The Best Treatments for Chronic Pain

Chronic pain affects 1.5 billion people worldwide. Of those, an estimated 100 million people live in the United States. It affects more people than diabetes, heart disease and cancer combined, according to the American Academy of Pain Medicine.

And it involves more than just accidentally touching a hot stove and suffering a burn. It’s more than a bee sting, a twisted ankle or a bout with the dentist’s drill.

Chronic pain is unrelenting. It persists when it should not and lasts longer than three to six months — well beyond the expected or the tolerable. “As we age, there is an increased frequency, severity and incidence of pain,” says Dr. Lynn R. Webster, author of The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us.

When you consider that 50 percent of older adults who live independently, and 75 to 85 percent of the elderly in care facilities suffer from chronic pain, it’s not surprising that Webster calls it “the No. 1 chronic health problem in America that compromises the individual’s quality of life.”

Pain’s most likely forms?

Low back pain, severe headache or migraine and neck or facial pain, according to a National Institute of Health Statistics survey. And there are a host of other causes, many of which are more likely to afflict the aging: arthritis, osteoporosis, shingles, kidney stones, neuropathy from cancer treatments, degenerative disc disease, diabetes and more.

When people with spinal stenosis (a common cause of lower back pain) were asked to choose either a treatment to reduce their pain or a treatment that would help their mobility, they overwhelmingly chose pain relief, according to a new study in the journal Neurology.

But unfortunately, patients’ strong preference for pain relief is not being met: despite its prevalence, chronic pain among older adults is largely undertreated. Pain may be underreported since some people believe it to be a normal process of aging, theorized a 2010 article published in The Ochsner Journal.

Because there are various types of pain with distinctive mechanisms and each individual responds differently to pain, Webster says it’s not uncommon for patients to try different things before settling on one or a combination that works best.

“There isn’t a therapy that is best for everyone; it depends on the person, the type of pain, where it’s located and whatever other conditions the patient has,” he says.

Commonly, the first line of defense in treating chronic pain is to begin conservatively, says Dr. Robert Bolash, an assistant professor of anesthesia at Cleveland Clinic’s Department of Pain Medicine. This includes oral over-the-counter (OTC) anti-inflammatory pain medications like Motrin, Advil, Aleve or Tylenol.

But sometimes, like a cook, “you need to throw several ingredients into a pot to get adequate results,” he says.

That’s where physical therapy might be added to the mix. A good therapist can evaluate the way your body and its muscles move to see if they are negatively impacting your pain, Bolash says. This takes more effort and time from the patient than just swallowing some pills, but has the greatest long-term success.

“Instead of withdrawing from activity, we focus on improving function in order to resume activity with less pain,” he says.

If there’s still no success, or along with the therapy, doctors may prescribe medications that are typically used to treat depression and seizures, like duloxetine (Cymbalta) and imipramine (Tofranil) and gabapentin (Neurontin) or pregabalin (Lyrica), sometimes in combination with one another.

Although the pain-killing mechanism is not totally understood, one theory is that antiseizure drugs may increase neurotransmitters in the spinal cord that reduce pain signals, and that antidepressants prevent endorphins, the bodies’ natural pain-killing chemicals, from breaking down. These types of medication are most commonly used to treat nerve pain or pain caused by spinal cord injury.

Other pain-relieving options include treatments like nerve blocks, steroid injections or trigger point injections (TPI). Various types of nerve blocks can block pain to a specific organ or region of the body related to a single or small group of nerves, while steroid injections reduce inflammation caused by a herniated disk, bursitis and tendonitis.

TPI treats painful areas, or knots of muscle, that form when muscles tighten up, most commonly in the arms, legs, lower back and neck.

When chronic pain doesn’t respond to medication or surgery, implantable devices (known as drug pumps or neurostimulators) may be used. Drug pumps deliver medication directly to the fluid surrounding the spinal cord, while neurostimulation therapy works by sending mild electrical pulses to an area near the spine.

Some turn to complementary therapies like acupuncture for pain relief. While some studies show conflicting results, others have shown acupuncture to help relieve pain and improve movement for those suffering from knee osteoarthritis.

Opioids like hydrocodone (Vicodin), oxycodone (Percocet) and morphine, though powerful treatments for acute or severe pain following trauma, burns, surgery or cancer, should be the last line of defense since they are the most liable to cause abuse and addiction, Dr. Howard L. Fields, wrote in a 2011 article in the journal Neuron.

“There are several evidence-based studies that show opioids are actually harmful in the treatment of chronic pain because they cause opioid-induced hyperalgesia (meaning they make you more sensitive to pain) and can suppress your hormone and immune function,” says Dr. Joshua Shroll, a UCLA pain-management specialist. Ultimately, you become more tolerant and more dependent on the medications, he says.

Addiction and the danger of overdose loom large: More than 16,000 deaths each year occur due to opioid-related overdoses, according to the Food and Drug Administration.

The question of opioid’s long-term benefits coupled with their danger of addiction has forced many experts to reevaluate their use in the management of chronic pain.

Bolash says that before getting caught up in the web of treatment, it’s important to have your pain condition carefully assessed by an expert who can make sure there’s not a reversible cause of pain that can be eliminated. As research into this epidemic expands, hopefully new treatment options will emerge.

“As physicians, we’re treating a larger number of pain conditions, and our interest in rendering the most effective treatment continues to grow,” he adds.