5 WAYS TO TREAT CHRONIC PAIN - conclusion

Zapping Chronic Pain With Targeted Procedures

For some, these procedures can also help with chronic pain relief:

Nerve blocks. When a group of nerves is causing pain to a specific organ or body region, the pain can be blocked with injection of a local anesthetic. That's a nerve block.

Injections and nerve blocks are more effective for treating acute pain. "But for people with a pinched nerve, nerve block injections can dampen pain so the patient can function ... get into physical therapy," Chan tells WebMD. "If they're used early on for a pinched nerve, they can prevent chronic pain from developing."

Radiofrequency ablation. In this outpatient procedure, a small area of nerve tissue is heated to decrease pain signals from that area. The procedure is conducted under guided CT imaging. A needle is inserted at the offending nerve site, then an electrical current produced by a radio wave is used for the heat-and-destroy mission. The chronic pain relief lasts for a relatively long period, from three to six months.

"This is a big advance because it is very localized, very specific, pain treatment," says Gallagher. "It's not a cure-all, but it can really make a difference in specific cases."

TENS. Transcutaneous electrical nerve stimulation (TENS) therapy is helpful for short-term pain relief. The treatment involves a small device to deliver low-level electrical current when it's needed to help block pain. "TENs is especially helpful in treating various types of muscle pain, and is often used with trigger point injections," says Abdi.

Trigger point injection. Trigger points are painful sites in muscle or connective tissue. These trigger points can irritate the nerves around them and cause pain in other parts of the body. Extreme tenderness can also develop in nearby muscles or regions of the body.

In a trigger point injection, a local anesthetic (sometimes with a steroid) is injected into trigger point to relieve the pain. It typically takes only a few treatments to resolve trigger point pain.

"Patients can get good muscle pain relief from these injections," Abdi says. "It's a relatively simple, safe procedure. It gives them enough relief that they can go to physical therapy. That's important in preventing a reinjury."

Pumps & Pacemakers: New Generation of Chronic Pain Relief

Pain specialists also turn to more sophisticated technology to offer chronic pain relief.

Pain pacemakers. The technique is called spinal cord stimulation, and it involves a pacemaker-type device that is implanted in the body. The body delivers low-level electrical signals to the spinal cord or to specific nerves, which helps block pain signals from reaching the brain. The patient can adjust the on/off button and adjust the intensity of the electrical signals.

Spinal cord stimulation is often used when other treatments have failed -- as with failed back surgery, says Abdi. "It is also used when cancercancer pain infiltrates a nerve root," he tells WebMD. "When medications don't work, we advise patients to try the stimulator. If it works well, then they can get a permanently implanted stimulator."

Spinal drug pumps. These are also called intrathecal pumps, because they send pain medication to the spinal cord. Local anesthetics, narcotics, and other painkillers can be delivered via these implanted pumps. With the push of a button, a painkiller is delivered to the site -- to block the nerve from sending a pain signal to the spinal cord.

"Often these are used with cancer patients, but also with patients who have tried pain medications but developed side effects," says Abdi. "The dosage is much, much less than an oral dose, so the side effects are less."

There's also a psychological benefit to the pumps, Gallagher says. "You can imagine if you're in agonizing pain after a major injury, and you're being transported to a hospital. If you have control over the pain, you can help prevent posttraumatic stress disorder (PTSD) due to the injury."

Surgery. While most severe pain is treated with medicine, surgery can also help in some cases. Removing a tumor can provide pain relief, as can shrinking a tumor using radiation therapy. In neurosurgery, pain nerves are cut to relieve pain.

Counseling to Cope Better With Chronic Pain

Living with chronic pain is hard, and depressiondepression, anxiety, stressstress, and anger can make pain worse. These negative emotions reduce the body's natural painkillers and increase the body's sensitivity to pain.

When chronic pain sets in, your life shrinks to fit your pain. You're less active, don't exercise. "That perpetuates the pain cycle, because it makes the perception of pain worse," Chan explains. "Your health, work, and relationships all suffer. You can't sleep. You're depressed. When your sleep and mood are affected, it perpetuates the feeling of pain."

With counseling, patients can learn coping skills in dealing with chronic pain. They can also figure out solutions to life problems that are causing stress or depression -- and regain a sense of control and pleasure in life.

Patients who get psychological counseling are also more likely to follow through with their treatment program, says Abdi. "Therapy keeps people actively involved in their physical therapy. Also, we need to make sure we involve family members in psychotherapy. They need to know what the treatment involves, and understand what the patient is going through. Families need to know they are part of the solution."

Alternative Approaches to Chronic Pain Relief

Stress makes pain worse, so learning to relax is a goal for patients. "If you're upset about something, your pain will go up several points on the pain scale," Gallagher explains. "Stress control techniques are very helpful for all types of pain."

Biofeedback, for example, helps people learn to train their minds to control body functions such as muscle tension, breathing, and heart rate -- all of which helps reduce anxiety and stress reactions. Studies have shown that biofeedback reduces frequency and duration of headaches, and works as well as many medications in providing chronic pain relief.

A new twist in biofeedback is being developed, Gallagher says. One group of Stanford researchers is working on an experimental technique in which patients retrain the part of brain involved in uncontrolled pain.

The treatment happens while the patient is having a functional MRI scan, he explains. "They learn to control activation of the brain's pain center... so they can turn off the pain. They are, in effect, teaching the brain to unlearn that pain response. This is very exiting for the field of pain managementpain management. They're helping the brain rewire and unlearn the bad signal activation -- the pain signal activation."

Relaxation techniques are an important part of pain treatment. Deep breathing, meditation, guided imagery, hypnosis -- all these allow mind to help the body. Through regular practice, they help to reduce stress and promote relaxation, which helps with chronic pain relief.

Acupuncture, a traditional Chinese practice, has gained respect in Western medicine. The National Institutes of Health recognizes acupuncture as an effective pain reliever particularly for headache pain and back pain -- and suggests that the practice may help with other chronic pain conditions, including arthritis, fibromyalgia, and muscle pain.

"Acupuncture is definitely helpful with pain, and increasingly more and more insurance companies are covering acupuncture treatments," says Gallagher. The bottom line from Chan: If you have an injury that causes pain, get the pain under control right away. "The attitude in this country is you need to suck it up," he tells WebMD. "But you're not doing yourself any favors if you do that. You need to see a doctor right away. If pain is addressed early on, it is much easier to treat -- before it becomes chronic."