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Chronic Pain: When no physical cause can be found

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Medication. Sometimes over-the-counter pain relievers or medicated creams or gels are effective. For more severe pain, your doctor may prescribe an opioid medication. Some people find relief with tricyclic antidepressants such as nortriptyline (Pamelor). Seizure drugs such as gabapentin (Neurontin) or carbamazepine (Tegretol) may relieve some types of chronic pain as well.

Injection therapy. Instead of prescribing pills to control chronic pain, your doctor might inject medication directly into the affected area. Such injections are usually a combination of a numbing agent (local anesthetic), which provides immediate relief, and a corticosteroid, which reduces inflammation.

Nerve stimulation. Various devices use electric impulses to help block or mask the feeling of pain. With transcutaneous electrical nerve stimulation (TENS), a portable, battery-powered unit delivers an electric impulse through electrodes placed on the affected area. Spinal cord and peripheral nerve stimulators are implanted beneath the skin with electrodes placed near the spinal cord. A hand-held unit allows you to control the level of stimulation.

Medication pumps. An implantable medication pump supplies pain medication directly into the spinal fluid. To replenish the pump, drugs are injected through the skin into a small port at the center of the pump.

Physical and occupational therapy. Stretching and strengthening exercises can improve your strength and flexibility. Sometimes learning new ways to handle daily activities can minimize the pain.

Complementary therapies. Various complementary therapies may offer relief from chronic pain, including acupuncture, biofeedback, chiropractic care and hypnosis. Ask your doctor if such therapies may be helpful for you.

Counseling. A counselor can help you manage your emotional response to chronic pain, as well as identify patterns of thought or behavior that may aggravate your pain.

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Exercise takes the edge off chronic pain

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Exercise can be a great way to ease chronic pain. Consider the risks of inactivity and the benefits of movement

From MayoClinic.com
Special to CNN.com

When you're in pain, exercise is probably the last thing on your mind. But it may be more important than you think. Regular exercise is a versatile weapon in the fight against chronic pain.

The risks of inactivity

When you're inactive, your muscles �?including your heart �?lose strength and work less efficiently. Your risk of high blood pressure, high cholesterol and diabetes increases. Inactivity can increase fatigue, stress and anxiety as well.

"Years ago, people who were in pain were told to rest," says Edward Laskowski, M.D., a physical medicine and rehabilitation specialist and co-director of the Sports Medicine Center at Mayo Clinic, Rochester, Minn. "But now we know the exact opposite is true. When you rest, you become deconditioned �?which may actually contribute to chronic pain."

The benefits of movement

As tough as it may be to start an exercise program, your body will thank you. Are you skeptical? Consider the facts. Exercise can:

Prompt your body to release endorphins. These chemicals block pain signals from reaching your brain. Endorphins also help alleviate anxiety and depression �?conditions that can make chronic pain more difficult to control.

"Endorphins are the body's natural pain relievers," Dr. Laskowski says. "Endorphins have the potential to provide the pain-relieving power of strong pain medications, such as morphine."

Help you build strength. The stronger your muscles, the more force and load you'll take off your bones and cartilage �?and the more relief you'll feel.

Increase your flexibility. Joints that can move through their full range of motion are less likely to be plagued with aches and pains.

Improve your sleep quality. Regular exercise can lower your stress hormones, resulting in better sleep.

Boost your energy level. Think a walk around the block will wipe you out for the rest of the day? Not likely, and if you do it again tomorrow and the day after, it'll be easier each time. In the long run, regular exercise can actually give you more energy to cope with chronic pain.

Help you maintain a healthy weight. Exercise burns calories, which can help you drop excess pounds. This will reduce stress on your joints �?another way to improve chronic pain.

Enhance your mood. Exercise contributes to an overall sense of well-being. It increases blood and oxygen flow to all your tissues, livening up your skin tones and nourishing your brain. These positive effects perpetuate themselves. The better you look and feel, the greater your confidence and motivation to keep exercising.

Protect your heart and blood vessels. Exercise decreases the risk of high blood pressure, diabetes, heart attack and stroke.

Getting started

Consult your doctor for help designing an exercise program that meets your specific needs. Your doctor will likely recommend various stretching, strengthening and aerobic activities. Exercises that help you relax �?such as meditation and yoga �?may be helpful, too.

It's natural to be worried about hurting yourself or making your pain worse. But with your doctor's reassurance and guidance, you can safely exercise with the knowledge that your pain isn't serving a useful protective purpose. Remember, regular exercise actually eases chronic pain for many people.

Exercise program components

Exercising regularly can both increase function and decrease pain in as little as three weeks, even when you're starting slowly. A multidisciplinary pain rehabilitation program can provide an individualized exercise prescription based on your current abilities and your goals for pain relief. Physical therapists also can help you understand body mechanics, posture principles and proper lifting techniques, all of which can decrease chronic pain. Rehabilitation programs are intended to give tools for long-term pain relief through functional improvement over time, but most people leave a pain rehab program with noticeably less pain than when they started.

Even if you're not in a pain rehabilitation program, you can adapt some of their recommendations in your own exercise routine with the advice of your doctor:

Aerobic exercise. For physical conditioning, start slowly at a safe point for your current abilities. Over several months, work up to a regular routine of working out for 20 to 30 minutes, four to five times a week. Low-impact exercise such as biking and walking are often good choices, and swimming may be especially effective �?and more comfortable �?if you have joint disease.

Strength training. Dumbbells, resistance tubing, body weight, strength training machines or sandbag weights can all be used for strength training. Start with a resistance with which you can perform 12 to 15 repetitions and try to work major muscle groups in the upper body, lower body and core.

Stretching. Increasing your flexibility can be a helpful component of pain relief. Start a consistent stretching routine with advice from your doctor. Gentle stretching exercise like yoga or body movement exercise such as Pilates may be beneficial as well.

If you're not consulting with a physical therapist, be sure to check in with your doctor periodically to be sure you're not pushing yourself too hard �?or letting yourself off too easy. While you might need encouragement to progress, others can get impatient and push themselves too hard, and need to be held back.

"Exercise is not an overnight success story, but if a person is consistent and patient, they are almost guaranteed success," says John Postier, R.P.T., a physical therapist in the Pain Management Center at Mayo Clinic in Rochester, Minn.

Staying on track

Even if you recognize the benefits of exercise, staying motivated can be a challenge.

"Remember to start slowly," Dr. Laskowski says. "Don't rush into a strenuous workout regimen before your body is ready. Consistency is more important than intensity �?especially if you have severe pain."

It's also helpful to build your exercise program around activities you enjoy. Exercise with a friend or join a class. Finding an activity within a group setting �?like in a fitness center �?is beneficial, especially if you can coordinate your workout with other people working toward pain relief. "Many people seem to get motivated in a setting where others are working on the same thing," says Postier. As your energy increases and your mood improves, you may actually look forward to exercising.

By Mayo Clinic Staff
Aug 29, 2007

© 1998-2007 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. A single copy of these materials may be reprinted for noncommercial personal use only. "Mayo," "Mayo Clinic," "MayoClinic.com," "Mayo Clinic Health Information," "Reliable information for a healthier life" and the triple-shield Mayo logo are trademarks of Mayo Foundation for Medical Education and Research.

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Antidepressants: Another weapon against chronic pain

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Antidepressants are a mainstay in the treatment of many chronic pain conditions �?even when depression isn't a factor.

From MayoClinic.com
Special to CNN.com

Some of the more effective and commonly used medications for chronic pain are drugs that were developed to control other conditions. Antidepressants are a mainstay in the treatment of many chronic pain conditions �?even when depression isn't a factor.

Tricyclic antidepressants

Amitriptyline is the antidepressant most commonly prescribed for pain, and it's the one that has been studied most thoroughly. Other tricyclic antidepressants used for pain include:

Imipramine (Tofranil)

Nortriptyline (Pamelor)

Desipramine (Norpramin)

Tricyclic antidepressants seem to work best for the burning or searing pain common after nerve damage, which sometimes occurs with diabetes, shingles or strokes. These drugs are also effective in some people for fibromyalgia, or as a preventative for migraines.

The painkilling mechanism of these drugs is still not fully understood. Tricyclic antidepressants may increase neurotransmitters in the spinal cord that reduce pain signals. But they don't work immediately. You may have to take a tricyclic antidepressant for several weeks before it starts reducing your pain.

Side effects

Tricyclic antidepressants don't cause dependence or addiction, and they're safe to take for long periods of time. But they can make you drowsy. To manage this side effect, take your tricyclic in the evening, just before bed. In addition, these drugs may cause dry mouth, constipation, weight gain, difficulty with urination and changes in blood pressure. If you have heart disease, these medications may not be a good choice. Discuss it with your doctor.

To reduce or prevent side effects, your doctor will likely start you at a low dose and slowly increase the amount. Most people are able to take tricyclic antidepressants, particularly in low doses, with only mild side effects. The doses that are effective for pain are typically lower than the doses used for depression.

Newer antidepressants

Two newer forms of antidepressants �?selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) �?have fewer side effects than tricyclic antidepressants and are sometimes used to treat chronic pain.

SSRIs include such drugs as paroxetine (Paxil) and fluoxetine (Prozac). People who have chronic pain may feel better while taking SSRIs, but this effect is believed to result more from the easing of accompanying depressive symptoms rather than from actual pain relief. Drugs such as venlafaxine (Effexor) and duloxetine (Cymbalta) are SNRIs, which appear to be more effective than SSRIs at pain control �?particularly pain caused by damaged nerves.

By Mayo Clinic Staff
Nov 20, 2006

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Magnet therapy: Can it relieve pain?

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Can magnet therapy relieve chronic pain? I have back pain, and I'm thinking about buying a magnetic mattress pad. - No name/No state given

Mayo Clinic rheumatologist
April Chang-Miller, M.D.,
and colleagues answer select
questions from readers.

Answer

There's no definitive evidence that magnet therapy relieves pain. However, anecdotal evidence seems to suggest that some people do experience some pain relief from magnet therapy.

Many theories have been proposed as to why magnet therapy may relieve pain. But none of these theories has been scientifically proved. Clinical trials involving magnet therapy have produced conflicting results. Some suggest effective pain relief from magnets, and others report no effect.

The vast majority of magnets marketed to consumers to treat pain are of a type called static magnets, because the resulting magnetic fields are unchanging. The other magnets used for health purposes are called electromagnets, because they generate magnetic fields only when electrical current flows through them. Currently, electromagnets are used primarily under the supervision of a doctor or in clinical trials.

Static magnets come in various strengths. Examples of products containing magnets include shoe insoles, heel inserts, mattress pads, belts and bracelets. Some of these products can be quite expensive.

Additional, larger and higher quality studies are needed to determine what role, if any, magnet therapy may play in pain relief. In the meantime, it is reasonable to say that some people appear to get some benefit from magnet therapy �?although this may be in part to a placebo effect. Also, no significant adverse effects have been reported with magnet therapy.

Bottom line: You must decide how much money you want to spend on a treatment that may or may not help but probably won't do any harm.

By Mayo Clinic Staff
Jul 13, 2006

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Pain quiz: Do you believe the myths?

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Pain can interfere with work, sleep, intimacy and overall happiness. But many people live with untreated pain anyway. Some don't seek relief because they've bought into the common myths, misconceptions and misunderstandings about pain and pain control.

Don't let yourself be duped. Learn to separate fact from fiction.

Click the button to take the quiz!

By Mayo Clinic Staff
Mar 27, 2007

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