Depending on the underlying cause of your chronic pain (if any cause can be determined), treatments specific to that condition may help control pain. Your healthcare provider will recommend chronic pain treatments based on the specifics of your condition and factors such as your age, overall health, and medical history.
Access to some pain treatments may be complicated by local laws and stigma. For instance, opioid prescriptions are increasingly restricted in many U.S. states. Medical marijuana is illegal in about half of U.S. states and many countries around the world. People seeking treatment for chronic pain often face suspicion or disdain from medical professionals.
Types of treatments for chronic pain
Most treatments for chronic pain fall into the categories of medication, surgical procedure, or nerve block injections. Some people with chronic pain try lifestyle changes, clinical trials, and alternative pain relief techniques to feel better.
Some medications used to treat chronic pain work by reducing inflammation. Other types of chronic pain drugs block pain signals sent by nerves or inhibit the body’s ability to sense pain.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
NSAIDs are the first treatment many people try for chronic pain. Some NSAIDs such as Aspirin, Advil (Ibuprofen) and Aleve (Naproxen) are available over the counter, while Naprosyn (Naproxen), Celebrex (Celecoxib), and Diclofenac (sold under the brand names Cambia, Cataflam, and Voltaren) require a prescription. NSAIDs are believed to work by inhibiting the production of chemicals that promote pain sensation and inflammation in the body. Taken regularly at high doses, some NSAIDs can cause gastrointestinal problems and abnormal bleeding.
For pain that is not controlled with other treatments, opioids such as Ultram (Tramadol), Percocet (Oxycodone/Acetaminophen), Vicodin (Hydrocodone/Acetaminophen), Morphine (sold under the brand names Avinza and Astramorph), Dilaudid (Hydromorphone), and Duragesic (Fentanyl) may be prescribed. Opioids are believed to work on the brain by altering the body’s ability to perceive pain. According to the National Institute on Drug Abuse, regular use of opioids – even as prescribed by a doctor – can lead to dependence. If misused, opioids can cause overdose and death.
Drugs that prevent seizures in people with epilepsy can help reduce chronic pain in some people. Anticonvulsants such as Lyrica (Pregabalin), Topamax (Topiramate), and Gralise (Gabapentin) work by reducing pain signals sent by damaged nerves. Anticonvulsants commonly cause drowsiness and loss of appetite. In some people, anticonvulsants can cause suicidal thoughts or behavior.
For chronic pain related to inflammation, doctors may prescribe a short course of corticosteroids such as Prednisone, Prednisolone, Cortisone, or Methylprednisolone. Steroids may be taken orally, administered intravenously, or injected directly into inflamed joints. Steroids cause serious side effects including weight gain, mood changes, and high blood glucose when taken long-term.
Depression and anxiety are common symptoms in people with chronic pain.
Some antidepressants such as Elavil (Amitriptyline), Lexapro (Escitalopram), Savella (Milnacipran), Pamelor (Nortriptyline), and Effexor (Venlafaxine) have also been shown to help manage neuropathic (nerve-related) pain.
Some pain medications may be applied locally. Lidoderm (Lidocaine) is a transdermal patch used to treat postherpetic neuralgia. EMLA (Lidocaine/Prilocaine) is a cream used to numb the skin before surgery.
Benzodiazepines are used to treat anxiety. Drugs in this class, such as Valium (Diazepam) and Ativan (Lorazepam), may help relieve muscle spasms in some people with chronic pain. Benzodiazepines can cause addiction.
Surgical procedures and injections
In cases of chronic pain, most surgical procedures and chemical injections seek to relieve inflammation or destroy or disable nerves responsible for relaying pain messages to the brain.
There are many types of injections for pain relief. Medication may be injected directly into a joint to relieve inflammation. In a nerve block injection, a doctor will inject medication into a cluster of nerves responsible for sending pain signals. Most injections to treat chronic pain are performed as outpatient procedures. The effects of nerve block injections are usually temporary. Effectiveness and duration of effect varies between individuals and type of injection, with pain relief ranging from partial to complete, and lasting anywhere between days and years.
Epidural steroid injection can relieve chronic pain in the neck, arms, back, and legs. Epidural steroid injection may help in cases of chronic pain caused by sciatica, spinal stenosis, spondylolysis, or the degeneration or herniation of a disc.
Facet joint injection can relieve chronic pain associated with the facet joints, the parts of your spine that allow you to bend and twist. Facet joint injection may help in cases of chronic pain in the low back, arms, neck, or legs caused by spinal stenosis, sciatica, spondylosis, a herniated disc, arthritis, or surgery.
Lumbar sympathetic block may be used to treat complex regional pain syndrome, Raynaud's syndrome, painful blood vessel spasms, or some types of chronic stomach pain.
Botulinum toxin injection, or Botox, has been used to treat many types of chronic pain involving the muscles. Types of pain for which Botulinum toxin may be beneficial include postsurgical pain, migraines and other headaches, piriformis syndrome, facial pain, myofascial pain, tennis elbow, chronic anal fissure, temporomandibular joint syndrome, low back pain, and chronic prostatic pain.
Stellate ganglion block may be used to treat chronic pain in the head, neck, upper arms, and upper chest caused by complex regional pain syndrome, postherpetic neuralgia, and phantom limb pain.
Celiac plexus block is an injection that can temporarily relieve some types of chronic abdominal pain.
Surgical procedures to control pain
Radiofrequency nerve ablation (RFA) is a technique used to provide long-term relief for some types of chronic pain. RFA is most often used to treat back pain including pain in the lumbar, cervical, and sacroiliac areas, plus the intervertebral discs, dorsal root ganglion, and sympathetic ganglia.
Chemical sympathectomy is a surgical technique used to provide long-term relief for some types of neuropathic chronic pain, specifically complex regional pain syndrome. During chemical sympathectomy surgery, the sympathetic nerves are destroyed with chemicals such as alcohol or phenol.
Intrathecal implants are pumps that are surgically placed in the body to deliver small doses of analgesics (painkillers) directly into the spinal fluid. Doctors may consider intrathecal implants in cases where more conservative pain relief techniques such as oral or injected medications are not effective. Intrathecal implants may be considered for many different types of chronic pain, including failed low back surgery syndrome.
Surgical decompression may be performed to relieve chronic pain associated with back problems such as spinal stenosis or herniated discs.
Other treatments for chronic pain
Cognitive behavioral therapy (CBT) is a type of psychotherapy focused on helping people identify and cope with stress or other negative emotions. CBT is goal-oriented, focusing on specific problems and how to improve them. CBT seeks to help people identify which situations and relationships are problematic in your life, ways that your thinking is negative or faulty, and better ways to approach these circumstances.
Physical therapy can improve strength and balance, help stabilize joints, and reduce many types of chronic pain. Physical therapy can also rehabilitate your body after surgery or injury.
Chiropractic is a health treatment that aims to correct problems with the muscles, nerves, and skeletal system. Chiropractic is a popular treatment for pain and stiffness, especially in the neck and back. Chiropractic may be used to treat conditions including sciatica, fibromyalgia, herniated or degenerated discs, and spondylosis.
Complementary and alternative therapies (CAT) are popular with many people who have chronic pain. Natural or alternative treatments for chronic pain may include acupuncture, yoga, massage, low-level laser therapy, herbal supplements, meditation, and Ayurvedic (traditional medicine modality from India) therapy.
Medical marijuana is widely used as a complementary therapy to treat chronic pain.
Most complementary or natural treatments for chronic pain have not been proven safe or effective in clinical trials. It is vital to check with your doctor before trying an alternative treatment so that they can warn you about any potential interactions and correctly interpret any side effects.
What are the side effects of chronic pain treatments?
Any medication can cause side effects. Each chronic pain treatment has specific potential side effects associated with it. This does not mean that anyone who takes that chronic pain medication will experience all, most, or any of the side effects it can potentially cause. Some side effects are very common, while some are extremely rare. Your doctor can help you assess the risks and benefits of each chronic pain treatment as they relate to your medical history and condition.
Which chronic pain treatments should I avoid?
Some chronic pain treatments carry a higher risk of causing serious side effects than others. For this reason, there are established guidelines for which chronic pain treatments should be tried first, and which should be reserved for people who do not show improvement on the first-line treatments. However, with any medication, your risk of experiencing serious side effects depends on the details of your condition and personal and familial medical history. For instance, some chronic pain medications carry a higher risk for people with kidney or liver problems, alcoholism, or a history of addiction.