How can chronic pain be cured?
Treating chronic pain is a challenge! Chronic pain usually does not respond to standard treatment, since establishing the cause of pain is often difficult. Further, the presence of pain for a long period of time may lead to other disease conditions such as depression. The accompanying condition, whether the cause of the chronic pain, or caused as a result of the pain, also need to be diagnosed and treated simultaneously. Lastly and most importantly, chronic pain affects the overall functioning and quality of life of the individual. Thus, one of the major goals of chronic pain treatment, along with reducing pain, is improving the quality of the patient’s life. Chronic pain is rarely cured ? but can be managed successfully, so that it significantly improves an individual’s functioning and quality of life.
Chronic pain can be caused by a number of conditions, such as headaches, back pain, arthritis, multiple sclerosis, depression, etc. Therefore, treatment should vary, depending on the cause of the chronic pain. Based on the cause and severity of the pain, accompanying conditions and the extent to which it affects the individual’s life, an individualized treatment program should be developed.
Typically treatment of chronic pain would involve a combination of medication and therapy (physical, psychological and social) aimed at:
- Reducing and managing pain better
- Addressing emotional/psychological issues
- Improving an individual’s ability to function
thereby enhancing the individual’s physical, psychological and social well being.
To accomplish all these goals, chronic pain is best managed by a multidisciplinary approach involving the following methods:
Medication: Medicines are used to stop or reduce the severity of the pain and are an integral part of chronic pain treatment. Pain killers, antidepressants, anticonvulsants, nonsteroidal anti-inflammatory drugs (NSAIDS) are some of the commonly used drugs to treat chronic pain. The first goal of treatment should be to ease pain in patients suffering from chronic pain. Until the patient is made to feel comfortable by alleviating the pain, other therapies, especially physical therapy which aims at getting the individual who has become inactive to be active, cannot be performed.
Stimulation Techniques – This involves placing tiny electric needles (electrodes) under the skin at specific points to stimulate the nerves to activate the body’s production of it’s natural pain killers -endorphins. Transcutaneous electrical nerve stimulation (TENS) is one such approach commonly used to treat chronic pain patients. Acupuncture (with or with out electrical stimulation) is also used and has proved effective.
Improving movement and function
Physical and Occupational Therapies – These therapies aim at improving movement and function in the individual suffering from chronic pain.
Physical Therapy (PT) aims at improving the strength and flexibility of an individual. PT techniques include low-impact exercises like walking, swimming or biking, stretching, massage, hot or cold applications, traction, positioning, ultrasound therapy and chiropractic manipulations. PT can be used to control pain and movement – heat, massage and stretching can be used to alleviate excess muscle contraction and pain.
Occupational Therapy (OT) – aims at improving a persons’ functional abilities. It teaches individuals with chronic pain to adapt to their problem and to perform everyday tasks in a way that any further pain or injury is avoided. OT is used as a preliminary desensitization technique with patients who have chronic pain. The desensitization techniques could involve rubbing or tapping the skin, exposing the skin to vibration etc. to reduce sensitivity and pain.
While both therapies aim at improving movement and function and sometimes overlap, they differ in their primary focus. The focus in physical therapy is addressing the physical injury – be it muscular, tissue or joint related – and improving movement and flexibility in the affected area/s. While occupational therapy aims at getting the individual with pain to work around the problem and learn new techniques to perform activities without causing further damage or injury.
Addressing Psychological factors
Psychological Therapies – Psychological evaluation and treatment forms an important part of chronic pain management, because many psychological factors can cause or increase pain and the disability associated with the pain. A psychologist is required to rule out underlying or accompanying psychological disorder, identify the levels of stress, anxiety, depression – if present – and ascertain the distress the individual is in. Psychological therapies aim at alleviating stress, improving coping skills, decreasing pain intensity and bringing about a sense of relaxation and well being in the patient. An important aspect of the individual’s life that usually gets affected is sleep, which only adds to their despair. Relaxation techniques and behavioral therapy can be used to address sleep related problems, stress and anxiety. Other therapies used to treat chronic pain patients are cognitive behavior therapy and biofeedback techniques which aim at changing the individuals’ perception of pain and gaining control over their pain.
Some cases of chronic pain cannot be taken care of by medication and/or physical and occupational therapies. In such cases surgery might be needed. Surgery is rarely suggested as a primary treatment for chronic pain. It is usually suggested to treat the disorder underlying chronic pain. For instance, when chronic pain is being caused by a disc in the spine which might have slipped out of place, a minor surgery might be performed to push it back in place. In such as case, no amount of medication, physical and occupational or psychological therapies would take care of the problem in the way that surgery would. Another example where surgery would be the required method of treatment is when the cause of pain is a malignant tumor.
With a well structured and comprehensive treatment plan, tailor made to the individual and taking into account the cause and effects of pain, chronic pain can be successfully controlled and minimized. Chronic Pain is a biopsychosocial condition and all three aspect of the pain – physical/biological, psychological and social, need to be treated. This condition is thus difficult to get treated by a single doctor and requires the services of an interdisciplinary team.