5 Ways To Treat Chronic Pain

Chronic Pain Relief: New Treatments

Reviewed By Louise Chang, MD

By Jeanie Lerche Davis

WebMD Feature

If you're living with chronic pain, here's important news. Today's pain specialists have sophisticated new treatments -- from effective drugs to implants and electrical stimulation -- to provide chronic pain relief. There's much that can be done to tame the beast.

These advances have emerged in the past several years, as researchers have gained a greater understanding of chronic pain and how it develops. The origins of chronic pain are all too familiar: sports injuries, back injuries, car accidents -- or health conditions like migraines, diabetes, arthritis, shingles, and cancer.

At times, however, there is no obvious cause of the chronic pain, no trauma or injury people can point to as a source of their chronic pain problem -- which has been frustrating for both patients and their doctors.

The Roots of Chronic Pain -- and Relief

In past generations, people often heard that chronic pain was "all in their heads," says Rollin M. Gallagher, MD, MPH, director of pain management at the Philadelphia VA Medical Center.

Today's pain specialists understand how the sensation of pain occurs -- how the nervous system, including the spinal cord, interacts with the brain to create that sensation, Gallagher says.

Insights into the neurotransmitter system -- the chemical messengers that pass nerve signals -- have opened the door for important new modes of chronic pain relief, he explains. In recent years, scientists have learned how to manipulate those chemical messengers to change the way they interact with the brain's signals.

That's led to use of antidepressants and other drugs that work with specific brain chemicals that affect emotions, and help with perception of pain. "We now have a whole new host of medications that are very effective" for chronic pain relief, Gallagher tells WebMD.

And with advances in MRI imaging, researchers can clearly demonstrate that the changes are very real in the brain, he says. "We can show exactly where the sensation of pain is occurring in the brain when it is activated by stimuli. We can see the effects of pain on emotion -- and emotion on pain."

There's new understanding, too, of a process called "central sensitization," says Kwai-Tung Chan, MD, a pain specialist and professor of physical medicine and rehabilitation at Baylor College of Medicine in Houston. "If initial pain from an injury is not adequately treated, those pain signals are sent repeatedly -- which leads to changes in the central nervous system, making it more and more sensitive. Over time, even the gentlest touch can become very painful."

Pain Specialists: Experts in Chronic Pain Relief With these insights, pain specialists now prescribe treatments that attack moderate-to-severe chronic pain from different angles -- innovative drugs, targeted nerve-zapping procedures, and drug pumps that deliver strong painkillers to the nerve root. Doctors also endorse the use of psychotherapy, relaxation techniques and alternative therapies, supported by growing evidence of the mind-body connectionmind-body connection in chronic pain relief.

It's an exciting time in pain managementpain management -- and there are more advances coming. "Our knowledge has increased tremendously in the last few years," says Salahadin Abdi, MD, PhD, chief of pain medicine at the University of Miami School of Medicine. "We still have a lot to learn, but research has given us clues in developing even newer treatment options."

There's one big problem: Many people don't know that there are medical doctors who specialize in treating pain, Abdi tells WebMD. "We do exist and we can help. But unfortunately, we see many patients in the later stages of chronic pain when it is more difficult to treat. The earlier we start treatment, the better chance we have of being successful in relieving pain."

Medications: First Step in Chronic Pain Relief

When treating pain, doctors typically start with oral painkillers like acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil, Motrin, Naprosyn, and Voltaren. These reduce inflammation and relieve pain, especially related to arthritis, tendinitis, nerve injury, mild to moderate cancercancer pain, and other forms of chronic pain.

Finding which drugs work for your chronic pain will likely be a trial-and-error process -- although specialists are honing in on the solutions. "There is no magic bullet," Chan says. "Some medications work better with specific types of pain. We try different drugs or combinations of drugs until we arrive at what is optimal. Individualized treatment is very important." When pain is severe, doctors turn to stronger pain relief medications:

Anticonvulsants. Drugs used to treat seizure disorders have been effective in chronic pain relief. It's still unclear how they control pain, but the drugs are believed to soften the effects on nerve-related pain such as postherpetic neuralgia from shingles. These include Lyrica, Neurontin, and Tegretol.

A new generation of anticonvulsant drugs is looking promising for chronic pain relief, says Gallagher. "There's a lot of work being done to improve these drugs, make them more convenient to take -- with fewer side effects."

Antidepressants. Low doses of common antidepressants are being prescribed for many chronic pain problems. These drugs adjust levels of brain chemicals, which is thought to be their mechanism for helping to control pain.

Antidepressants often help when patients don't get complete chronic pain relief from other treatments. They relieve pain whether the person is depressed or not. The doses needed to treat pain are usually lower than doses used for depression treatment.