What are your chronic pain management options?

By Candace Kastanis | Updated on Sep. 16, 2020 Medically reviewed by Karen Berger, Pharm.D.

Chronic pain is defined as any pain that lasts for three to six months or more. Typically, it is a direct result of an underlying health condition such as past injuries, back problems, nerve damage, or fibromyalgia. Statistics indicate that one in five adults in the U.S. live with chronic pain. At the same time, reports show it is increasingly under-treated. Chronic pain management in patients with multiple conditions can be complex. It starts with determining the cause.

Types of chronic pain

Chronic pain usually falls into three basic classification types:

Nociceptive pain represents the normal response to insult or injury of tissues such as skin, muscles, visceral organs, joints, tendons, or bones. An example of nociceptive pain is arthritis.
Neuropathic pain is otherwise known as nerve pain. It is a type of chronic pain that occurs when nerves in the central nervous system become injured or damaged. Spinal cord injury pain, phantom limb (post-amputation) pain, and post-stroke central pain or shingles are some examples of neuropathic pain.
Inflammatory pain is a result of the activation and sensitization of the nociceptive pain pathway by a variety of mediators released at a site of tissue inflammation. Examples of pain caused by inflammation include appendicitis, rheumatoid arthritis, inflammatory bowel disease, and herpes zoster.

There are certain kinds of chronic pain—such as fibromyalgia and tension headaches—that can’t be easily classified, and fall outside these main types. These categories are important because the pain type plays a huge role in what chronic pain treatment options will be most effective.

Common medications for chronic pain relief

There are a number of medications that are commonly prescribed for people with chronic pain, including:

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. Others, such as Mobic (meloxicam), are available by prescription.
Topical pain medications: Over-the-counter topical creams can give relief. Or, prescription lidocaine patches applied to the area (for 12 hours on and 12 hours off) can alleviate pain.
Antidepressants: Some of the older categories of antidepressants may be very helpful in controlling pain; most notably the tricyclic antidepressants. These medications 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 spasms.
Nerve blocks: This involves injections into the epidural space of the spinal column and provides long-term pain management, especially for those with chronic back conditions. There are several types of nerve blocks administered in a hospital setting, and they 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 trigger point injection (TPI). This is an injection that contains a corticosteroid and/or an anesthetic, and is injected directly into the area causing the pain.
Opioids: When used appropriately, if non-opioid medications are not effective or not tolerated, 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 that is present all day and night, a long-acting opioid is usually recommended, and may be supplemented with a shorter-acting opioid for breakthrough pain. A pain management specialist can evaluate the need for opioids.

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 U.S. Food and Drug Administration (as well as individual state and even pharmacy policies) from overuse of opioids. The amount of opioid-related deaths has increased dramatically in the past few years, which has left both physicians and patients who experience chronic pain seeking ways to treat low to moderate levels of chronic pain.

Natural chronic pain relief

For long-term chronic pain management, non-opioid methods are preferable, such as:

Alternative therapy: Recommended non-medicinal therapies include acupuncture, biofeedback, cognitive behavioral therapy, massage, and the use of external TENS units. Reports indicate that these pain management techniques paired with psychotherapy are extremely effective.
Exercise: Light exercise, like yoga, can help with certain types of chronic pain by improving circulation and reducing stress. It’s especially effective for arthritis and back pain.
Heat and cold: Heating pads and ice can be used frequently with minimal side effects to help manage many kinds of chronic pain.
Spinal cord stimulation: SCS is a therapy that masks pain signals before they reach the brain—the small device is implanted in the body to deliver signals to the spinal cord. It may be an option for chronic back, leg, or arm pain.

Emerging chronic pain treatment options

Because of the potential for opioid addiction, researchers are continuously searching for effective alternatives that stop the pain sensation rather than mask it.

Transcranial direct-current stimulation, or tDCS, has been gaining traction as a potentially effective non-pharmacological approach to chronic pain treatment. A clinical trial has shown significant improvements in pain associated with knee osteoarthritis.

Research has also focused on the autoimmune causes of chronic pain. An infection or injury can prompt an autoimmune response that is often invisible, and can result in extreme pain. Antibody panels could be a new treatment for chronic pain and research should open exciting new options.

SPR Therapeutics was 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 System and help conduct advanced clinical trials for those living with neuropathic pain. It’s designed to activate target nerve fibers and deliver pain relief without opioids.

Resources for chronic pain management

The American Chronic Pain Association offers a wealth of valuable information for those who have chronic pain. Those who are currently being treated can explore other options and medications, but it’s always best to consult your personal physician and pharmacist first.

For those who have found the pain has taken an emotional toll on their health, the U.S. Pain Foundation provides listings of awareness campaigns and online support groups.