Understanding and managing chronic pain

Acupuncture, exercise and massage and physical therapy are among the ways to deal with chronic pain that don't require narcotic painkillers, says Nancy Elder, MD, professor of family and community medicine at the University of Cincinnati.

06 july 2014--"A lot of patients think, 'Oh, I hurt a lot, I hurt a lot all the time, the doctor should give me OxyContin and Vicodin,'" says Elder. "I think the most important thing that doctors and patients need to know is there is much we can do to help patients with chronic pain outside of narcotics.

"That doesn't mean narcotics aren't appropriate for some people in certain situations, but there are a whole lot of people that can get better without them," she adds.

Elder says more doctors must have initial conversations with patients to manage expectations in dealing with chronic pain.

"Part of it is understanding the natural course of chronic pain and some of it is understanding the difference between being cured and being able to 'do what I want to do with pain that is manageable,'" says Elder.

"I may not be able to cure somebody of their chronic pain, but I can make them feel a whole lot better and help them do more of the activities they want to do."

Elder says whenever possible, physicians should involve a multimodality team that may include specialists in physical therapy, massage therapy, acupuncture and chiropractic treatment to address chronic pain. Acupuncture may relieve pain caused by conditions such as fibromyalgia, osteoarthritis and back injuries.

Exercise under a doctor's supervision can improve energy levels and mood and relieve chronic pain, while chiropractic treatment may work well in treating certain types of lower back pain, says Elder. Addressing behavioral/mental health is also important when dealing with chronic pain.

"Pain can worsen depression and depression may make chronic pain worse," says Elder.

There are also surgical possibilities and nerve injections that address some types of chronic pain so collaborations with anesthesiologists are also important, says Elder.

"There are medicines besides narcotics to help chronic pain such as antidepressants; even if you are not depressed, they can help," says Elder.

Medicines that were originally developed for epilepsy may have a benefit in chronic pain. Depending on the type of pain, there are even some cardiac medications that are very helpful, explains Elder. "A lot of other medicines from various areas of medicine have also been found to help with chronic pain," she says. "We call them adjuvant medications because they aren't painkillers, but they work to help decrease chronic pain.

"People with chronic pain, both doctors and patients, need to think outside of the opioid/narcotic pain box," Elder says.