Chronic Pain Management

Blaine MitchelAll, Back Pain, TreatmentsLeave a Comment

Chronic pain is outlined as pain which persists for more than six months. What makes it particularly frustrating is that it is unknown as to why pain lasts long after the injury has gone. It’s theorised that for some reason, the body’s nervous system continues to transmit pain signals even when the root cause has been recognised and solved.

Effective chronic pain management is a multidimensional approach which combines medication, physical and psychological treatments. Patients with chronic pain usually see doctors who specialize in chronic pain management. Pain management specialists comprise of experts from a variety of areas who come at pain from different directions, such as specially trained psychiatrists, neurologists, anesthesiologists, and physiatrists (medical rehab specialists).


Pain and Your Brain

Abrupt and powerful acute pain can cause the nervous system to become overly sensitive, changing the slightest discomfort into extreme pain. New findings regarding brain processes, memory and learning, called neuroplasticity are providing information as to how the nervous system and brain work together. As researchers learn more about neuroplasticity and how it may relate to chronic pain, they can create better ways of stopping chronic pain before it starts. Until then, there are treatments and techniques which can provide relief for chronic pain.

Neuroplasticity is a fairly recent concept which explains how our nervous system participates in memory. When we learn new things or experience events, nerves transmit signals to one another, forming new connections. Via repetition and intensity, lasting connections among neural pathways are formed. For instance, such pathways were formed when you first learned to walk, which makes walking second nature. The nervous system holds information regarding all sorts of things, and this includes pain. When the pain is particularly intense and/or long lasting, the central nervous system (brain and spinal cord) can be reprogrammed. It’s conceivable that the neurons which prevent pain signals actually die. There are no longer the natural checks and balances for pain signals, allowing pain-producing signals to flow freely, hence resulting in chronic pain.



Unluckily for many chronic pain sufferers, over-the-counter medications usually don’t provide enough relief. These patients often need prescription medications. Doctors will begin with lower doses of prescriptions, a particularly important step as chronic pain patients will need to take these drugs regularly.

Bear in mind that pain meds don’t cure; they reduce pain and allow people to lead more normal lives. The medications for chronic pain are alike to those taken for acute or postsurgical situations. Because different medications do different things, they may be prescribed in combination. Chronic pain meds include antidepressants, neuropathic agents, muscle relaxants, nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, and opiates:

  • Antidepressants can obstruct pain signals from getting to the brain. These drugs may also promote the release of endorphins, natural pain killers. Of course, chronic pain can cause depression, which is another reason your doctor might prescribe this type of medication.
  • Neuropathic agents target chronic pain problems which result from nerve damage or hypersensitive nerves. These drugs alter the way pain signals travel and how they are interpreted in the brain.
  • Muscle relaxants are prescribed when the pain is a result of muscle sprains and strains.
  • Nonsteroidalanti-inflammatory drugs (NSAIDs), as the name implies, lower inflammation. When tissue swelling and pain-signaling molecules lessen, pain is reduced too.
  • Steroids also lower inflammation, but they are much more powerful drugs with bigger side effects. Doctors often prescribe these after NSAIDs have failed.
  • Opiates work by preventing pain signals from reaching the brain. The issue with opiates is not so much addiction as it is habituation, or tolerance. This means the body uses up the medication faster and so you need an increasingly higher dose the longer you are on it.

Conventional medical investigators state that the ancient Chinese medical treatment of acupuncture can notably reduce pain. The findings were published in the May 11, 2009, issue of the Archives of Internal Medicine. Over 600 patients with chronic lower back pain were included in what was the largest study of its kind in the United States. The study discovered that acupuncture was effective for treating back pain, but the researchers were unable to explain exactly why it worked.



Spinal-Cord Stimulation

This treatment involves the use of low-voltage electricity to prevent the transmission of pain through the spinal cord before it reaches the brain. A small pulse generator connects to an electrode inserted underneath the skin along the surface of the spinal cord. Here the electricity replaces the normal pain transmission and swaps it for a gentle, prickly sensation. On a physiological level, it is similar to rubbing your foot after you stub your toe. By rubbing, you are stimulating nerves which block pain. The spinal-cord stimulator does this electronically.

Nevertheless, spinal-cord stimulation devices are not suitable for everybody. Doctors advise them only after other therapies have been unsuccessful. You are unable to get magnetic resonance imaging (MRI) scans with them in and sometimes scar tissue prevents them from working as intended. In addition to this they are also quite pricey, they usually cost about $20,000. If it is the chosen route, patients are thoroughly screened to ensure that the device is appropriate for their lifestyle. A trial device is first used to check if the therapy will be effective or not. If it is, the surgeon implants a permanent device.


Intrathecal Pumps

In contrast to oral pain medication which needs to go through the gastric system, the pump (an implanted device) supplies medication directly to the spinal canal. Site-specific delivery produces fewer side effects when compared to powerful pain meds such as morphine. The amount and frequency of the medication are regulated by a computer chip. Similar to spinal-cord stimulators, neurosurgeons first implant a temporary device to test its effectiveness for the patient. The problem with this approach is that all the medication is kept inside the implanted device. The medication is usually refilled every few months. It’s very rare, but a fault could cause the pump to stop or over deliver medication. If complications do happen, the surgeon can remove the pump. The problem of tolerance to the medication and some of the sedating side effects can still happen. On the positive side, the majority of patients report immediate relief.


Emotional and Spiritual Therapy

Chronic pain affects life as you know it. It alters your body, mind, and spirit. A study in a 2008 edition of the Journal of Neuroscience claimed chronic pain impacts overall brain function, including your emotions. The researchers looked at people with chronic back pain and those without and compared them. Using MRIs, researchers saw that suffers of chronic pain had continuous activity in the part of the brain which is connected to emotions. This overactivity results in chronic pain sufferers to experience more stress, depression, anxiety, and sleeplessness. If your brain is too busy dealing with chronic pain, your mind is not able to get adequate rest. This is why getting the emotional and spiritual help necessary is as important as any pain medication. Depression and anxiety often accompany chronic pain, so speaking with a psychologist trained in pain management is a good idea. Alternately or additionally, seeking the counsel of a trusted religious or spiritual leader is also a great idea. There is isn’t a single, correct method for dealing with the emotional distress which chronic pain causes. The best method is the one that which is most appropriate for you.

A psychologist that is educated in pain management will listen and understand your pain in a way that family and friends perhaps may not. Their office is a place where you can let out your feelings. It can be a huge relief to just have someone to talk to. And by listening to your challenges and your feelings, a psychologist can develop a plan for your specific requirements. Stress, of course, is a huge element of chronic pain. Through psychologists and others, you can learn to reduce stress. Spiritual counsellors can teach you how to find peace using prayer, whilst other mind and body experts can teach you meditative techniques.

Massage, exercise, and physical therapy are great for dealing with chronic pain. Massage can help reduce stress and stimulate the release of endorphins. Exercise can also release endorphins and help you build muscles which will support your spine. Physical therapy allows you to maintain the correct posture and develop an exercise program designed for your needs. Emotions cannot be overlooked. As much as we might like to simply pop a pill to numb symptoms, it’s a short-term solution that ultimately will not be enough to manage long-term pain. Fortunately, the subject of emotions is no longer taboo in our society. Emotions shape and govern our experiences, our health, and our quality of life. That’s why learning to work with emotions is an especially crucial piece in the chronic pain management puzzle.

Some people find chiropractors to be helpful, but in my experience they are best for acute lower back pain and thats about it.

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