If you suffer from chronic pain, here is some good news: Recently, many new treatments in the management of chronic pain are showing great results, including newer drugs, electrical stimulation, implants and several other breakthrough methods.
New in-depth insights into the brain’s neurotransmitter system and its chemical messengers have been able to better explain how the sensation of pain occurs, writes Syed S. Rahman, MD, a pain management specialist with Westchester Health Orthopedics and Sports Medicine, in his recent blog. This in turn has led to the evolution of new modes of chronic pain management.
Common origins of chronic pain:
- sports injuries
- back injuries
- motor vehicle accidents
- work related accidents/injuries
- health conditions such as arthritis, diabetes, certain cancers, migraines and others
Successful treatments for chronic pain
- Oral pain killers: Tylenol and other NSAIDs (nonsteroidal anti-inflammatory drugs) are still the first line of treatment for chronic pain, especially for arthritis and mild to moderate cancer pain. Lyrica, Gabapentin and Tegretol are all in the NSAID category. Also, a newer generation of anticonvulsants are looking promising and have fewer side effects.
- Antidepressants: Low doses of common antidepressants are currently being used for chronic pain management, relieving pain irrespective of whether the pain sufferer is depressed or not. Specifically, tricyclic antidepressants are successfully managing cancer pain, diabetic neuropathy and postherpetic neuralgia (nerve pain due to shingles). These particular drugs work by affecting the levels of CNS chemicals in the brain, especially norepinephrine and serotonin.
- Cymbalta: This has proven to be an effective SNRI (serotonin and norepinephrine reuptake inhibitor) and is FDA-approved as a medication drug for treatment of diabetic neuropathy, fibromyalgia and musculoskeletal pain.
- Pain patches/pain relief creams: The lidocaine patch, an FDA-approved transdermal patch, is effective for postherpetic neuralgia (due to shingles). Similarly, capsaicin cream is also effective in the treatment of chronic nerve pain. And recently, the introduction of compound pain cream (combinations of various medications including anti-inflammatory, muscle relaxants and anesthetics) is showing promising results.
- Narcotics: These continue to be one of the mainstays for managing severe chronic pain relief. However, there is a serious risk of addiction. Extended-release Tramadol is a non-narcotic drug which works on opioid receptors and is being successfully used for moderate and moderate-to-severe chronic pain, especially when continuous pain relief is targeted. A duragesic patch provides continuous delivery of the narcotic fentanyl (a powerful synthetic opiate analgesic) for 72 hours. Also, Aqtic (in lollipop form) and Fentora (a tablet dissolved in the mouth) are two newer, effective, fast-acting versions of drugs containing the narcotic fentanyl.
How to manage chronic pain with more targeted procedures
- Nerve blocks with anesthetics are very effective.
- Radiofrequency ablations cause thermal injury to nerve tissue to decrease pain signals from that area. A localized and very specifically targeted approach, this is a big step in chronic pain management.
- Spinal cord stimulator placement: Basically a pain pacemaker, this is a small device that is implanted in the body which helps block pain signals from reaching the brain. This is indeed another big step in the management of chronic pain.
- TENS (transcutaneous electrical stimulation): These trigger-point injections to painful sites of muscles and connective tissue are also effective approaches to successfully manage chronic pain.
To read Dr. Rahman’s blog in full, click here.