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Treatment Options for Chronic Pain _____________________________ Chronic pain is as unique in character as are the millions of people who suffer with it, making it one of medicine’s greatest challenges. Your pattern of pain, intensity of pain, frequency of pain, and response to various pain treatments may differ significantly from someone with the same diagnosis. Pain also changes — not just over time, but also from day to day and hour to hour, according to your activity, mood, stress level and general health. Pain physicians are specialists concerned with the study, treatment and rehabilitation of persons in pain. They often act as consultants to primary care physicians for referral of chronic pain patients when general treatments fail to provide pain relief. Pain specialists provide care at various levels, such as direct treatment, prescribing medication and rehabilitation services, performing pain-relieving procedures, counseling patients, directing a multidisciplinary care team, and coordinating care with other health care providers to optimize health care delivery to the patient suffering from pain. The complex character of chronic pain makes it difficult to treat. Pain specialists recognize this, and have created a strategy to deal with the enigma of chronic pain. This strategy is called a treatment continuum. Three Steps Toward a Solution for Your Pain
The treatment continuum ensures that your chronic pain is treated systematically, in a deliberate, ever-more-invasive and costly progression of therapies. The treatment continuum represents a generalized clinical strategy for treating chronic pain, and it is essential to finding the best solution for your chronic pain — ensuring that no potential solution is overlooked.
The treatment continuum represents a multitude of available therapies. It is important to know that it is a generalized treatment strategy only, and that it can vary depending on your condition, your response to previous treatments and the recommendation of your pain physician. The chronic pain treatment continuum has three main segments. The first two segments include a variety of therapies — from pain medications, physical therapy and TENS to nerve blocks. If you have suffered with chronic pain for a year or more, you are probably familiar with this course of treatments, and may be frustrated by a lack of lasting pain relief. But what if your pain does not respond to any of these therapies?
If your pain does not respond to either of the first two levels of treatment, then your doctor may consider a more aggressive and advanced approach to pain relief. These approaches represent the third segment of chronic pain treatment continuum. These advanced pain therapies generally will not be considered unless lower-level treatments have not provided you with adequate pain relief. However, there are some exceptions where a higher-level treatment will be tried before a lower- level one. An example of this is when neuropathic pain medications fail to provide relief for a chronic neuropathic pain condition causing pain in the trunk or limbs. In this case, the pain specialist may skip successive treatments in the continuum and proceed directly to neurostimulation because of previous successes in treating these kind of conditions. Your doctor will evaluate your individual situation and decide what treatment option is best for you. Pain Relief: Better Late Than Never?
Advanced pain therapies include two types of implantable devices that have been used to treat many types of chronic pain.
Depending upon your diagnosis, medical history, type (neuropathic pain or nociceptive pain) and severity of pain, you may be a candidate for either an implantable neurostimulator or an implantable drug pump (shown below). Implantable neurostimulators use low levels of electrical energy to partially or completely block the sensation of pain. Implantable drug pumps dispense very small doses of medications either at preset intervals, or as required to maintain pain relief. In cases of severe, chronic intractable pain that does not respond to any other treatment, surgery or neuroablation may be considered. | |  | | Neurostimulator | Implantable Drug Pump |
©1999 The National Foundation for the Treatment of Pain. Backgrounds ©2003-2004 by Shorty. Button © 2004 by Shorty | 
