No one has time to be in pain. And for those who live with pain every day, relief can’t come soon enough, regardless of when the pain started or how long it has lasted.
Chronic pain is pain that lasts and lingers — sometimes defined as pain that persists for more than six months. This is in contrast to acute pain — such as pain from a broken bone, a kidney stone or surgery — which is circumstantial and resolves over time.
Everybody’s experience with chronic pain is different, and there are different types of chronic pain. To successfully treat and manage chronic pain, it’s important for your healthcare team to first diagnose and understand what type you have.
For example, if you’re given a diagnosis of low back pain, your next questions should be, “What are the potential causes of my low back pain?” “Are there problems with my spine anatomy or nerves that are producing pain and any other related symptoms?” according to W. Michael Hooten, M.D., a pain specialist, anesthesiologist, psychiatrist and medical director of the Pain Rehabilitation Center on Mayo Clinic’s campus in Rochester, Minnesota.
Keep asking questions until you understand the potential causes or sources of your pain, Dr. Hooten says. This type of clinical assessment of your pain may take time. It may require a thorough physical examination and diagnostic testing. And establishing effective communication between you and your healthcare team is critical.
But it’s worth the effort, because this information can help your healthcare team find the most effective treatments for you — which may include a broad range of nondrug treatments or carefully selected pain medications, says Dr. Hooten.
Different types of pain
Sometimes nondrug pain treatments and medications do not provide the anticipated level of pain relief. This is often partly due to an incomplete understanding of the medical causes of chronic pain symptoms, Dr. Hooten says.
When considering the potential causes of chronic pain, it can be helpful to organize symptoms and other clinical information around the three main categories or types of pain: neuropathic pain, nociceptive pain and nociplastic pain. Knowing which type you have can help determine the best treatment for you.
Neuropathic pain
Neuropathic pain is pain that is caused by damaged nerves. That type of pain is often associated with tingling, burning or electrical sensations.
“For example, if a nerve is injured by surgery or trauma, this could result in permanent nerve damage that could cause neuropathic pain,” Dr. Hooten says. “There are also many diseases that can cause nerve damage and neuropathic pain.”
For example, diabetes is one of the most common diseases that damages the peripheral nerves in the feet and lower legs. This disease process is called diabetic peripheral neuropathy and it is an important cause of neuropathic pain.
Nociceptive pain
Nociceptive pain is caused by damage to joints, muscles and tendons, or bones, such as pain from osteoarthritis, a torn rotator cuff in the shoulder or tendinitis.
“Chronic low back pain is a common example of nociceptive pain, where the small joints and muscles of the lumbar spine are important sources of chronic pain,” Dr. Hooten says.
Nociplastic pain
The most common symptom of nociplastic pain is increased sensitivity to painful and nonpainful sensations. For example, you may experience certain sensations — such as gentle touch — as painful when others do not. One of the most commonly occurring nociplastic pain conditions is fibromyalgia.
Is it OK to use opioids for chronic pain?
Opioids are often useful in treating severe, acute kinds of pain including postoperative or surgical pain. These types of medications include morphine (Duramorph, MS Contin, others), fentanyl (Actiq, Fentora), codeine, hydrocodone (Hysingla ER) and oxycodone (OxyContin, Roxybond, others). Opioids attach to opioid receptors, which are distributed throughout the body. Pain signals are blocked when an opioid medication is attached to an opioid receptor. These medications can also boost or create temporary feelings of pleasure or relaxation.
Because of their risks, including addiction and accidental overdose, opioids are typically not a good choice to treat chronic pain. Instead, opioids are best used at the lowest dose possible and often for just a few days.
Due to extensive media coverage of the dangers of opioids, most people Dr. Hooten encounters are very aware of the risks and want to either avoid these medications entirely or proceed with caution, he says.
“I do believe most people are generally informed about the risks of opioids, and the vast majority are very cautious about using an opioid pain medication,” he says.
However, opioids can be useful in treating a limited number of chronic pain conditions including cancer-associated pain. In neuropathic pain, very low-dose opioid pain medications can be successfully combined with other nonopioid drugs.
“This is called multimodal pharmacotherapy and it refers to the process of carefully prescribing pain medications that affect different receptor systems in the body. This can improve pain relief by ‘attacking’ pain from different angles,” Dr. Hooten says. “So when using a multimodal approach, the opioid medication is used at very low dosages and it is a very small component of a larger treatment plan.”
What nonopioid medications can help treat pain?
Nonopioid medications can be helpful components of pain management, but they are not without their own set of side effects and potential benefits. There are several types or classes of medications to consider, including:
- Antidepressants and anti-seizure medications. These may be prescribed for chronic neuropathic pain or nerve pain because they help suppress pain signals that can be produced by damaged nerve cells. Examples of pain-relieving antidepressant medications include amitriptyline, nortriptyline (Pamelor) and duloxetine (Cymbalta). Examples of pain-relieving anti-seizure medications include gabapentin (Neurontin, Gralise) and pregabalin (Lyrica). Side effects of these medications are common and may include nausea, dizziness, drowsiness and a sense of tiredness.
- Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs include ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). Generally, these drugs are safe but can cause stomach and kidney problems, especially when used long-term or when used in amounts greater than the recommended dosages. Your healthcare team may recommend acetaminophen (Tylenol, others) for certain types of chronic pain, such as osteoarthritis. Taking more than the recommended dose or taking acetaminophen with alcohol increases the risk of liver damage over time.
Getting proper care for your chronic pain
If you are experiencing chronic pain, you may need to advocate for yourself in your healthcare provider’s office. After seeing your care team, some important questions to ask yourself include:
- Did members of the healthcare team take time to listen, or was I cut off?
- Did I receive a thorough, pain-focused physical examination?
- Were the reasons for ordering diagnostic tests discussed? Were the test results explained?
- Does the recommended treatment plan fit the chronic pain diagnosis?
It can help to come to appointments with a list of questions you need your care team to address. Some people like to bring along another person to appointments to provide support, take notes or ask further questions.
But sometimes a healthcare professional is not a good fit, and you may want to consider switching to a different one if possible. This may be necessary to find the safe and effective pain management you deserve.
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