Treatment is Available to Ease Your Chronic Pain
Persistent pain is a devastating condition that affects as many as 90 million Americans. Unlike short-term, acute pain—the kind that happens when you sprain an ankle—persistent pain may last for months, or even years. Whether the source of your suffering is arthritis, back pain, or nerve pain, it is important for you to know that there is help available.
The most common cause of persistent pain in older adults is musculoskeletal pain, such as osteoarthritis or lower back pain. Another common cause is neuropathic pain. Neuropathic pain is caused by nerves or mechanisms in the spinal cord or brain that result in the perception of pain, even though the source of the injury is long gone. There are good treatments for both these types of pain, according to Bruce Ferrell, MD, editor-in-chief of Healthy Years.
First-line treatment
The most common treatment for pain is the use of analgesic medications. Acetaminophen (Tylenol, for example) is the safest analgesic medication for most patients with mild-to-moderate pain, especially those with arthritis, back pain, headache, or other causes. Acetaminophen, as compared to non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil) or naproxen (Naprosyn), does not cause stomach problems or kidney damage and usually does not interfere with most other medications or disease processes.
“The NSAIDs have probably been over utilized for treatment of persistent pain,” says Dr. Ferrell. “The NSAIDs usually do not produce better pain control than acetamino¬phen, but are more likely to cause stomach bleeding and side effects on the kidneys.”
More importantly, he notes, many NSAIDs may interact with other drugs, such as high blood pressure medications, and cause significant problems. “NSAIDs should not be used in high doses for long periods of time for persistent pain because of the risk of these side effects,” says Dr. Ferrell.
The opioid option
Opioid drugs, such as codeine, oxycodone (Oxycontin), hydrocodone (Vicodin), morphine, hydromorphone (Dilaudid), and transderm fentanyl (Durgesic) are often used for more severe pain problems. Although these drugs can cause drowsiness and constipation, and can be habit-forming, they may be essential to control persistent pain that is severe from any cause.
“We probably don’t use these drugs as often as we should. There is probably an over-concern by many physicians and patients about the potential for addiction using these drugs in high doses for long pe-riods of time,” says Dr. Ferrell. “In older patients, this fear is often way out of pro¬portion to the actual occurrence of these problems and may be a barrier to their use.
“In fact, for many patients with persistent pain, opioid drugs may be safer than NSAIDs for long-term use,” he adds. “Opioid drugs are often available in both short-acting and long-acting forms, which make sense for either intermittent or continuous pain problems.”
Treating neuropathic pain. Neuropathic pain—sometimes associated with nerve injuries, diabetes, or shingles—may be different. Although this kind of pain may be treated with the medications mentioned previously, neuropathic pain may also respond to some medications that are not classified as traditional analge-sic medications. For example, medications for neuropathic pain may include anti-seizure medications like gabapentin (Neurontin) and pregabalin (Lyrica), or antidepressants such as amitriptyline (Elavil) and duloxetine (Cymbalta). These drugs help change the way the body senses pain by short-circuiting nerve-impulse signals from the brain. Side effects may include sleepiness and swelling.
“These drugs are interesting because they may help alleviate neuropathic pain, but unfortunately they do nothing for most other types of pain, including arthritis, most cancer-related pain, and many other common pain problems,” says Dr. Ferrell. “These drugs all require a prescription and you should always consult your doctor about the cause of your pain and the best drug strategy to use.”
Non-drug strategies
A variety of non-drug strategies are available that can help alleviate persistent pain. Cognitive behavioral therapy (CBT) provides a variety of techniques that research has shown to be quite effec-tive for most patients. These treatments include relaxation techniques, biofeedback (in which physiological signals such as muscle tension and heart rate are used to help the patient learn to change his or her physiology), and self-help techniques that reduce depression, enhance quality of life, and get patients back on track with their lives. CBT is usually led by a clinical psychologist and can be done individually or in group therapy, and it is often available through multidisciplinary pain centers or clinics.
Don’t underestimate the effects of physical therapy, exercise programs, massage, and many relaxa-tion techniques that can help strengthen muscles and joints and relieve the problem of pain-associated muscle spasm. Use of acupuncture, chiropractics, and other interventions also may be safe and effective for a variety of musculoskeletal problems. It is important to consult with your doctor about the treatments you would like to try.
People with chronic pain should seek help—first from their primary care physician, and then from a pain-management specialist, if necessary.
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