What are the Different Choices of Treatment for Chronic Pain?

Choices of treatment for chronic pain are as follows:

What are the Different Choices of Treatment for Chronic Pain?

Is It Possible to Control Pain With Only Medications?

Yes, mild to moderate pain may respond to medications. Severe pain may not respond to only medications. Pain caused by injuries, trauma and cancer may need surgical treatment. Severe intractable pain responds to opioid treatment in the beginning. In 4 to 6 months or later patient may develop tolerance, resistance, dependence and addiction to opioids. Neuropathic pain is treated with opioids and adjuvant pain medications.

What are the Choices of Pain Medication to Treat Chronic Pain?

Mild to moderate chronic pain is treated with anti-inflammatory medications like motrin and naproxen, which are not expensive. Severe pain may not respond to NSAIDs. Chronic intractable pain not responding to NSAIDs are treated with opioids, muscle relaxants and adjuvant pain medications. In most of the cases of chronic pain treatment, combination of two or three medications are necessary. Opioid treatment for chronic pain includes long acting opioids and short acting opioids. Breakthrough pain is often treated with short acting opioids. Long acting opioids are also known as Extended Release or Slow Release opioids.

What is Breakthrough Pain?

Breakthrough pain is sudden increase of pain intensity during activities despite patient taking long acting pain medications. Breakthrough pain is treated with short acting opioids. Chronic pain at rest responds well to long acting opioids. Pain is often increased with activities.

Which Medications are Considered Adjuvant Pain Medications?

Adjuvant Pain Medications

Adjuvant pain medications are either antidepressant analgesics or antiepileptic analgesics. Antidepressants such as Cymbalta and Elavil are effective and act as analgesics against neuropathic pain. Similarly, antiepileptic Neurontin and Lyrica are effective against neuropathic pain. Pain caused by severe muscle spasm are treated with muscle relaxants. These medications are considered as adjuvant pain medications.

How Common is Opioid Dependence and Addiction in the Treatment of Chronic Pain?

Opioid dependence and addiction is common in chronic pain patients taking opioids for over 6 months. Opioids are by far the best pain medications available to treat chronic pain. Opioids do cause dependence and addiction. Symptoms of dependence and addiction become severe if opioids are continued over 5 to 6 months. Opioids very rarely causes symptom of addiction when given for short period of time for treating acute pain. Acute pain caused by fracture or surgery is treated for short period. Opioid side effects are very common in chronic pain patients treated with opioids for over 6 months. Opioid addiction is often seen with short acting opioids used for breakthrough pain.

Why Are Medications to Treat Chronic Pain Expensive?

Long acting opioids, muscle relaxants and adjuvant pain medications to treat chronic pain are very expensive. Medications used in treating chronic pain are extensively studied for side effects, addiction prevention and structure modification of pills to prevent tampering by drug seeking individuals. Medications overall are very expensive in USA because of third party payment bundled into price of medication. Third party payment includes legal cost and penalties. If pain relief is inadequate with pain medication then alternate or different treatment should be tried.

What Different Treatments are Available to Prevent Opioid Addiction in Chronic Pain Patients?

Alternate treatments that can be considered for treating chronic pain includes manual therapy, interventional pain treatment, alternative therapy and surgery.

What is Manual Therapy?

Manual therapies include massage therapy, physical therapy1 and chiropractic treatment.

What is Interventional Treatment for Chronic Pain?

Interventional treatment2 for chronic pain involves cortisone injection, nerve ablation and cryo ablation of sensory nerve. Advanced interventional treatment for chronic pain involves placement of spinal cord stimulator or intrathecal pump.

What is Alternative Treatment for Chronic Pain?

Non-traditional chronic pain treatment is known as alternative treatment. Traditional treatments are allopathic medications, physical therapy, interventional pain therapy and surgery.

Why is Management of Chronic Pain So Expensive?

Prolonged Pain and Suffering - Chronic pain may last for 6 months or longer. Continuous treatment of chronic pain for several years or lifetime adds up the cost of therapy, hospitalization and nursing home care.

Multiple Choice of Treatment - Chronic pain is an annoying obnoxious sensation and often not tolerated by most of the patients. Patient's demand for pain relief is extremely high. Close relatives often expect immediate optimum pain relief. Chronic pain is aggressively treated by care provider resulting in simultaneous multiple therapies. Patient may be treated with one of the following choice of treatment or combination of more than one modality of therapy.

  • Multiple pain medications.
  • Manual Therapy, Massage Therapy, Physical Therapy and Chiropractic Treatment.
  • Injection Treatment.4
  • Surgeries.
  • Alternative Treatment.

Treatment Cost of Complications:

Side effects-treatment of side effects of opioid and other medications increase the treatment cost of chronic pain.

  • Opioid addiction- cost to treat opioid addiction and dependence5
  • Drug seekers - opioid addict pretend to be pain patients and consume expensive pain medications to treat addiction.
  • Doctor shopper- few individuals pretend to be patient and collect prescription opioids to divert at street for profit.
  • Long term care- cost of hospitalization and nursing home care.
  • Disability- long term and short term disability.
  • Unemployment benefits.
  • Time off from work.
  • Cost of alternative treatment.
  • Litigation.

Is it Worth Spending on Treatment for Chronic Pain?

Yes. The answer to such question by patient, spouse, parents and children is "Yes it is worth spending for chronic pain treatment just to see their loved one without severe pain for one day or one week or one month".

Can Chronic Pain Cause Disability?

Chronic pain is devastating for patient and family. Pain intensity is severe at rest and intensity at times increases several folds with activities. Chronic pain relief is often inadequate with medications, physical therapy, interventional treatment and surgery. Adequate pain relief often lasts for short period of time. Disability is caused by pain, suffering and physical impairment. Severe intractable chronic pain restricts activities. Patient, spouse and relatives often demand sufficient pain relief and also hope the treatment will prevent disability. Individual when unable to work because of severe pain ends up in partial or permanent loss of income or disability. Disabled patient supports his spouse and children with contribution from Worker's Comp or Medicare disability monthly contributions. In most cases disability benefits amount is lot less than actual earning capacity of same individual prior to suffering with chronic pain.

References:

  1. Validity testing of patient objections to acceptance of tamper-resistant opioid formulations.

    Argoff CE, Stanos SP, Wieman MS.

    J Pain Res. 2013 May 16;6:367-73. doi: 10.2147/JPR.S37343.

    Department of Neurology, Albany Medical College Neurology Group, Albany, NY, USA.

  2. Interventional Pain Management for Failed Back Surgery Syndrome.

    Hussain A, Erdek M.

    Pain Pract. 2013 Feb 3. doi: 10.1111/papr.12035.

    Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, Maryland, U.S.A.

  3. Neuropathic pain post spinal cord injury part 1: systematic review of physical and behavioral treatment.

    Mehta S, Orenczuk K, McIntyre A, Willems G, Wolfe DL, Hsieh JT, Short C, Loh E, Teasell RW; SCIRE Research Team.

    Top Spinal Cord Inj Rehabil. 2013 Winter;19(1):61-77. doi: 10.1310/sci1901-61.

    Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute , London, Ontario.

  4. Cost Utility Analysis of Caudal Epidural Injections in the Treatment of Lumbar Disc Herniation, Axial or Discogenic Low Back Pain, Central Spinal Stenosis, and Post Lumbar Surgery Syndrome.

    Manchikanti L, Falco FJ, Pampati V, Cash KA, Benyamin RM, Hirsch JA.

    Pain Physician. 2013 May-Jun;16(3):E129-E143.

    Pain Management Center of Paducah, Paducah, KY, and University of Louisville, Louisville, KY; Mid Atlantic Spine & Pain Physicians, Newark, DE, and Temple University Hospital, Philadelphia, PA; Millennium Pain Center, Bloomington, IL.

  5. Evaluating the cost of opioid dependence treatment models in europe.

    Taylor M, Lewis L.

    Value Health. 2013 May;16(3):A53. doi: 10.1016/j.jval.2013.03.298.

    York Health Economics Consortium, York, UK.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: May 11, 2016

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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