The Enid News and Eagle, Enid, OK

September 18, 2013

Many treatments now are available for chronic pain

By Judy Rupp, columnist
Enid News & Eagle

— 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.