Nociceptive pain is caused by damage to somatic (bone or muscle) or visceral (lung or bladder) tissue. It is typically well localized, constant, aching or throbbing, and resolves as tissue damage heals. A notable exception is arthritis. Nociceptive pain generally responds to nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids.
Neuropathic pain is the result of an injury or malfunction in the peripheral or central nervous system. Nerves are irritated by compression, scar tissue, or inflammation. Faulty signals are sent to the brain and experienced as pain and may be described as burning, lancing, or “electric shock-like.” Examples include sciatica from herniated discs. Neuropathic pain is often chronic, tends to be less responsive to opioids but may respond to anti-epileptic and antidepressant medications. In some conditions, pain can be mixed. An initial nervous system dysfunction or injury may trigger the neural release of inflammatory mediators and subsequent neurogenic inflammation. An example is migraine headaches. Treatment aims at both causes.
Alternatives tools to treat chronic pain include nonpharmacologic modes (lifestyle changes), nonopioid adjuvant analgesics (NSAIDs), opioids, psychological therapies (counseling or cognitive behavior therapy), physical rehabilitation, surgical intervention, and complementary medicine. Treatments may be combined and should be tailored to patient circumstances and integrated as part of a multimodal plan.
Pain medications are now the most commonly prescribed class of medications. All chronic pain should not be treated with opioids. Tramadol, an analgesic that activates mu receptor activity and leads to norepinephrine and serotonin reuptake inhibition, is useful in neuropathic pain and fibromyalgia treatment. Duloxetine is effective in treating chronic musculoskeletal pain, diabetic neuropathy, or fibromyalgia. Topical medications are often underused. Lidocaine 5% patch is approved by the Food and Drug Administration for postherpetic neuralgia. Topical NSAIDs provide significant analgesia, minimal adverse events, and are useful for muscle and joint pain.
Several alternative therapies have demonstrated excellent results in chronic pain treatment of. Practicing meditation over an 8-week period reduces the severity of irritable bowel symptoms in women. Researchers found that participants in the meditation group had greater reductions in symptom severity immediately after the training and at 3-month follow-up. (Gaylord, S.A., Palsson, O.S., Garland, E.L. et al. Mindfulness training reduces the severity of irritable bowel syndrome in women: results of a randomized controlled trial. Am J Gastroenterol. 2011; 106: 1678–1688)
According to 2007 guidelines, acupuncture is 1 of several therapies to consider when patients with chronic low-back pain do not respond to conventional treatment. (Chou, R., Qaseem, A., Snow, V. et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007; 147: 478–491). A large, rigorously designed clinical trial reported in May 2009 found that actual and simulated acupuncture were equally effective—and both were more effective than conventional treatment—for relieving chronic low-back pain. (Madsen, M.V., Gøtzsche, P.C., and Hróbjartsson, A. Acupuncture treatment for pain: systematic review of randomized clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups. Br Med J. 2009; 338: a3115).
Tai chi is a complex integration of mental, spiritual, philosophical, and physical practices. In 1 study, (Wang, C., Schmid, C.H., Rones, R. et al. A randomized trial of tai chi for fibromyalgia. N Engl J Med. 2010; 363: 743). Six fibromyalgia patients who practiced tai chi twice weekly reported less pain, better sleep, more energy, and improved overall health than a comparison group treated with wellness education and stretching exercises.
Chronic pain treatment is optimized by using multiple modes. Careful history, assessment, and diagnoses of type of pain are essential. Complementary therapies are effective and can give patients control in managing chronic pain.
Taken from “Managing Chronic pain:Useful tools and approaches” at http://dx.doi.org/10.1016/j.nurpra.2012.12.015.