Any pain or discomfort that lasts more than 6 months is called chronic pain. Chronic pain cannot be defined by a specific condition or location. It often has a varying degree of intensity and sensation. According to National Institutes of Health, more than 25 million Americans suffer from chronic pain. Unfortunately, chronic pain not only affects physical health but puts a toll on mental health as well. Chronic pain sufferer often suffers from anxiety and depression.
Treatment Options For Chronic Pain
1. Prescription Drugs
There is a variety of treatment options for chronic pain. According to American Society of Regional Anesthesia and Pain Medicine, there are 2 types of therapies that are available for treating chronic pain.1
1. Oral Medications
- Non-steroidal anti-inflammatory drugs and acetaminophen.
- Antidepressant – Some of the antidepressants such as tricyclic is used in treating pain, but it should be used in a lower dose.
- Anti-convulsant Drugs – It is useful for treating some kind of nerve pain.
- Muscle relaxant.
- Opioids – It is very effective for treating certain kinds of pain when used appropriately.
2. Topical Medications
Topical medication can be applied to the skin as ointment or cream.
When To Use Prescription Drugs For Treating Chronic Pain?
In general, a primary physician or a pain management therapist determines the doses and requirement of this medication. Some medications like opioids may be very effective in controlling certain types of chronic pain. According to WebMD, a medicine may work best when it is used along with other types of treatments, such as physical therapy and counseling – to address the different causes of chronic pain.
There are various steps that are very important before prescribing oral medication, especially, opioids for chronic pain. Such as:
- Access pain and function.
- Consider if non-opioids therapies are appropriate.
- Talk to the patient about the treatment plan and evaluate the risk, harm, or misuse.
Also after prescribing, it is must to start low and go slow, in general. In fact, after initiation of opioid therapy, it is must to tailor and taper the dose. Here is a complete guideline about how to prescribe opioids for chronic pain.
2. Physical Therapy
Physical therapy may play an important role in managing chronic pain. It includes strengthening and flexibility, exercise, manual therapy, and posture awareness. According to American Physical Therapy Association, it can make you stronger and help you move and feel better.2 Physical therapy is used to alleviate sources of chronic pain that include osteoarthritis, fibromyalgia, rheumatoid arthritis, and chronic headache.
When To Use Physical Therapy For Treating Chronic Pain?
After growing opioid epidemic, CDC released opioid prescription guideline that recognized opioid prescription as appropriate in certain cases including cancer treatment, palliative care, and end of life care, if properly dosed.3
But for other management, a patient should choose physical therapy under following conditions:
- When a patient wants to do more than just mask the pain, most of the prescription drugs provide palliative and symptomatic care; but physical therapy treats pain through the movement. When the patient wants to improve his mobility and quality of life, physical therapy is the best option.
- When the risks of opioid use such as depression, overdose, and addiction over-weigh the benefits, it is better to choose physical therapy as a treatment option.
- When the pain becomes chronic (lasts more than 90 days), the risk of continued opioid increases the risk of addiction, and it is then advisable to select physical therapy as a treatment option.
Physical Therapy Vs Prescription Drugs
When we seriously evaluate the effectiveness and safety of prescription drug use for chronic pain, choosing a better option to treat the chronic pain is often a matter of concern. According to American Physical Therapy Association, physical therapy has long been considered as a safer, cheaper, and more effective treatment option for chronic pain.4
The CDC also agrees with the same thought. According to a recent research, physical therapy and exercise are specifically mentioned as better options for managing chronic pain. It may work better than opiate painkiller sources, such as vicodine and codeine.
According to the American Academy of Pain Medicine, FDA strengthened existing warning in prescription drugs and over-the-counter drugs.5 Drug labels to indicate that NSAIDs can increase the chance of heart attack, either of which can lead to death.
According to New England Journal of Medicine, the widespread use of drugs has resulted in a National epidemic of opioid overdose death and addiction.6 More than one-third (37%) of the 44,000 drugs overdose deaths are reported in 2013. At the same time, there has been a parallel increase in the rates of opioid addiction, affecting 2.5 million adults in 2014.
For these reasons, physician and medical associations have begun questioning practices for opioids, particularly, as they relate to the management of chronic pain. Moreover, many physicians admit that they are not confident about how to prescribe opioids safely and how to detect abuse or how to discuss this issue with the patients.
According to National Institutes of Health, a report reveals “together the prevalence of chronic pain and opioids has created a silent epidemic of distress, disability, and danger to a large percentage of Americans.7 Of course, “it is an overriding question, whether – we as a nation – are approaching chronic pain in the best possible manner that maximizes effectiveness and minimizes harm”.
As a conclusion, physical therapy can play a vital role in the patient’s education process, including setting realistic expectations for recovery with or without opioids, but before you agree to a prescription drug or physical therapy, it is must to consult a therapist to select a suitable option for you.
Did you have any experience with the prescription drug or physical therapy? Please share!
|↑1||American Society of Anesthesiologists Task Force on Chronic Pain Management. “American Society of Regional Anesthesia and Pain Medicine. Practice guidelines for chronic pain management: an updated report by the American Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine.” Anesthesiology 112, no. 4 (2010): 810-833.|
|↑2, ↑4||Gardner, Kelly. “Manage Chronic Pain With the Help of a Physical Therapist.” (2013).|
|↑3||CDC Guideline for Prescribing Opioids for Chronic Pain. Centers for Disease Control and Prevention.|
|↑5||AAPM Facts and Figures on Pain Drug. The American Academy of Pain Medicine.|
|↑6||Opioid Abuse in Chronic Pain —Misconceptions and Mitigation Strategies. The New England Journal of Medicine.|
|↑7||Pathways to Prevention Workshop: The Role of Opioids in the Treatment of Chronic Pain. National Institutes of Health.|