Pain Treatments

Basic pain therapies include conservative treatment options. These treatment options include rest and nutrition, non-steroidal anti-inflammatory drugs (NSAIDS), exercise and physical therapy, and cognitive and behavioral modification. The goal of these therapies is to reduce pain and improve mobility.

Rest and Nutrition

Your pain specialist will usually recommend sufficient rest and proper nutrition as a first line of therapy for the treatment of chronic pain. A rested and well-nourished individual is better equipped to battle physical stress and properly recover from pain.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)

The first line of therapy for chronic pain is often non-steroidal anti-inflammatory drugs (NSAIDS). These include common over-the-counter medications, such as aspirin, acetaminophen, and ibuprofen, which treat fever, swelling, arthritis, and other painful conditions.

Physicians may prescribe stronger NSAIDS if rest and over-the-counter medications do not sufficiently relieve pain. Side effects of NSAIDS are usually mild and may include nausea, heartburn, rashes, or upset stomach.

Exercise and Physical Therapy

In addition to rest and medication, your physician may recommend a program that includes physical conditioning to improve flexibility and strengthen your body for a greater chance of recovery. Your physical therapist will evaluate your baseline condition and tailor a plan specifically for you.

Cognitive and Behavioral Modification

Because pain also takes a toll on your mental and emotional well-being, physicians often prescribe cognitive and behavioral modification techniques. These techniques are used to help you relax, reduce stress, and cope with your pain. Forms of cognitive and behavioral modification include meditation and relaxation training, biofeedback, and counseling.

Mid-level pain therapies include more aggressive approaches. When pain does not respond to conservative treatment options, your pain specialist can provide a second level of therapy, including epidural steroid injections or nerve blocks. These injections can lessen the painful signals transmitted to the nerves, offering relief that may range from a few hours to several months.

Transcutaneous Electrical Nerve Stimulation (TENS)

A TENS unit is an external stimulation device that sends electrical impulses through your skin to the painful area. Instead of feeling pain at the site, you feel a tingling sensation. Unlike a spinal cord stimulator, the TENS device does not apply energy directly to the nerve, as it must be transmitted through the skin and muscle to reach the nerves. TENS can alleviate mild to moderate pain, but is often ineffective in treating more complex conditions.

Opioids

Opioids are prescription painkillers that block the ability of receptors in the brain to interpret pain signals. Physicians typically prescribe opioids for severe pain conditions that do not respond well to Level 1 treatment. Opioids can be very effective in relieving pain, but they can carry significant side effects, including drowsiness, constipation, dizziness, and potential addiction.

Epidural Steroid Injections and Nerve Blocks

An epidural steroid injection (ESI) or nerve block is performed by injecting a combination of local anesthetic, steroid, and/or anti-inflammatory agents into the affected area of pain. These injections are used to lessen the painful signals transmitted by nerves with relief ranging anywhere from a few hours to several months.

ESIs and nerve blocks may need to be repeated for sustained relief and to give patients enough relief to successfully complete physical or rehabilitation therapy.

If it is not possible to achieve acceptable pain relief with basic or mid-level therapies, pain specialists will consider more advanced treatment options, such as spinal cord stimulation (SCS). SCS is widely used by pain specialists and is FDA approved for the treatment of trunk and limb pain.

Spinal Cord Stimulation

Spinal cord stimulation (SCS) uses electrical signals to mask the perception of pain traveling from the painful area to the brain. In place of pain, patients feel a mild tingling sensation called paresthesia. SCS can provide long-lasting pain relief and can be used in conjunction with other therapies. Patients are able to control the intensity of the therapy, as well as turn it on and off using a remote control.

Implantable Drug Pumps

Implantable drug pumps, also known as intrathecal drug pumps, deliver pain medication directly to the cerebrospinal fluid in the space surrounding the spinal cord. Direct application reduces the amount of opioids needed to relieve painful symptoms. Pain pumps are often used to treat cancer pain and other conditions that involve both nociceptive and neuropathic pain.

Radiofrequency Ablation

Signals traveling along nerves from painful areas to the brain can be disrupted using extreme heat delivered through needles or probes. Radiofrequency lesioning (ablation) uses high-frequency energy to destroy the nerves that transmit pain signals. The process may temporarily relieve pain, but pain may return as the nerves regenerate. Repeated applications may be necessary for continued relief.

Surgery

Surgical procedures for pain can range from minor outpatient procedures to more invasive brain and spinal procedures. Surgery may be required when pain is caused by an injury, structural problems, or disease. It may also be prescribed in conjunction with other treatments. If our pain management specialists determine that you need surgery for your pain, we will refer you to a neurosurgeon.