Our guide below examines the risks and benefits of three types of treatments: sleep, exercise, and hands-on therapies; drugs and supplements; and surgeries and injections. You should work with your doctor to figure out the combination of treatments that makes the most sense for you. Reducing pain is important, but the most important goal might be improving your ability to move through your daily activities. Any single nondrug approach to treating chronic pain, such as acupuncture or yoga , might offer only modest benefits.
But research suggests that combining the treatments is the key to lasting pain relief. Move on and try something else. Tauben and other experts CR interviewed say that getting enough sleep can be challenging for people with chronic pain but that it should be one of the first goals in a treatment plan. A psychologist or counselor who specializes in chronic pain can help devise strategies for better sleep, such as sleeping in a dark, quiet room and limiting the use of devices and caffeine before bedtime.
And regular walking, aquatic exercise, and posture improvement programs, such as the Alexander Technique and the Feldenkrais Method, can help reduce pain and make movement easier. Also consider forms of exercise that incorporate mindfulness, such as tai chi and yoga. In a Consumer Reports nationally representative survey of 3, back pain sufferers, 89 percent of respondents who went to a yoga or tai chi instructor for help said the advice or treatment was beneficial. Try Hands-On Healing Last year, a comprehensive research review published by the Agency for Healthcare Research and Quality found good evidence that acupuncture helped with chronic back and neck pain and fibromyalgia, that massage helped with chronic back pain and fibromyalgia, and that spinal manipulation helped with chronic back pain and tension headaches.
And a review by the American College of Physicians found that heat can help ease back pain. Hands-on therapies help in two ways, Schneiderhan says.
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A therapist with a solid understanding of anatomy and physiology can help address a physical problem that is triggering pain. For example, massage can break up scar tissue, improve circulation, and help relax tight muscles that may be putting pressure on nearby nerves. Hands-on treatments increase awareness of the many small factors that contribute to pain, such as slouching at a desk for hours.
Harness Brain Power The gold standard for psychological treatment of chronic pain is cognitive behavioral therapy. Through a limited, goal-oriented set of CBT sessions—typically seven to 12—the therapist can teach a patient to identify thoughts and behaviors that worsen pain, and replace them with new thought patterns designed to calm the nervous system and relieve pain.
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Ask your doctor for a referral or look for a therapist who has training and experience in treating chronic pain, Darnall says. CBT for pain is generally covered by insurance, and sessions can take place in person, online, or by phone. Other psychological approaches, such as progressive relaxation exercises, mindfulness, and meditation—alone or with CBT—also have been shown to reduce pain.
The goal of pills, patches, and creams is to take the pain down a couple of notches to allow for exercise, work, and socializing—activities vital to recovery. The risks of more potent drugs, such as opioids, often outweigh the benefits. Most get far less relief.
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Marijuana may relieve certain types of pain. And though little research has been done in humans, preliminary findings suggest that cannabidiol CBD , a cannabis compound found in marijuana, can reduce inflammation, which could alleviate pain. Fish oil reduces inflammation and helps some with rheumatoid arthritis pain. NSAIDs are typically better for muscle and joint pain, Tauben says; neither is very effective against nerve pain, such as that from shingles.
NSAIDs can be powerful. A JAMA study showed that patients who received ibuprofen plus acetaminophen for severe pain reported the same amount of pain reduction as those who received an opioid plus acetaminophen.
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Always check with your doctor before combining any drugs, taking more than the recommended dose, or continuing an OTC drug for longer than 10 days. Side effects for ibuprofen can include heart attack or stroke, stomach bleeding and kidney disease; for acetaminophen: liver disease. Topical Pain Relievers Pain relievers in cream or patch form—OTC or prescription—may cause fewer side effects than pills because less of the drug is absorbed into the bloodstream.
Their ingredients can help in one of three ways: by reducing pain and inflammation NSAIDs or aspirinlike compounds called salicylates , by producing a feeling of heat or cold to keep nerves busy transmitting those sensations instead of pain chili-pepper-derived capsaicin or cooling menthol , or by numbing the area lidocaine.
Prescription Drugs Antidepressants. But for years, doctors have prescribed other antidepressants off-label.
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Small doses can help with fibromyalgia, headache prevention, and pain due to nerve damage. But they can come with side effects, such as weight gain, constipation, and suicidal thoughts. Three drugs used to prevent seizures are also FDA-approved—and increasingly prescribed—for certain types of nerve pain: gabapentin Neurontin and generic , pregabalin Lyrica , and carbamazepine Epitol and generic , which can cause deadly allergic reactions.
Studies suggest they help with nerve pain but not common ills such as back pain. Side effects can include suicidal thoughts. Muscle relaxants. Drugs such as cyclobenzaprine Amrix and generic can be useful against a pain flare-up. Avoid carisoprodol Soma because it carries a high risk of abuse and addiction. And never take these alongside opioids.
These drugs—which include codeine, oxycodone OxyContin , and hydrocodone, and are sometimes combined with acetaminophen Vicodin, Percocet —should be considered only if no other treatments work and only if there are more benefits than risks for an individual patient, according to the American College of Physicians. They work well in the short term for severe pain from an injury or from surgery but not against chronic pain because they often lose effectiveness over time, can increase sensitivity to pain, and carry risks of addiction and overdose.
Possible side effects include constipation, breathing problems, confusion, irritability, and sedation. Five years ago, Austin Kessler of Driftwood, Texas, was lifting a rock in his yard when he heard a loud pop. It was his back, and he fell to the ground in excruciating pain. The year-old suffered a herniated, or slipped, disc. His primary care doctor referred him to an orthopedist, who recommended surgery. After a second opinion, Kessler decided against surgery, and his pain abated over time with physical therapy and exercise.
This is not uncommon. Orthopedic surgery has more people seeking second opinions than any other specialty, according to one study of thousands of patients. More than a third of these second opinions lead to a change in treatment plan. Surgeries and injections do help in certain cases. But they carry more risk than most other treatments, so you should generally seek a second opinion if a doctor is pushing surgery, says David Hanscom, M. Steroid Injections For decades, doctors have commonly treated painful joints by injecting a corticosteroid to reduce inflammation and decrease pain.
But more than two or three shots a year may damage joint cartilage. Steroid shots are also sometimes used in the epidural space outside the sac of fluid around the spinal cord, but a misplaced needle can cause rare but serious complications, including stroke, paralysis, and even death.
These are safer in the buttocks or legs, Hanscom says, and can temporarily ease the pain of a slipped disk or sciatica. Am I a good candidate? Surgery is most likely to help when an underlying structural problem is the cause of the pain, Hanscom says. If the pain is widespread or severe despite only minor damage visible on an X-ray, a sensitized nervous system is more likely to be the problem, he says.
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Sure, I can give you some meds to dampen the pain
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