Pain Therapies

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Pain Management Information for Patients
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Injections

When other therapies are ineffective, therapeutic injections can be used to treat some types of pain. A nerve block involves injecting a regional anesthetic (e.g., procaine) into the area surrounding a nerve or into the nerve endings. This treatment reduces pain by temporarily preventing pain signals from being transmitted from the nerves to the brain.

Localized pain (e.g., arthritis, bursitis, tendonitis) may respond to cortisone injections. These injections, which include a local anesthetic and a corticosteroid, are used to treat pain caused by inflammation. They often provide relief for several weeks or months at a time, and usually are not administered more frequently than once every 3 months.

Side effects of cortisone shots include a brief increase in pain (flare), infection, and discoloration of the skin surrounding the injection. Long-term use can cause thinning of the skin, cartilage, tendons, and bones.

Trigger points are areas in muscle that are often painful when pressed and can cause referred pain (i.e., pain that occurs in another part of the body). Trigger point injections can be administered to inactivate trigger points and reduce pain. They involve the injection of procaine or lidocaine and often are used to treat myofascial pain syndrome, which may cause neck pain and tension headache, and other types of muscle pain (e.g., back pain, shoulder pain).

Neurostimulation

Neurostimulation (e.g., brain stimulation, spinal cord stimulation, transcutaneous electrical nerve stimulation) may be used to treat some types of chronic pain (e.g., RSD/CRPS). This treatment involves using painless electrical impulses to interrupt pain signals.

There are two types of neurostimulation systems. One system is powered using a battery that is surgically implanted beneath the skin, and the other system uses a battery that is worn outside the body. Both types are controlled using an external device and deliver electrical stimulation to the nervous system (e.g., brain, spinal cord, nerves) to interrupt pain signals.

Internal/external neurostimulation systems include leads (electrodes) and a receiver, which are implanted in the skin, an antenna that is placed over the receiver on the skin, and an external battery. The antenna delivers electrical stimulation from the battery to the receiver.

In the completely internal neurostimulation system, the electrodes, receiver, and battery are implanted in the skin, often in a two-step surgical procedure performed under local anesthesia and sedation.

Iontophoresis can be used to treat some types of acute pain and inflammation. In this treatment, mild electrical current is used to deliver medication (e.g., topical steroids) to painful tissue.

Rehabilitation Techniques

Some types of pain can be controlled using physical therapy and lifestyle changes. Physical therapy involves physical methods (e.g., exercise, heat/cold therapy, massage) as well as other forms of treatment, such as traction, ultrasound, and cold (low-level) laser therapy.

Lifestyle changes may include weight control and exercises to increase strength and range of motion. Promptly discontinue any activity that causes pain and use proper posture and body mechanics, especially when lifting heavy objects or performing repetitive motions.

Counseling

Counseling can help patients develop the coping skills necessary to manage pain. It can reduce pain, anxiety, and depression. In many cases, counseling can help lessen disability caused by chronic pain. Types of counseling include individual, family, and group therapy.

Surgery

Severe pain that does not respond to other pain therapies may be treated surgically. The type of surgery performed depends on the cause for the pain. For example, spinal cord compression may require a procedure called discectomy and some types of wrist pain may require carpal tunnel release.

Other surgeries that may be performed to relieve chronic, severe pain include arthroscopic procedures (using a tube-like instrument to repair tissue within a joint), joint replacement (e.g., knee replacement, hip replacement), tumor removal (excision), and procedures that involve cutting and cauterizing nerves (e.g., cordotomy, sympathectomy).

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