Overview
First-line treatment of chronic pain is with medications. This includes common painkillers such as paracetamol, anti-inflammatory drugs, muscle relaxants and weak opioids such as codeine and tramadol. The rational use of strong opioids and other adjuvant medications (e.g. tricyclic antidepressants, anticonvulsants) may be indicated in complex pain conditions. Topical agents such as ketoprofen, capsaicin and lignocaine are also useful options. Every attempt is made to optimise medication use. For example, if an opioid is ineffective or is being inappropriately used, such a drug will be withdrawn gradually and replaced with non-addictive medications to avoid dependence and abuse.
Injections of local anaesthetics with or without corticosteroids have both diagnostic and therapeutic value in the treatment of various chronic pain conditions. They act to inhibit pain transmission and reduce inflammation around affected nerves or within joints. Botulinum Toxin A injection also has a role in the treatment of chronic myofascial pain and painful muscle spasms.
Neuroablation or destruction of nerves using radiofrequency is sometimes used to treat chronic pain. Some examples include trigeminal neuralgia, facet joint pain and cervicogenic headaches. The nerve is heated to denervate the source of pain, thereby blocking the pain pathway.
Neuromodulation techniques are used to treat chronic pain. They help by blocking the transmission of pain signals from travelling along nerves or the spinal cord to the brain. Spinal cord stimulation is an advanced interventional pain treatment available for intractable low back pain or neck pain, radicular pain, occipital neuralgia, complex regional pain syndrome, phantom limb pain, painful neuropathies as well as angina. Peripheral nerve field stimulation therapies can be used to treat neuropathic pain resulting from peripheral nerve injuries.
Implantable intrathecal catheters and pumps can be used to deliver opioids or other compounds directly into the spine to treat severe back pain, pelvic pain as well as other intractable regional pain syndromes. Such devices are also very effective in treating cancer pain, especially metastatic cancer that has involved many parts of the body.
Unfortunately, not all pain conditions can be treated conservatively or with minimally invasive interventional pain therapies. In some circumstances, surgery may be needed to treat chronic pain, especially if the underlying problem can be corrected.
Rehabilitation through patient education, workplace modification, and exercise programmes form an integral part of chronic pain management. Physiotherapy and occupational therapy help patients take control of their pain, relearn new pain reduction techniques and return to work as soon as possible.
Psychology-based assessments and therapies are essential in any pain management. Relaxation therapy, cognitive-behavioural therapy, management of addiction, biofeedback, or a combination of these interventions are useful in treating chronic pain.
Traditional Chinese Medicine (TCM) specialist service provide various alternative therapies including acupuncture, tui na and herbal medicines that can be effective in treating pain conditions such as headaches, myofascial pain, arthritis etc.
Changes in lifestyle including exercise, weight loss, nutritional supplementation and smoking cessation are other important ways of complementing various treatments for reducing pain.