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How is Pain Treated?
The goal of pain management is to improve function, enabling individuals to
work, attend school, or participate in other day-to-day activities. Patients
and their physicians have a number of options for the treatment of pain; some
are more effective than others. Sometimes, relaxation and the use of imagery
as a distraction provide relief. These methods can be powerful and effective,
according to those who advocate their use. Whatever the treatment regime, it
is important to remember that pain is treatable. The following treatments are
among the most common.
Acetaminophen is the basic ingredient found in Tylenol® and its many
generic equivalents. It is sold over the counter, in a prescription-strength
preparation, and in combination with codeine (also by prescription).
Acupuncture dates back 2,500 years and involves the application of needles
to precise points on the body. It is part of a general category of healing called
traditional Chinese or Oriental medicine. Acupuncture remains controversial
but is quite popular and may one day prove to be useful for a variety of conditions
as it continues to be explored by practitioners, patients, and investigators.
Analgesic refers to the class of drugs that includes most painkillers,
such as aspirin, acetaminophen, and ibuprofen. The word analgesic is derived
from ancient Greek and means to reduce or stop pain. Nonprescription or over-the-counter
pain relievers are generally used for mild to moderate pain. Prescription pain
relievers, sold through a pharmacy under the direction of a physician, are used
for more moderate to severe pain.
Anticonvulsants are used for the treatment of seizure disorders but
are also sometimes prescribed for the treatment of pain. Carbamazepine in particular
is used to treat a number of painful conditions, including trigeminal neuralgia.
Another antiepileptic drug, gabapentin, is being studied for its pain-relieving
properties, especially as a treatment for neuropathic pain.
Antidepressants are sometimes used for the treatment of pain and, along
with neuroleptics and lithium, belong to a category of drugs called psychotropic
drugs. In addition, anti-anxiety drugs called benzodiazepines also act as muscle
relaxants and are sometimes used as pain relievers. Physicians usually try to
treat the condition with analgesics before prescribing these drugs.
Antimigraine drugs include the triptans- sumatriptan (Imitrex®), naratriptan
(Amerge®), and zolmitriptan (Zomig®)-and are used specifically for migraine
headaches. They can have serious side effects in some people and therefore,
as with all prescription medicines, should be used only under a doctor's care.
Aspirin may be the most widely used pain-relief agent and has been sold
over the counter since 1905 as a treatment for fever, headache, and muscle soreness.
Biofeedback is used for the treatment of many common pain problems,
most notably headache and back pain. Using a special electronic machine, the
patient is trained to become aware of, to follow, and to gain control over certain
bodily functions, including muscle tension, heart rate, and skin temperature.
The individual can then learn to effect a change in his or her responses to
pain, for example, by using relaxation techniques. Biofeedback is often used
in combination with other treatment methods, generally without side effects.
Similarly, the use of relaxation techniques in the treatment of pain can increase
the patient's feeling of well-being.
Capsaicin is a chemical found in chili peppers that is also a primary
ingredient in pain-relieving cream.
Chemonucleolysis is a treatment in which an enzyme, chymopapain, is
injected directly into a herniated lumbar disc in an effort to dissolve material
around the disc, thus reducing pressure and pain. The procedure's use is extremely
limited, in part because some patients may have a life-threatening allergic
reaction to chymopapain.
Chiropractic refers to hand manipulation of the spine, usually for relief
of back pain, and is a treatment option that continues to grow in popularity
among many people who simply seek relief from back disorders. It has never been
without controversy, however. Chiropractic's usefulness as a treatment for back
pain is, for the most part, restricted to a select group of individuals with
uncomplicated acute low back pain who may derive relief from the massage component
of the therapy.
Cognitive-behavioral therapy involves a wide variety of coping skills
and relaxation methods to help prepare for and cope with pain. It is used for
postoperative pain, cancer pain, and the pain of childbirth.
Counseling can give a patient suffering from pain much needed support,
whether it is derived from family, group, or individual counseling. Support
groups can provide an important adjunct to drug or surgical treatment. Psychological
treatment can also help patients learn about the physiological changes produced
by pain.
COX-2 inhibitors may be effective for individuals with arthritis. For
many years scientists have wanted to develop a drug that works as well as morphine
but without its negative side effects. Nonsteroidal anti-inflammatory drugs
(NSAIDs) work by blocking two enzymes, cyclooxygenase-1 and cyclooxygenase-2,
both of which promote production of hormones called prostaglandins, which in
turn cause inflammation, fever, and pain. The newer COX-2 inhibitors primarily
block cyclooxygenase-2 and are less likely to have the gastrointestinal side
effects sometimes produced by NSAIDs. In 1999, the Food and Drug Administration
approved a COX-2 inhibitor-celecoxib-for use in cases of chronic pain. The long-term
effects of all COX-2 inhibitors are still being evaluated, especially in light
of new information suggesting that these drugs may increase the risk of heart
attack and stroke. Patients taking any of the COX-2 inhibitors should review
their drug treatment with their doctors.
Prepared by: Office of Communications and Public Liaison
National Institute of Neurological Disorders and Stroke
National Institutes of Health
Bethesda, MD
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