The Enid News and Eagle, Enid, OK

Enid Features

September 18, 2013

Many treatments now are available for chronic pain

— Pain happens. It’s a prime symptom of most injuries and illnesses. When the pain fades, you know that you’re getting better.

But what happens when the pain does not go away — when it lingers for months or even years? Some define chronic pain as pain lasting six months or longer; others say it’s pain lasting longer than expected. It can occur from a number of causes: sports injury, car accident, headaches, arthritis, shingles, sciatica, chronic fatigue syndrome, fibromyalgia or headaches. Chronic pain is closely associated with depression, both as a cause and an effect. In many cases, doctors cannot really find a satisfactory explanation for the pain.

Pain begets pain. Frustration related to chronic pain leads to stress, and stress causes more pain. Pain that keeps you awake at night makes you feel tired and painful the next day. And the increased pain makes it even harder to sleep.

The most obvious way to deal with pain is to pop a pill — aspirin, ibuprofen, naproxen. While these are perfectly safe over-the-counter pain killers for occasional use, they are not intended to be taken at high doses for long periods, as many patients use them.

All nonsteroidal antiinflammatory drugs (NSAIDs) — both over-the-counter and the stronger prescription medications — increase the risk of gastrointestinal bleeding — often severe.    

COX-2 selective inhibitors were introduced in the 1990s in order to reduce this risk. Clinical studies found they were very effective in doing so, and they were hailed as a major advance for patients suffering chronic pain.

That optimism quickly faded, however, when studies found an unequivocal association between COX inhibitors and the risk of heart attacks.

And in the fallout from this discovery, large meta-analyses found they were indeed no more nor less dangerous to the cardiovascular system than traditional NSAIDs. The Food and Drug Administration now requires that all NSAIDs carry a boxed warning about their cardiovascular risks.

In the meantime, though, researchers have gained greater knowledge of chronic pain and how it develops. Using brain scans, researchers found that the architecture of the brain changes in response to persistent pain.

Through a process known as “central sensitization,” the initial pain from an injury or illness can gradually become chronic. If the pain signals are not adequately treated, they are sent again and again, causing changes in the central nervous system. Eventually, even the slightest touch becomes painful. Clearly, “toughing out” pain is not the answer; early treatment is the key to long-term success.

Most patients, and even doctors, find it hard to think of pain as something separate from the underlying cause. It’s important to treat the underlying cause, and that will usually make the pain subside. In some cases, though, the pain continues even after successful treatment. Long-term  management then typically requires seeing a pain expert, as well as your regular physician.

Most pain experts take a holistic approach that involves treating both mind and body. Patients are encouraged to think less about their pain and more about what they want to do that they can’t do because of their pain. The goal is to find ways to do those things.

One of the best treatments — nearly all agree — is exercise or physical activity. It improves circulation and muscle tone, distracts the mind from the pain, elevates mood and stimulates the production of natural pain killing neurochemicals.

Traditional pain killing drugs — even NSAIDs — are still used for short-term relief from pain caused by inflammation. The next level, for severe or persistent pain, involves narcotic medications such as codeine, fentanyl, morphine and oxycodone. These work directly on the pain receptors in nerve cells. Contrary to belief, there is only a small risk of addiction with such drugs if prescribed appropriately for patients with no risk factors for addiction.

There are other approaches: 1) anticonvulsants such as Lyrica, Neurontin or Tegretol; and 2) antidepressants such as Elavil, Pamelor, Norpramin or Cymbalta. These have been found effective whether the patient is depressed or not.

Non-drug treatments include TENS (transcutaneous electrical nerve stimulation), biofeedback, relaxation therapy, hypnosis, massage, acupuncture, nerve blocks and trigger point injections. In some cases, surgery (such as removing a tumor) can give relief.

Dealing with chronic pain is never easy and nearly always requires more than one approach or treatment. A good pain management team can help you reduce your suffering, even if the pain is never entirely eliminated. And, more important, they can help you learn to go on with your life.

Rupp is a certified information and referral specialist on aging for NODA Area Agency on Aging. Contact her at 237-2236.

1
Text Only
Enid Features
  • peggy goodrich.jpg Are you hungry for knowledge?

    I am so pleased that Enid and other cities are offering “Lifelong Learning.” It consists of classes on current events, art appreciation, psychology, our government and other interesting topics.

    April 15, 2014 1 Photo

  • denny.krick.80th.jpg Krick, 80

    Dr. Denny Krick will celebrate his 80th birthday in Branson, Mo., from April 17-21. Cards may be sent to 2610 Indian Dr., Enid, OK 73703.

    April 15, 2014 1 Photo

  • Mary.Oller.90th.jpg Oller, 90

    Mary Oller will celebrate her 90th birthday with family on Saturday, April 19. Cards may be sent to 3219 W. Cherokee, Enid, OK 73703.

    April 15, 2014 1 Photo

  • Menus for 4/14/14

    April 13, 2014

  • Datebook for 4/13/14

    April 12, 2014

  • Judy rupp.jpg Crohn’s: Another type of urgency

    April 11, 2014 1 Photo

  • Leatherman, Mildred_94.jpg Leatherman, 94

    Mildred Leatherman will celebrate her 94th birthday with a reception for family and friends at 3 p.m. Saturday, April 12, at the TPI Building, 320 W. Maple. She requests no gifts. Cards may be sent to 125 N. Burdet, Enid, OK 73701.

    April 8, 2014 1 Photo

  • peggy goodrich.jpg Gadgets for every purpose

    Do you fall for every new-fangled gadget? Think about it.

    April 8, 2014 1 Photo

  • Lansdown, Maxine, 88.jpg Lansdown, 88

    Maxine Tomlin Lansdown will celebrate her 88th birthday with family on Monday, April 14, 2014, at her home at 4913 Evandale, Enid, OK 73703.

    April 8, 2014 1 Photo

  • Menus for 4/7/14

    April 6, 2014

Featured Ads
AP Video
Raw: Ferry Sinks Off South Korean Coast Town, Victims Remember Texas Blast Freeze Leaves Florida Panhandle With Dead Trees At Boston Marathon, a Chance to Finally Finish Are School Dress Codes Too Strict? Raw: Fatal Ferry Boat Accident Suspicious Bags Found Near Marathon Finish Line Boston Marks the 1st Anniversary of Bombing NYPD Ends Muslim Surveillance Program 8-year-old Boy Gets His Wish: Fly Like Iron Man Sex Offenders Arrested in Slayings of CA Women India's Transgenders Celebrate Historic Ruling Tributes Mark Boston Bombing Anniversary Raw: Kan. Shooting Suspect Faces Judge
NDN Video
Baby Sloths Squeak for Their Cuddle Partners in Adorable Video Miley Cyrus Hospitalized After Severe Reaction To Medicine Raw: Ferry Sinks Off South Korean Coast Toddler climbs into vending machine 8-year-old Boy Gets His Wish: Fly Like Iron Man Much-Anticipated 'Gone Girl' Trailer Finally Debuts! (VIDEO) Dog and Toddler Wear Matching Outfits in Adorable Photo Series VP Biden: "World witnesses ordinary citizens doing extraordinary things" It's Official! Michael Strahan Joins "GMA" Blood Moon Time-lapse Actress Lake Bell Goes Topless The Five Weirdest Local Taxes in America Applicants Vying for 'World's Toughest Job' Get Heartwarming Surprise Awkward: Crist catches Lt. Gov. insulting him on camera NASA Showcases Lunar Eclipse US Airways Tweets Graphic Photo of Nude Woman Behind the scenes of the Marathon anniversary photo shoot American Airlines Responds After Girl Tweets Alleged Terror Threat 'Joke' Charlie White's "Dancing" Mistake Olympic Great & Baltimore Native Michael Phelps Ends Retirement; Eyes Rio
House Ads
Comics