If you are dealing with pain due to an injury or a disease for over 3 months, you are likely suffering from chronic pain. Chronic pain can interrupt sleep, trigger depression, and isolate you from people and activities.

There are many treatments that can help you regain control over your life. They range from exercise-based home therapies to more advanced treatments offered by a pain specialist. However, good pain relief often requires a combination of several treatments.

Here are 7 popular treatments that can help relieve your chronic pain.

1.  Medications

These are common treatments when you first develop chronic pain. Mild headaches and muscle pains can improve with Tylenol (acetaminophen) or nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen). NSAID’s are especially effective for arthritis pain. Prolonged use can cause stomach problems. However, this can be avoided by applying NSAID creams or sprays directly to a painful joint or muscle.

For stronger relief, your doctor may prescribe Celebrex (celecoxib), muscle relaxants, or a short course of opioids. Opioids can be taken alone or mixed with Tylenol to increase pain relief and lower side effects. Opioid patches release medicine slowly into the blood, over 48 to 72 hours. They help people who can’t swallow pills and cancer patients who need constant pain relief.

Agents such as Cymbalta (duloxetine) or Neurontin (gabapentin) treat neuropathic pain, a severe problem that can start after an injury to the nervous system.  Click here to read more about this.

Advantages

• Convenience.  Medications are easy to take at home. They come in several forms that can fit your needs: pill, cream, or patch.
• Fast acting. You feel pain relief in 5-10 minutes.

Disadvantages

• Limited use.  The liver and kidneys are the main organs that remove medications from the body. Diseases affecting these organs can prevent you from using some medications.
• Side effects.  In addition to the desired pain relief, unwanted effects like drowsiness, nausea, or constipation are possible.
• Effective.  Depending on the pain condition, oral medications can be less effective than injections directed at the pain generator.

2.  Epidurals

Epidural steroid injections (ESI) are injections that work directly at the source of pain in the spinal disc and nerve root. They treat neck or back pain, by decreasing inflammation and blocking nerve pain. The ESI is often more effective than oral or topical agents because it places the medications directly along the irritated nerves.

ESIs don’t change the underlying problem, for example, your herniated disc. However, they can relieve pain for weeks and months at a time, allowing you to complete physical therapy and recover.

ESIs can treat pain in your:

• Neck and arm.  Used for herniated (bulging) discs, spinal stenosis (pain from a narrowed spinal canal), or degenerative disc disease.
• Mid-back area and chest.  Used for herniated discs, fractured ribs, or shingles pain.
• Low back and leg area.  Used for herniated discs, degenerative disc disease, spinal stenosis, or sciatica (shooting nerve pain in your leg).

Advantages

• Targeted relief.  Medicine is injected directly to your painful area, preventing body-wide side effects.
• Can be repeated.  You can have this treatment up to three times over a six month period.

Disadvantages

• Must stop blood thinners.  You should stop blood thinners several days before an epidural in order to prevent unwanted bleeding.
• Increased glucose.  ESIs can increase glucose levels in diabetics. You may need additional monitoring.

3.  Nerve Blocks

Nerve blocks are like epidurals in several ways. They use the same medications, offer lasting relief, and target a certain painful area instead of the whole body. However, while epidurals work on the spinal cord, nerve blocks usually stop pain along a single nerve.

Nerve blocks can treat pain in your:

• Face 
• Eye and scalp area 
• Forehead 
• Upper jaw 
• Nose and roof of your mouth
• Shoulder, arm, hand, elbow, and wrist 
• Abdomen and pelvis 
• Neck and back 

Advantages

• Fewer narcotics.  Nerve blocks provide good pain control without the opioid side effects or risk for addiction.
• Safety.  The use of ultrasound or x-rays to see nerves, allows your doctor to perform blocks safely.
• Convenient.  This procedure takes only 5-15 minutes and is performed in our outpatient clinic.

Disadvantages

• Weakness. You may feel some weakness in the treated area, along with pain relief. This resolves on its own.

4.  Joint Injections

Placing medicine directly into a painful joint is useful in people who have not improved with oral medications and physical therapy. This treatment helps people with arthritis or joint injuries.

A joint injection typically contains two medications. The first medication is a local anesthetic, a fast-acting numbing agent similar to what you receive at the dentist. The second medication is a steroid that decreases inflammation for long-term pain relief.

Types of joint pain that can improve with this treatment include:

• Knee
• Shoulder
• Ankle
• Elbow
• Wrist
• Small joints in the hands and feet
• Hip 

Advantages

• Safe and quick.  Done on an outpatient basis.
• Long lasting.  Pain relief can last several months or longer. The injections may be repeated.

Disadvantages

• Window period.  After an injection, you may have an immediate but temporary pain relief from the local anesthetic. Steroids need several days to fully start working. This creates a window of time when your pain may return. At this time, it helps to take some mild pain medications such as Tylenol or Advil or to apply ice.

5.  Vertebroplasty and Kyphoplasty

These procedures are used to strengthen weakened vertebrae (backbones) in people with spine fractures due to osteoporosis.

Osteoporosis causes bone loss in the backbones that normally support your spine. It is common in people who are 60 years of age or older. The ongoing bone loss causes your bones to become brittle and to fracture. In addition to the typical back and hip pain, you also have a “hunched back”.

The two procedures are similar. Your pain specialist places a special needle into the damaged backbone and injects bone cement. With vertebroplasty, bone cement is injected directly into the fractured bone. With kyphoplasty, a balloon is first placed and then expanded into the collapsed backbone before filling the space with bone cement.

Advantages

• No surgery.  Can be safely performed under X-ray guidance, on an outpatient basis. They can restore your height and normal posture without surgery.
• Quick results.  Patients have instant pain relief or they improve within 24-48 hours.

Disadvantages

• Should be done early. If vertebroplasty is not done within the first couple of weeks after the fracture, it is less likely to work. Over time, a fractured backbone is likely to heal incorrectly on its own.

6.  Neuromodulation – Device Implant

This therapy changes the way nerves communicate in people with chronic pain. It uses targeted electrical stimulation to stop unwanted pain signals.  All normal sensations and movement are maintained. Since it was first used in the 1960s, this field has grown and improved.

This type of treatment requires the implant of a device near the spinal cord or close to a certain painful nerve. The implant requires special skills that only a board-certified professional, such as a pain specialist, can provide. The device remains with you for years, providing constant pain relief. You can control the strength and timing of your own treatment by remote control. 

Conditions treated:

• CRPS (complex regional pain syndrome) – pain, swelling and skin color changes in an arm or leg
• Lasting or new onset pain after back surgery
• Back or neck pain from disc problems
• Spinal stenosis  

Different techniques:

• Spinal cord stimulation
• Peripheral nerve stimulation
• Peripheral nerve field stimulation

For more information, click here. 

Advantages

• Trial.  You can try the device for a 5-7 day trial period to see if it works well for your pain.
• Lasting relief.  The device is permanent, allowing you to control your pain for the long-term.
• Decreased opioid use.  Patients often find that they can decrease or stop their oral pain medications.
• Invisible.  The device is inside your body. No one will know you have it.

Disadvantages

• The device is permanent.  It requires a surgical implant of a battery and wires, similar to a pacemaker. Therefore, some patients are reticent to have an implant. That is why the trial process is so important.

7.  Physical Activity

You may tend to rest more when you suffer from chronic pain. However, while rest can decrease pain, too much rest can increase the risk for new injuries. When you try to become active again, you may suffer new back pains, muscle soreness, and ligament strains. Try to stay active, within the safety limits suggested by your doctors and physical therapists.

Regular physical activity can decrease pain by:

1. Building muscles
2. Improving flexibility
3. Releasing endorphins, the body’s “feel good” chemicals

Some people with chronic pain require guidance from a physical therapist. Others may eventually be able to exercise on their own.

Some gentle exercises, suited for chronic pain sufferers:

• Swimming
• Biking
• Walking
• Yoga
• Tai chi

Advantages

• Better sleep.  Staying active can help you get a more restful sleep.
• Improved mood.  People who exercise report less anxiety and depression.

Disadvantages

• Exertion.  Be careful not to overdo it, and progress slowly to avoid an increase in pain or an injury.

If pain prevents you from the activities you enjoy, reach out to one of our experienced pain specialists. At JSPC, our focus is to help chronic pain sufferers return to an active and enjoyable lifestyle. Click here for an appointment.