte DSC®, Relax-DS®, Remular S®).
• Cyclobenzaprine (Fexmid®, Flexeril®).
• Metaxalone (Metaxall®, Skelaxin®).
• Methocarbamol (Robaxin®).
• Orphenadrine (Norflex®).

Antispastic skeletal muscle relaxants that providers can currently prescribe in the U.S. include:

• Baclofen (Lioresal®).
• Dantrolene (Dantrium®).

Two skeletal muscle relaxants have both antispastic and antispasmodic effects. They include:

• Tizanidine (Zanaflex®).
• Diazepam (Valium®).

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Beta-blockers

Beta-blockers slow down the heart and stop hormones, such as adrenaline, from working. Some people use them to treat migraines.

A study shows that beta-blockers at low doses can temporarily improve chronic pain in females with fibromyalgia and temporomandibular syndrome.

However, beta-blockers may not be suitable for everyone. Consult with a doctor before using them for chronic pain.

Medical Marijuana

Medicinal cannabis and cannabidiol (CBD) are increasingly common pain treatments.

A 2017 review states that cannabis may ease neuropathic pain, but not pain due to fibromyalgia, headaches, or rheumatoid arthritis.

In addition, cannabis for medicinal purposes may not be legal everywhere. High doses can trigger side effects, so it is best to check with a health professional before using cannabis CBD for pain relief.

Trigger Point Injections

Trigger point injection is a procedure used to treat painful areas of muscle that contain trigger points, or knots of muscle that form when muscles do not relax. During this procedure, a healthcare professional, using a small needle, injects a local anesthetic that sometimes includes a steroid into a trigger point (sterile salt water is sometimes injected). With the injection, the trigger point is made inactive and the pain is alleviated. Usually, a brief course of treatment will result in sustained relief.

Trigger point injection is used to treat muscle pain in the arms, legs, lower back, and neck. In addition, this approach has been used to treat fibromyalgia, tension headaches, and myofascial pain syndrome (chronic pain involving tissue that surrounds muscle) that does not respond to other treatment.

Onabotulinumtoxina (Botox) is a toxin that blocks signals from the nerves to the muscles. It can also be injected to alleviate chronic migraine headaches. The procedure involves multiple injections around the head and neck every 12 weeks and may alleviate pain for up to three months.

Surgical Implants

When standard medicines and physical therapy fail to offer adequate pain relief, you may be a candidate for a surgical implant to help you control pain. When they are used, which is rare, there are two main types of implants to control pain:

• Intrathecal Drug Delivery. Also called infusion pain pumps or spinal drug delivery systems. The surgeon makes a pocket under the skin that’s large enough to hold a medicine pump. The pump is usually about one inch thick and three inches wide. The surgeon also inserts a catheter, which carries pain medicine from the pump to the intrathecal space around the spinal cord. The implants deliver medicines such as morphine or a muscle relaxant directly to the spinal cord, where pain signals travel. For this reason, intrathecal drug delivery can provide significant pain control with a fraction of the dose that would be required with pills. In addition, the system can cause fewer side effects than oral medications because less medicine is required to control pain.
• Spinal Cord Stimulation Implants. In spinal cord stimulation, low-level electrical signals are transmitted to the spinal cord or to specific nerves to block pain signals from reaching the brain. This method being especially used for back and limb pain. In this procedure, a device that delivers the electrical signals is surgically implanted in the body. A remote control is used by the patient to turn the current off and on or to adjust the intensity of the signals. Some devices cause what’s described as a pleasant, tingling sensation while others do not.
  Two kinds of spinal cord stimulation systems are available. Partial and totally implanted units. The unit that is more commonly used is fully implanted. The latter system’s antenna and transmitter are carried outside the body, while the receiver is implanted inside the body

TENS

Transcutaneous electrical nerve stimulation therapy, more commonly referred to as TENS, uses electrical stimulation to diminish pain. During the procedure, low-voltage electrical current is delivered through electrodes that are placed on the skin near the source of pain. The electricity from the electrodes stimulates the nerves in an affected area and sends signals to the brain that “scramble” normal pain signals. TENS is not painful and may be effective therapy to mask pain such as diabetic neuropathy. However, TENS for chronic low back pain is not effective and cannot be recommended, says the American Academy of Neurology (AAN).

Bioelectric Therapy

Bioelectric therapy relieves pain by blocking pain messages to the brain. Bioelectric therapy also prompts the body to produce chemicals called endorphins (endorphins are also released by exercise) that decrease or eliminate painful sensations by blocking the message of pain from being delivered to the brain.

Bioelectric therapy can be used to treat many chronic and acute conditions causing pain, such as back pain, muscle pain, headaches and migraines, arthritis, TMJ disorder, diabetic neuropathy, and scleroderma.

Bioelectric therapy is effective in providing temporary pain control, but it should be used as part of a total pain management program. When used along with conventional pain-relieving medications, bioelectric treatment may allow pain sufferers to reduce their dose of some pain relievers by up to 50%.

Psychological Treatment

When you are in pain, you may have feelings of anger, sadness, hopelessness, and/or despair. Pain can alter your personality, disrupt your sleep, and interfere with your work and relationships. In turn, depression and anxiety, lack of sleep, and feelings of stress can all make pain worse. Psychological treatment provides safe, nondrug methods that can treat your pain directly by reducing high levels of physiological stress that often aggravate pain. Psychological treatment also helps improve the indirect consequences of pain by helping you learn how to cope with the many problems associated with pain.

A large part of psychological treatment for pain is education, helping patients acquire skills to manage a very difficult problem.

Alternative Therapies

In the past decade, many people have found relief for their pain in mind-body therapies, acupuncture, and some nutritional supplements. Others use massage, chiropractic and osteopathic (bone) manipulation therapies, therapeutic touch, certain herbal therapies, and dietary approaches to alleviate pain. However, there is little if any scientific evidence supporting these therapies for pain relief.

Therapeutic Touch and Reiki Healing

Therapeutic touch and reiki healing are thought to help activate the self-healing processes of an individual and therefore reduce pain. Although these so-called “energy-based” techniques do not require actual physical contact, they do involve close physical proximity between practitioner and patient.

In the past few years, several reviews evaluated published studies on the efficacy of these healing approaches to ease pain and anxiety and improve health. Although several studies showed beneficial effects with no significant adverse side effects, the limitations of some of these studies make it difficult to draw definitive conclusions. Further studies are needed before these approaches for pain treatment can be recommended.

Nutritional Supplements

Dietary supplements, such as fish oils and SAMe, also show some evidence of benefit, although more research is needed.

Herbal Remedies

25 Naturally Pain Relievers

It has been difficult to draw conclusions about the effectiveness of herbs, though there are a few, such as white willow bark, devil’s claw, cat’s claw, ginger, and turmeric, that have some evidence supporting their use. If you decide to use herbal preparations to better manage your pain, tell your doctor: Some herbs may interact with drugs you are receiving for pain or other conditions and may harm your health.

Dietary Approaches to Treating Pain

Some people believe that changing dietary fat intake and/or eating plant foods that contain anti-inflammatory agents can help ease pain by limiting inflammation.

A mostly raw vegetarian diet was found helpful for some people with fibromyalgia, but this study was not methodologically strong. One study of women with premenstrual symptoms suggested that a low-fat vegetarian diet was associated with decreased pain intensity and duration. Weight loss achieved by a combination of dietary changes and increased physical activity has been shown to be helpful for people suffering from osteoarthritis.

Still, further research is needed to determine the effectiveness of dietary modifications as a pain treatment.