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pain manegament

Doctors with special training in pain management. Most pain, such as that from cuts and scrapes, is self-limiting and goes away within a few days or weeks. Chronic pain, usually defined as pain that lasts longer than three months, may require a specialist in its treatment. Some of the most common conditions that cause chronic pain are chronic headaches, persistent back pain, cancer, arthritis, and nerve damage, such as diabetic neuropathy.

More than ever before, doctors are taking chronic pain very seriously. They now realize that injury
to the body’s tissues can trigger long-term changes in the spinal cord and brain, so that people can feel significant pain even when no organic cause can be found. As a result, pain management has become a medical specialty. Pain management specialists are doctors who have taken extra training in pain management, and most of them are board certified in this specialty. They are specially trained in the diagnosis and treatment of chronic pain.

With proper diagnostic testing such as x-rays and magnetic resonance imaging (MRI), the underlying cause of chronic pain can be determined in an estimated 90% of cases. Even when the exact cause is unknown, chronic pain can often be at least partially alleviated.

There are now a number of different approaches doctors can use to alleviate chronic pain. One is medication. For most types of pain, aspirin or other over-the-counter pain relievers are effective. For stronger pain, several different types of drugs are available, including the following:
• Opiate-related drugs such as codeine, propoxyphene (brand name Darvon), morphine, and meperidine (Demerol) offer highly effective pain control but may have harmful side effects.
• Some antidepressants have turned out to have some pain-relieving effects, especially in nerve-related conditions such as diabetic neuropathy.
• Antiepileptic drugs such as phenytoin (Dilantin) and carbamazepine (Tegretol) may also be useful in treating the pain associated with nerve-related disorders.

In some cases of intense chronic pain treated with opiates (also called narcotics), there comes a point where the dose cannot be increased because of side effects. These cases may be treated with nerve blocks, using anesthetics and steroids injected directly into nerves along the pain pathway. Delivering the drugs directly to where they do the most good can prevent the side effects associated with large doses of narcotics, which include vomiting, respiratory depression, and sedation.

Electrical stimulation techniques, which use the body’s own natural pain relief mechanisms, have been used successfully to treat neuropathic pain without the side effects associated with drugs. Electrical spinal cord stimulation (ESCS) uses electrical current to stimulate the nerves of the spinal cord that inhibit pain perception. A similar technique called transcutaneous electrical nerve stimulation (TENS), which involves sending electrical pulses through the skin, may work by stimulating blood circulation to the affected areas, by stimulating pain-relieving endorphin release, or by blocking pain messages from reaching the brain.

Some “mind over matter” approaches may help people to tolerate chronic pain better. In some cases, anxiety, depression, and feelings of helplessness, hopelessness, and isolation can make the suffering worse. Behavioral medicine “tools” such as positive imagery, stress reduction, involvement in enjoyable activities, and trying to move people out of the “sick role” can help people better cope with chronic pain. Hypnotherapy may relieve pain symptoms, or at least the stress that accompanies them, in many chronic pain sufferers.

If you are experiencing chronic pain, speak with your doctor about your options. Even if one treatment has been unsuccessful in the past, other approaches may be more successful.