Chronic pain is defined as any pain that lasts for three to six months or more. Typically, chronic pain is a direct result of an underlying health condition such as past injuries, back problems, nerve damage, fibromyalgia, and more. Statistics indicate that over 100 million adults suffer from chronic pain conditions, while reports have come out that painful conditions are increasingly undertreated. Management of chronic pain in patients with multiple problems can be complex.
Chronic Pain usually falls into three basic classification types. These classification types are important because the pain type plays a huge role in what relief solutions rank highest in efficacy. There are certain kind of pain types that can’t be easily classified such as that associated with cancer. However, the three common chronic pain types are:
- Nociceptive: represents the normal response to noxious insult or injury of tissues such as skin, muscles, visceral organs, joints, tendons, or bones. Examples include: arthritis, fibromyalgia, and tension headaches
- Neuropathic: otherwise known as nerve pain – is a type of chronic pain that occurs when nerves in the central nervous system become injured or damaged. Examples include spinal cord injury pain, phantom limb (post-amputation) pain, and post-stroke central pain or shingles.
- Inflammatory: a result of activation and sensitization of the nociceptive pain pathway by a variety of mediators released at a site of tissue inflammation. Examples include appendicitis, rheumatoid arthritis, inflammatory bowel disease, and herpes zoster.
Common Medications for Chronic Pain
- Nonsteroidal Anti-inflammatory Drugs and Acetaminophen: There are many types of nonsteroidal anti-inflammatory medications (NSAIDs), some of them (such as ibuprofen) may be obtained over-the-counter.
- Antidepressants: Some of the older categories of antidepressants may be very helpful in controlling pain; most notably the tricyclic antidepressants. The pain-relieving properties of these medications are such that they can relieve pain in doses that are lower than the doses needed to treat depression.
- Anticonvulsants (Anti-seizure) Medications: These medications can be very helpful for some kinds of nerve type pain (such as burning, shooting pain).
- Muscle Relaxants: These medications are most often used in the acute setting of muscle spasm
- Opioids: When used appropriately, opioids may be very effective in controlling certain types of chronic pain. They tend to be less effective or require higher doses in nerve type pain. For pain is present all day and night, a long acting opioid is usually recommended.
Non-Opioid Pain Management
When the pain is severe, patients may prefer to turn to opioids for relief. However, doctors have had to adhere to new prescription standards set by the FDA from overuse of opioid. The amount of opioid-related deaths has increased dramatically, which has left both physicians and pain sufferers seeking ways to treat low to moderate levels of chronic pain. As a result, patients are recommended to receive more specific and long-term care to avoid opioid dependency.
- Alternative Therapy: To illustrate the strength of the mind body connection, the NIH has brought forth powerful evidence supporting alternative therapies. Recommended non-medicinal therapies include yoga, biofeedback, acupuncture, massage, and the use of external TENS units. Reports indicate that these pain management techniques paired with psychotherapy are extremely effective.
- Nerve Blocks: Nerve Blocks are also a viable option that has grown in popularity. It involves injections in the spinal column and provides long term pain management especially for those with chronic back conditions. There are several types of nerve blocks that are administered in a hospital setting and they are depend on the area of the body being treated. Typically, they are injected into the spinal region.
- Trigger Point Injection: Another type of pain management technique is referred to as a TPI or Trigger Point Injection. This is an injection that contains a corticosteroid and is injected directly into the patients trigger point area.
- Spinal Cord Stimulation: SCS is a therapy that masks pain signals before they reach the brain – the small device is implanted in the the body to deliver signals to the spinal cord. It may be an option for chronic back, leg, or arm pain.
Future Treatment Options
With the opioid abuse epidemic, researchers are now trying to find more effective alternative treatments to tackle the pain sensation rather than mask it. Transcranial Magnetic Stimulation, or tDCS, has been gaining traction as a potentially effective nonpharmacologic approach to chronic pain treatment. A new clinical trial has showed significant improvements in pain associated with knee osteoarthritis.
Research has also been recently focused on the autoimmune causes of chronic pain and interest that autoimmunity processes may treat chronic pain disorders is growing. Researchers have discovered that an infection or injury can prompt an autoimmune response that is often invisible, but results in extreme pain. Study panelists believes that antibody panels for chronic pain will be available within five years and research should open exciting new options for people with chronic pain.
SPR Therapeutics was recently awarded a $6 million contract from the U.S. Department of Defense for research in non-opioid pain management therapy. It will help advance SPR’s SPRINT Peripheral Nerve Stimulation and help conduct advanced clinical trials for those suffering from neuropathic pain. It’s designed to activate target nerve fibers and deliver pain relief without opioids.
Resources for Chronic Pain Sufferers
The American Association for Chronic Pain Sufferers offers a wealth of valuable information for those who suffer from chronic pain. Those who are currently being treated can investigate other options and medications, but it’s always best to consult your personal physician and pharmacist first. For those who have found the pain to taken an emotional toll on their health, the US Pain Foundation is just one of the many chronic pain resources that has listings of awareness campaigns and online support groups.