Treatment Considerations

Pain – especially chronic pain – involves the central nervous system in complex ways. Chronic pain is often accompanied by a restriction in activities, disuse of the painful body part and deconditioning. It is essential to work to regain optimal function and return to normal life activities, as much research has shown that such approaches are very important in achieving optimal pain management. Rehabilitation and physical therapy help people recover strength, movement and function to manage pain following an injury, surgery or illness. Physical therapists (PTs) use exercise and special techniques to help people improve their mobility, restore function and prevent further disability. Treatments are tailored to each individual patient. It is an important part of treatment, because exercise that is done incorrectly or improperly can make pain worse.

Techniques to help reduce pain used by physical therapists include structured exercise, stretching and strengthening to improve flexibility and range of motion. Physical therapists use a range of other modalities, including heat or cold therapy, massage and TENS (transcutaneous electrical nerve stimulation) therapy. TENS therapy blocks the body’s pain signals by sending gentle electrical pulses along the nerve, which reach the brain before the pain signals do. 

Physicians and physical therapists can help design fitness and wellness programs to achieve optimal health and manage pain over the long term. Regular exercise can help reduce pain by improving muscle tone, strength and flexibility. Exercise causes the body to release endorphins, the body’s natural painkillers, as well as other important biologic processes to aid the body to repair injured tissues, return the central nervous system to normalcy and aid in managing the emotional and psychological aspects of chronic pain. 

Psychosocial treatment is an important component of pain management because pain is an emotional, social and psychological phenomenon as well as a physical one. Also, stress and depression can trigger muscle tension or spasms and make pain worse. Psychologists and/or social workers can help people in pain learn to cope better and manage the emotional aspects of pain such as anger, despair, depression, anxiety and stress. Individual or group counseling may be part of a treatment plan. Counseling and other forms of psychological treatment can help patients learn relaxation techniques and lifestyle modifications and build self-management skills to help understand the importance of pacing, exercising and stress reduction. Understanding emotions and their impact on pain, sleep hygiene, nutrition, and other skills is important in taking an active role in moving from patient to person. 

Additional complementary techniques may be part of a balanced pain management plan. These approaches can help with the physical and emotional aspects of pain treatment and may augment other forms of therapy. These include:

• Acupuncture – Based on traditional Chinese medicine, acupuncture is a technique used to treat pain that involves the insertion of extremely thin needles through the skin at strategic points on the body. It is based on the belief that energy or life force – known as qi or chi (chee) – flows through pathways, called meridians, in the body. The acupuncture points work to stimulate nerves, muscles and connective tissue, which increases blood flow and boosts the activity of the body’s natural painkillers. Acupuncture is believed to restore balance and health to the body and mind, and there are hundreds of well-done scientific studies validating its usefulness in pain management.  

• Therapeutic yoga – A practice that blends gentle yoga and stretching with modified yoga poses, breathing and meditation, therapeutic yoga can help people improve function, relieve pain and reduce stress. Therapeutic yoga uses gentle stretching to strengthen muscles without putting additional strain on the body. The focus is on healing and pain management while improving overall well-being.

• Self-hypnosis, meditation and visual imagery – These relaxation techniques can help reduce stress and control pain that interferes with sleep and daily functioning. These approaches may also help increase one’s ability to focus on activities they enjoy and with overall well-being.

• Biofeedback – This approach teaches people how to control their responses to chronic pain. Sensors attached to the skin measure your body’s response to stress by tracking a number of biologic responses including skin temperature, muscle tension, heart rate, blood pressure and even brain waves. As you learn strategies to relax your muscles and your mind, you can watch on a computer screen as your body’s stress response decreases. By understanding how the body responds to stress, you can learn relaxation strategies that are most effective and use them to control your body’s response to tension.

Other complementary pain management approaches include therapeutic massage, nutrition counseling and music therapy, which can all complement other forms of therapy for pain.

Over-the-counter pain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, aspirin and naproxen may provide relief for milder to moderate pain caused by muscle aches, swelling, tenderness and joint stiffness, as well as menstrual pain, headaches and backaches. These medications work by reducing inflammation that causes pain. Non-prescription pain medications are available in pill (oral), liquid, cream and lotion formulations. It is important to recognize that all medications have side effects, including over-the-counter medications. NSAIDs are known to cause potentially serious renal, gastrointestinal and other side effects and should always be used within recommended doses and for as short a time as possible.

Doctors may prescribe other medications if over-the-counter remedies don’t provide enough pain relief. There are many different types of prescription pain medications, known as analgesics, including COX-2 inhibitors, muscle relaxants, anti-anxiety drugs, antidepressants, anti-seizure medications, steroid injections and opioids, also known as narcotics.

Medications may have a single ingredient or a combination of ingredients. They can be taken by mouth (orally) or via injection. Some of these medications may be habit-forming and their use should be carefully supervised by a physician.

Before beginning a prescription strength pain medication, talk to your doctor about the risks and benefits of the medication. If pain medications are prescribed, patients and their doctors should work together to formulate an “exit strategy” for removing unused medications from the home. Using safe storage and disposal methods also helps to ensure that medicines stay out of the hands of teens or others for whom they were not intended. This kind of planning can help safeguard against any misuse or abuse of prescription painkillers and help minimize potential risks from these drugs.  

Trigger point injections are also sometimes used to treat muscle pain. Using a small needle, a health care professional injects a local anesthetic with or without a steroid into muscles in the arms, legs, lower back or neck. Trigger point injections are also sometimes used to treat myofascial pain found in tissues that surround muscles and to treat headaches, migraines and fibromyalgia.