Pain Management or Surgery?
Pain Treatment Options
The range of treatment options for pain is vast and deep. Treatments for pain involve both non-surgical and surgical options. Treatments for chronic pain (regardless of the cause) are quite diverse. Surgical alternatives are a later course of treatment if other means have been exhausted. Generally, no single technique will yield complete pain relief. Therefore, it is often necessary to utilize a combination of treatments. Your doctor will work with you to identify a course of treatment that is best for your diagnosis.
Pharmacotherapy: includes both prescription and nonprescription medications delivered via several routes (e.g., orally, intravenously, topically).
- Acetaminophen: available over-the-counter; commonly used for headaches and minor aches and pains. It is both a pain reliever (analgesic) and a fever reducer (antipyretic). Tylenol is a brand name example.
- Nonsteroidal Anti-inflammatory Drugs (NSAIDs): there are both over-the-counter and prescription NSAIDs. They are both a pain reliever and an anti-inflammatory agent. Aspirin, ibuprofen, naproxen, and Celebrex are examples.
- Muscle relaxants: available only by prescription; they reduce muscle spasms but are also sedatives. Cyclobenzaprine (Flexeril) and metaxalone (Skelaxin) are examples.
- Corticosteriods: available only by prescription; they are anti-inflammatory agents. Examples include prednisone and dexamethasone.
- Opioids: morphine-like drugs available only by prescription; there are several classes of opioids. They are the most effective analgesic agents and are used for moderate to severe pain. Opioids reduce the pain signals sent to the brain. Percocet and Vicodin are examples.
- Anti-convulsants: available only by prescription; these can be used to treat neuropathic pain. Neurontin and Tegretol are examples.
- Anti-depressants: available only by prescription; many anti-depressant medications are also analgesics. They can be used to treat chronic pain even in patients without depression. Elavil, Paxil and Wellbutrin are examples.
- Topical agents – standard and compounded: there are both over-the-counter and prescription topical agents. These are drugs applied to the skin via a spray, cream or patch. Topical capsaicin is an over-the-counter example; lidocaine patches are a prescription example.
Injections and blocks: these are site-specific injections that deliver medications to decrease swelling, inflammation and/or pain.
- Epidural: injection of an anesthetic and/or steroids around nerve roots in the epidural space.
- Root/peripheral nerve injection: this is an alternative way to access the nerve root; it too is an injection of an anesthetic and/or steroids around nerve roots.
- Facet joint injection: injection of an anesthetic and/or steroids into the facet joint(s) in the spine.
- Ganglion block: an injection of an anesthetic around a ganglion (group of nerves) to reduce pain.
Acupuncture: An ancient Chinese practice of inserting extremely thin needles into specific points of the skin to relieve pain.
Chiropractic care: focuses on the relationship between structure and functionality of the body. Chiropractic manipulations often involve movement of joints beyond their usual range of motion in an attempt to provide relief from pain and improve functionality.
Physical therapy/physiatry: a tailored stretching and exercise program is used to increase mobility and decrease pain. Other treatment modalities may be used, including: ultrasound, transcutaneous electrical nerve stimulation (TENS), deep tissue massage of muscles and connective tissues, as well as heat and ice therapy.
Trigger point injections: these injections treat areas in a muscle that contain knots (trigger points). The injection may allow muscles to relax and decrease inflammation.
Psychological therapy: Psychological treatments provide methods that can treat pain directly by reducing physiological stress that often aggravate pain, and helping patients learn how to improve their quality of life. Specific treatment techniques may include: individual and group counseling, cognitive and behavioral therapy (including mindfulness-based cognitive therapy), relaxation and stress reduction training, hypnosis, and biofeedback.
Nutritional therapy: many pathological conditions can be either caused or exacerbated by nutritional deficiencies. Patients often work with a physician and clinical dietician to determine the presence of any nutrient deficiencies (including vitamin and mineral) and formulate a corrective plan.
Neurostimulation: a device is surgically implanted that delivers electrical signals to the spinal cord, brain or specific nerves. Basically, the electrical signals disrupt the pain signals being sent to the brain.
- Peripheral nerve stimulation: an electrode is placed along the course of a peripheral nerve (e.g., sciatic, ulnar or median nerves) that may be the cause of pain, numbness or tingling.
- Spinal cord stimulation: a device is surgically implanted that delivers electrical signals to the spinal cord to disrupt pain signals.
- Deep brain stimulation / motor cortex stimulation: an electrode is implanted directly into the brain, which delivers an electrical stimulus to specific parts of the brain. The electrical stimulus disrupts pain signals from reaching a specific region of the brain.
Targeted drug delivery: this is delivery of medications directly to a specific site deep within the body versus taking a medication orally, intravenously or topically.
- Intrathecal drug delivery (aka pain pump): a pump is surgically implanted under the skin and it delivers medication (e.g., opioids or anesthetics) directly into the cerebral spinal fluid (CSF).
- Intraventricular drug delivery: medication is injected directly into a specific portion of the brain (called a ventricle); alternatively an implantable pump can be used.
Neuroablation / radio frequency (RF) ablation: these procedures use radio waves to deactivate a specific part of the nerve, spinal cord or brain that is causing pain.
- Spinal cord ablation: radio waves are used deactivate specific portions of the spinal cord. Cordotomy, myelotomy, dorsal root entry zone lesion are examples of spinal cord ablation procedures.
- Peripheral nerve ablation: radio waves are used to deactivate specific portions of a peripheral nerve (e.g., sciatic, ulnar or median nerves) that may be the cause of pain, numbness or tingling. Rhizotomy and sympathectomy are examples of peripheral nerve ablation procedures.
- Brain / brainstem ablation: radio waves are used to deactivate specific portions of the brain or brainstem that may be the cause of pain. Tractotomy, thalamotomy, cingulotomy and hypophysectomy are examples of brain and brainstem ablation procedures.
This list is thorough, but by no means all-inclusive. Your doctor will recommend the course of treatment that is most appropriate for your individual condition. Always ask your doctor about the efficacy of treatment, the duration, the results you can expect, and any other questions you have to help you understand the care provided. Read all the pain articles found within this website and ask questions about terminology and treatments. Conversations between you and your doctor will help him understand your condition better and will involve you in the outcome of your treatment.