In the first part of this “Pain 101” series of articles, we discussed what pain is (nerve impulses telling us something is wrong with the body) and where it is experienced (in the brain, not necessarily where we “feel” the pain). In this second part, the pain management specialists from MTV IR explain how modern medical science treats pain, to either eliminate or manage it.
Treatment depends to some extent on the nature of the pain
In PAIN 101A, we explained that there are two basic types of pain – acute (short-lived) pain, and chronic (long-term) pain. The treatment option that will work best for you depends to some extent on several factors – whether your pain is acute or chronic, how severe your pain is, and how you respond to different types of pain treatment.
Acute pain – which in most cases is caused by tissue damage from disease or injury – is most often first treated directly, by helping to heal the source of the pain. If you break your leg, for example, the doctor’s first step is set the broken bones and do everything possible to help the leg heal. The same is true of many forms of disease. For example, if you have a cancer that is causing pain, the first step (if possible) is to remove the tumor so that it isn’t destroying nearby tissues and continuing to cause pain.
In some cases, however, direct treatment doesn’t always eliminate all of the pain, and it becomes chronic. So a secondary approach to the treatment of pain is to block the pain, to prevent the nerve impulses that are really causing the pain from reaching the brain.
Different types of pain may be treated in completely different ways, and using very different methodologies. Treatments that are effective at managing one type of pain may not work on another type.
Basic pain treatment
Acute (short-term) pain can often be effectively treated using a combination of the two approaches discussed above. First, the doctors do everything they can to remove or repair the damaged tissues so that they are no longer sending out as many pain signals to the brain.
But because full healing can take some time, doctors supplement direct treatment of the illness or injury as necessary with treatment options to block the nerve impulses that are still being generated from reaching the brain. If the nerve impulses can be prevented from reaching the brain, it can’t receive them and interpret them as pain. Thus basic pain treatment includes:
- Repairing the source of the pain.
- Prescribing rest and dietary changes to help the body heal itself.
- Exercise and physical therapy, to help damaged tissues heal faster.
- Topical heat or cold treatments, applied externally.
- Anti-inflammatory drugs (NSAIDs, such as Ibuprofen) to block nerve impulses traveling to the brain, so you don’t experience them as pain.
- Opioid-based drugs are sometimes prescribed for the most extreme acute pain, such as that experienced following surgery, burns, and broken bones.
In many cases, this basic approach is sufficient. Patients whose pain steadily diminishes and goes away within a couple of months rarely need more treatment.
Mid-level pain treatment
Pain that either becomes so severe that the above measures don’t work, or that persists long enough to be considered chronic pain may require more extensive treatment, including:
- Prescribing stronger opioid-based painkillers. In many cases, these drugs work to block the nerve impulses to the brain so that you feel less pain.
- Nerve blocks, created by injecting steroid, anesthetic, or anti-inflammatory drugs directly into the pain area.
- More extensive thermal treatments, such as delivering extreme heat or cold to the pain area through needles or probes.
- Psychotherapy, in the form of cognitive and behavioral modification, may help with the emotional side of pain, to keep chronic pain from completely dominating your life.
- Other treatment techniques such as transcutaneous electrical nerve stimulation (TENS), in which low-voltage electrical currents are used to block local pain receptors from sending nerve impulses to the brain.
Of these options, the most prevalent, of course, is the use of prescription drugs, most of them opioid-based. For many people, these more powerful painkillers work to eliminate most or all of the chronic pain they’re experiencing.
As you’ve undoubtedly seen in the news, however, these drugs come with some pretty serious “down sides,” such as the risk of addiction or overdose. They also – for reasons doctors don’t fully understand – don’t work as well for some people as they do for others, and they can lose their effectiveness over time.
Some people dealing with chronic pain have found some relief from alternative treatments such as acupuncture, biofeedback, relaxation and massage therapy, mindfulness meditation, and physical manipulation therapy.
When chronic pain doesn’t respond to either basic or mid-level treatment
There are many cases in which the treatments discussed above just don’t seem to work. They eliminate some of the pain, some of the time. But the person is still left experiencing pain on a regular basis, sometimes every day.
This is a debilitating condition that really takes its toll, both on an individual and a societal level. Researchers estimate that chronic pain that doesn’t fully respond to treatment costs America 560 to 635 million dollars per year in treatment costs, lost wages, and missed days of work.
In some cases, chronic pain that doesn’t respond to treatment can result in intractable pain – pain so continuous and so intense that it can destroy a person’s quality of life and will to live. Intractable pain can cause a person to become bed-ridden, and puts him or her at a much higher risk of early death.
Fortunately, there are treatment options other than the basic and mid-level ones discussed above. The interventional pain management procedures we specialize in at MTV IR may offer help to those dealing with chronic or intractable pain. In many cases these advanced treatments can help people to “get their lives back” from chronic pain, and once again maintain their daily activities and an active quality of life. In the third part of this PAIN 101 series, we will discuss these procedures.