Chronic pain is pain that persists for three or more months. Chronic pain syndrome is persistent pain that coincides with other symptoms. Chronic pain treatment has become very popular as chronic pain syndrome grows. Approximately 25% of adults in the US suffer from a form of chronic pain. It typically occurs after an injury or surgery. The first step in treatment is getting a diagnosis. The type of treatment one will receive depends on the symptoms and cause of the pain.

Symptoms of Chronic Pain:

Chronic pain can last all day every day or can come and go. It shows up as:

• Stiffness
• Burning
• Throbbing
• Shooting
• Dull and Aching
• Squeezing
• Stinging
• Pins and needles

Having these symptoms on a daily basis can cause severe emotional and mental symptoms, as well as physical side effects. Some of these symptoms and side effects may include:

• Irritability
• Physical exhaustion
• Lack of patience
• Depression
• Poor sleep
• Poor appetite
• Low to no sex drive
• Weight loss or weight gain
• Drug and alcohol addiction
• Insomnia
• Mood swings

Causes of Chronic Pain

There are many things that can cause chronic pain. Aging of bones and joints can be a cause. Nerve damage caused by an injury or surgery. Perhaps an old injury failed to heal properly or was treated improperly. A lot of times there are multiple causes for chronic pain.

There are certain diseases that cause chronic pain. Some common diseases are:

• Fibromyalgia- widespread pain and tenderness (sensitivity to touch) and is the result of a hypersensitive and hyperactive central nervous system.
• Lupus- an autoimmune disease where your body’s immune system attacks your own tissues and organs. Inflammation caused by lupus can affect many different body systems — including your joints, skin, kidneys, blood cells, brain, heart, and lungs.
• Rheumatoid Arthritis- an autoimmune disease where your body’s immune system attacks your own joints and tissues.
• Cancer-a disease in which some of the body’s cells grow uncontrollably and spread to other parts of the body, destroying body tissue.

Then there is chronic pain not related to any disease or injury. There is: 

Psychogenic pain results from psychological disorders such as mental or emotional stress. Psychological problems are the main cause of the pain.

Psychosomatic pain has a known physical source, but psychological issues keep the pain progressing, instead of healing. For example, depression and anxiety exacerbate an endocrine disorder.

Top Forms of Chronic Pain Treatment

Now that we know what chronic pain is and what some of its causes are, we can look at the top forms of chronic pain treatment. 

Drug Therapy

Drug therapy is the most common form of treatment used for chronic pain. These are best for short-term pain relief. Most doctors will start off with mild over-the-counter medications before moving on to strong prescription medications.

Non-prescription

Over-the-counter medications doctors will try include:

• NSAIDs- reduce inflammation and pain caused by stiff muscles and muscle aches. Examples of NSAIDs are ibuprofen and naproxen. These medications can be harsh on your digestion system and therefore should not be used over long periods of time.
• Acetaminophen- used for pain relief and fever reducer. An example of acetaminophen is Tylenol. If taken for long periods of time, especially in high doses, can cause liver damage.
• Topical pain relief- these are creams, rubs, and sprays applied to the skin to help relieve pain. These tend to use things such as menthol, lidocaine, capsaicin, and salicylates to bring relief. Some common topical pain relievers are Tiger Balm, Ben Gay, Icy Hot, Aspercreme, and Biofreeze.

Prescription

Sometimes non-prescription pain medications are not strong enough to relieve your pain and your doctor may need to prescribe something that may help. There are different types of medications that interact with your body in different ways. The most common types of prescription medications are antidepressants, anti-seizure medications, muscle relaxers, anti-anxiety medications, opioids, steroids, and topical creams.

Antidepressants

Antidepressants, especially tricyclics, can be used for chronic pain. The relief is not instant, as the medication needs to build up in your system. These medications work by increasing the neurotransmitters in the brain that stimulate the spinal cord to decrease pain. 

Serotonin and norepinephrine reuptake inhibitors (SNRIs) and Selective serotonin reuptake inhibitors (SSRIs) can also be used to relieve chronic pain. SNRIs are good for helping relieve depression that may coincide with chronic pain. Whereas SSRIs help with nerve pain and are often prescribed to boost tricyclics. 

Anti-Seizure Medications

Although these medications were created to stop seizures, it has been found that these medications can also be used to help reduce chronic pain. These medications help reduce chronic pain by hampering the conveyance of pain signals sent to the brain by damaged and overactive nerves.

Muscle Relaxants and Anti-anxiety Medications

Muscle relaxants and anti-anxiety medications have the same effects. They help relieve muscle spasms and tightness by relaxing the muscles and calming the body. Muscle spasms are involuntary contractions of muscles and do not relax. This can cause tightness, pinching of nerves, and severe pain. 

Opioids

Opioids, also known as narcotics, help relieve pain by attaching to opioid receptors that are on nerve cells throughout the body. The opiates then impede the transmission of pain from the nerves to the brain. These medications should be taken directly as prescribed and can cause addiction. These can make your body believe it needs this medication, even after your body has healed.

Corticosteroids

Corticosteroids act like the natural steroids your body creates. They reduce inflammation by altering the immune response that is creating pain, swelling, and stiffness. These medications are very strong and therefore should be used short term. If used long-term they can cause severe complications such as infection and chronic diseases.

Injections

Injections used for chronic pain treatment provide longer relief than oral medications. Oral medications have to be retaken after several hours, and the injections can last from a few days to a few months. There are multiple types of injections.

Facet joint injections

Using fluoroscopy to guide them, doctors will inject an anesthetic or other medication to numb a facet joint. A facet joint is a joint located in pairs on each side of the vertebrae in the spine. These joints are responsible for the motion of the vertebra and supporting the spine. This is also one way the doctor can diagnose which joint is causing pain. If the joint that was injected has more than initial relief from the pain, that tells the doctor this is the problem area. This can be done three times a year.

Epidural steroid injections

Using fluoroscopy to guide them, doctors will inject an anesthetic and a steroid medication. This will help reduce inflammation in and around nerve roots. Using these injections help to reduce the amount of oral medication needed, allows the person to get back to their daily routines, and may delay or stop the need for surgery. Steroid injections are great for shooting nerve pain such as sciatica pain.

Sacroiliac joint steroid injections

A sacroiliac joint injection, also known as a sacroiliac joint block, is for the diagnosis of sacroiliac joint dysfunction or to reduce low back pain and/or sciatica symptoms. The sacroiliac joints are located on both sides of the spine and connect the sacrum with the hip on both sides. Using fluoroscopy to guide them, doctors will inject an anesthetic and a steroid medication into the sacroiliac joint. This will help reduce the inflammation in and around the joint, thus relieving pain.

Selective Nerve Root Block

Selective nerve root block injection is an injection of cortisone around the nerve root that exits the spinal column. This injection can also be used to help determine which nerve is irritated and causing the pain. The injection reduces the inflammation which then reduces the pain caused by the nerve being pinched. Using fluoroscopy to guide them, doctors will inject an anesthetic and medication. 

Lumbar Sympathetic Block

The sympathetic nerves are located on both sides of the spine in your lower back. Using fluoroscopy to guide them, doctors will inject an anesthetic and a steroid medication into the area around the sympathetic nerves to reduce inflammation and pressure on the nerve. Relief from this injection can take a few days to begin working. 

Surgical Implants

If medications and injections have not worked, as a last resort, doctors will use surgical implants. Because there are a lot of changes made by surgical implants, most doctors require a psychological evaluation before surgery. 

• Spinal cord stimulators deliver an electric current to the dorsal columns, (a sensory pathway of the central nervous system), of the spinal cord to intercept neural pain signals. A spinal cord stimulator device consists of a radiofrequency-controlled neurostimulator or generator and one or more thin wires called leads. These are surgically implanted in the abdomen or buttocks and deliver electrical signals to the space near the spinal cord. These signals block the transmission of pain to the brain.
• Spinal pump technology, also known as intrathecal pumps, are programmable pumps that are surgically implanted into a subcutaneous pocket of the abdomen then a tunneled catheter is inserted into the intrathecal space of the spine. These pumps are filled with opioid medication and can be refilled every month to three months. The doctor will have control over the volume, concentration, and dosage of the pump.

Conclusion

There are many options available these days for chronic pain treatment. Make sure you work with your doctor honestly so that you may receive the best treatment possible. With so many options available, you do not have to live your life in pain.