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Chronic pain can be defined medically as pain lasting for more than three months. The severity of the pain may vary depending on the etiology. Chronic pain can occur as a  result of tissue damage or neuro-psychic issues. The etiology could arise from the body or any part of the central nervous system. It could be treated with opioids, nonopioids, and psychotherapy (cognitive behavior therapy and commitment therapy). The treatment can be influenced by on the etiology of the disease.

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Chronic Pain can be Divided into 3 Types

  • Psychopathic(from nervous system) and nociceptive( damaged due to inflamed tissues)
  • Nociceptive can be divided into Somatic (superficial organs such as skin) or visceral( deep organs).
  • Psychopathic can be divided into central and peripheral depending on what part of the nervous system is affected. Peripheral pain is often described as tingling, pin and needle pain.

Pathophysiology: Nociceptive chronic pain majorly occurs when there is a “pain wind up the phenomenon” that happens when there is nociceptive fiber activation of the dorsal horn. This leads to a reduction in the pain threshold of the body.

Classification of Chronic Pain According to ICD 11

  • Chronic primary pain: This is described as pain lasting more than three months consistently, and occurring in one or more anatomical regions without any other traceable etiology.
  • Chronic cancer pain: These are illnesses that are related to the musculoskeletal system, visceral organs, cancer or its treatment procedures.
  • Chronic post traumatic pain: These are pains that occur after a traumatic condition or surgery consistently for more than three months, without any pre-existing infection or condition.
  • Chronic neuropathic pain: These are the types of pain caused by nervous system damage.
  • Chronic orofacial or head pain: These are illnesses that occur in the facial region or head region for more than fifty percent of the day over the course of three months.
  • Chronic visceral pain: These are pains originating from visceral
  • Chronic musculoskeletal pain: These are pains that occur anywhere along the musculoskeletal system.

 

Chronic pain can be treated by opioid, non-opioid and psychological treatment depending on the etiology of the disease. Nociceptive pains are majorly treated by opiates, but the psychopathic pain is treated with non-opioids such as antidepressants, anticonvulsant, and selective serotonin reuptake inhibitors. Opioid treatments have some side effects such as poor sex drive, infertility, and addiction. Nonpharmaceutical treatment is prescribed except if unnecessary.

Types of Non -Pharmacological Treatments for Chronic Pain:

Nonpharmaceutical treatment of chronic pain can be used as a single treatment or to complement an ongoing pharmaceutical treatment plan.

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Natural Treatments for Chronic Pain Includes:

  • Cognitive and integrative therapy: Behavioral and cognitive therapy can be used to treat chronic pain for short and long term purpose.
  • Self-hypnosis: This can be utilized as an adjuvant therapy, and it involves a subjective way of managing the pain by focusing on something else apart from the pain or seeing and embracing the pain as part of your lifestyle. It involves positively seeing the pain, and thinking about fun memories and thought that brings happiness and serves as a distraction from the pain. This method of managing pain works by distracting yourself from the pain. Why think of pain when you can think of fun moments with your loved ones? Focus your attention on things that make you happy and brings out the smile on your face and not the pain. If you can’t stop it, you can distract it.
  • Guided imagery: This procedure involves a patient imagining a picture in their head, and guiding their thought towards the image as a form of distraction to the It helps to change the way the body recognizes and respond to pain.
  • Diaphragmatic breathing: This involves taking a deep breath and exhaling slowly, this helps in alleviating the pain if done consistently for an extended period.
  • Muscle relaxation: Alternating between tensing and relaxing your muscles helps in relieving the pain. This should be done caudocephaly. This method in combination with diaphragmatic breathing is useful for alleviating pain in cancer patients.
  • Meditation and yoga: This helps you to take your focus off your pain, and it helps in improving the state of mind and general well-being of an individual. It serves as a relaxation technique and helps in alleviating pain.
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  • Acupuncture therapy: This involves using fine, thin needles to create an energy balance in the body, at this moment helping in relieving chronic pain, this is a practice used in ancient days as a form of medicinal treatment and pain management. It can be used to manage multiple pain conditions.
  • Aromatology: This is the use of non- pharmaceutical scents, oils, or extracts from herbs to control These compounds can be inhaled or used during shower, body or facial massage or body wraps.
  • Massage and physical therapy:
  • These involve massaging the body and getting involved in various types of physical exercise like stretching, walking, and endurance training, to improve the strength of the muscles and decrease the chronic pain.
  • Thermoregulation: these involve applying heat to reduce pain and muscle spasm and ice to reducing swelling.
  • Use of Transcutaneous Electrical nerve stimulator (TENS): This involves attaching a device powered by a battery to your skin to reduce pain.
  • Use of spinal cord stimulator: this involves the use of electric signals to relieve chronic pain.
  • Music triggered endorphins: Listen to music triggers the release of happy hormones( serotonin, Endorphins, and dopamine) which helps in reducing chronic pain.
  • Use of biofeedback machine: This machine helps you to understand how your body regulates pain; you can master these process and apply it when you feel pain.
  • Pet therapy: This involves playing with your favorite pet to distract you from the pain.

Now that we know how to treat chronic pain with different methods. The interesting question Is Neuropathic Pain Management Effective in the Treatment of Back and Neck Pain?   Since the pain is located in the back and neck why should we treat like it is a nerve problem? If you are asking that question, you are one of the few critical thinkers we have in this world.  We treat chronic pain based on the etiology.We treat neuropathic chronic back pain with a multidisciplinary approach, which involves the use of nonpharmaceutical methods described earlier, and pharmaceutical options. The goal is to reduce the pain as fast as possible by at least thirty percent. The doctors prescribe drugs in the following order:

  • First line drugs which include: Anticonvulsant, serotonin reuptake inhibitors, and Tri cyclic antidepressants.
  • Second line drugs include Capsaicin, Lidocaine, and tramadol.
  • The third line of medications includes Botulinum toxins A and strong opioids like morphine.

Nonpharmaceutical treatments like cognitive and behavioral therapy and pharmaceutical treatments are a good combination for treating chronic pain.

Chronic back and neck pain are eliminated by medical, non- pharmaceutical, and surgical means.  There are some indications for surgery of chronic back and neck pain. These signs include:

  • Where there is a bony protrusion that can be removed by surgery. Discectomy with or without fusion helps I eliminating this
  • If there is degeneration of joints and hard disc after discectomy causing an unbearing dipsogenic pain, then it is necessary to perform open decompression and fusion.

Most people ask this question what if these plan or surgery doesn’t work. Should I go back to my drugs? At What Point Should Chronic Pain Management be implemented in the Case of Failed Back or Neck Surgery? You are free to start using your chronic pain management drugs as soon as your doctor cleared you, these treatments include steroids injections into the joints and trigger points, spinal space and nerve roots surroundings. Combination of opiate and anti-epileptic drugs helps to stabilize the joint, ligaments and reduce pain.

It is not advisable to self-medicate when it comes to chronic back pain; it is desirable to see an advanced pain management doctor or locate the nearest pain management clinic.

Advanced Pain Management Doctors

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They are doctors that specialize in pain management and anesthesiology. They attend special medical programs and internships on how to manage, diagnose, treat and perform pain relieving procedures. They are a specialist in pain management. Do you prefer to take your damaged Toyota car to a general mechanic or a Toyota expert? Advanced pain management doctors are like your Toyota mechanic expert. You can trust them with anything related to pain, that is what they are trained and equipped to treat.

Pain Management Clinics

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These are specific health care facilities that focus on diagnosing, treating, and managing pain related conditions. These clinics contain various facilities and e equipment that help in diagnosing and treating pain faster and efficiently.

There are Two Kinds of Pain Management Clinics:

  • Specialized pain management clinic: These types of clinics focus on managing specific parts of the body, they pick a particular part of the body to address, for example, a pain management clinic, could be dealing with chronic pain of the back and leg. They focus and specializes in a particular part of the body, not the whole body. For example, we have a general genre of music, but some decide to concentrate on the rapping aspect of music. This type of pain management clinic specializes in reducing the pain in specific parts of the body.
  • Interdisciplinary clinic: These types of clinics are involved in reducing the pain of the whole body, they don’t specialize in particular areas of the body, but rather relieves pain from the entire body as an organism. These clinics contain expertise that then treats pains from any part of the body; They work with generalized pain management doctors.

The pain management clinic consists of a group of physicians that works together as a team in other to achieve a mutual goal, which is a reduction of pain. They also educate patients about pain, various pharmaceutical and nonpharmaceutical management of pain, and how to manage these conditions when alone or from home.

Do you have any questions or confusion about pain? A Pain management clinic is the place to go for answers.

The team that forms a pain management clinic includes:

  • Medical doctors and nurses
  • Psychologists
  • Physical, occupational, and vocational therapists.
  • Nutritionists and dietitians.

What is the Difference Between an Advanced Pain Management Doctor and a Pain Management Clinic

The significant difference between an advanced pain management doctor and pain management clinic is that the doctors are the one trained to treat, and the clinic is the building for treating the patient. The advanced management doctors are like the car repairers, and the clinic is in the automobile repair shop.

Despite the fact, that doctors have sworn an oath called Hippocratic Oath to save as many lives as possible. Even with these good intentions the decisions and actions of doctors are regulated by governing bodies through guidelines.

These guidelines include:

  • Evaluation of patient: This involves, getting the accurate and adequate medical history of the patient, and ensuring the conclusion of diagnosis.
  • Management: This makes it compulsory for doctors to discuss certain things with the patient. The doctor should educate the patient about the etiology, diagnosing, treatment options of chronic Doctors should explain to the patients and their family members about the treatment options and their complications.

The patient should be informed before any decision is made on her behalf, and must remain agreed before the beginning of any procedure. This rule is called informed consent and treatment agreement.

  • Imaging technology: The right imaging technology should be utilized at every given time, and the patient’s safety should be prioritized first.
  • Documentation: Everything about the patient’s condition, causes, signs, and symptoms, medical history, diagnosis method, treatment options should document.
  • Communication: Maintenance of Constant communication between the doctor and patient at all time.
  • Quality oriented services: The doctor must ensure that the patient receives quality oriented services at all time, the quality of the services rendered to the patient should not the reduced at any point in time.

Now, that you know everything about chronic pain, It is not enough to have this knowledge. Correct application of this knowledge is what produces a result. Apply this knowledge, and you can save a life. When you have chronic pain, contact the nearest pain management doctor near you.

References

Chaudhary, S. and Compton, P. (2016). Use of risk mitigation practices by family nurse practitioners prescribing opioids for the management of chronic nonmalignant pain. Substance Abuse, 38(1), pp.95-104.

Chronic Opioid Therapy in Patients with a History of Substance Abuse. (1996). Topics in Pain Management, 11(11), pp.41-43.

Fisher, K., Coderre, T. and Hagen, N. (2000). Targeting the N-Methyl-d-Aspartate Receptor for Chronic Pain Management. Journal of Pain and Symptom Management, 20(5), pp.358-373.

Gatchel, R. (2005). Clinical essentials of pain management.

Guidelines for Pain Management Programmes for adults. (n.d.). .

Hocking, G. and Cousins, M. (2003). Ketamine in Chronic Pain Management: An Evidence-Based Review. Anesthesia & Analgesia, 97(6), pp.1730-1739.

Lansbury, G. (2017). Chronic pain management: a qualitative study of elderly people’s preferred coping strategies and barriers to management.

Walk, D. and Poliak-Tunis, M. (2017). Chronic Pain Management.

 

 

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