Treatments for Pain
Treatments for Pain
The list of treatments mentioned in various sources
for Pain
includes the following list.
Always seek professional medical advice about any treatment
or change in treatment plans.
- Experimental use of iloprost and thrombolytics
- The use of antibiotics to treat infected ulcers
- Palliative treatment of ischemic pain with nonsteroidal and narcotic analgesics
- Physical exercise
- Complete cessation of smoking
- See a vascular surgeon
- Omental transfer
- Sympathectomy
- Spinal cord stimulator implantation
- Use of well-fitting protective footwear to prevent foot trauma and thermal or chemical injury
- Early and aggressive treatment of extremity injuries to protect against infections
- Avoidance of cold environments
- Avoidance of drugs that lead to vasoconstriction
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Pain: Research Doctors & Specialists
- Nerve Specialists:
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Drugs and Medications used to treat Pain:
Note:You must always seek professional medical advice about any prescription drug, OTC drug, medication, treatment
or change in treatment plans.
Some of the different medications used in the treatment of Pain include:
- Etodolac
- Lodine
- Lodine XL
- Aspirin
- Acetylsalicylic acid
- ASA
- Added Strength Analgesic Pain Reliever
- Adult Strength Pain Reliever
- Aggrenox
- Alka-Seltzer Effervescent Pain Reliever and Antacid
- Alka-Seltzer Night Time
- Alka-Seltzer Plus
- Alka-Seltzer Plus Cold
- Anacin
- Anacin Maximum Strength
- Anacin w/Codeine
- Ancasal
- APC
- APC w/Codeine
- APO-ASA
- Arthritis Pain Formula
- Arthritis Strength Bufferin
- A.S.A. Enseals
- Asasantine
- Ascriptin
- Ascriptin A/D
- Aspergum
- Aspirin PROTECT
- Asprimox
- Astrin
- Axotal
- Azdone
- Bayer Aspirin
- Bayer Children's Chewable Aspirin
- Bayer Enteric Aspirin
- Bayer Plus
- BC Powder
- Buffaprin
- Bufferin
- Bufferin Arthritis Strength
- Bufferin Extra Strength
- Bufferin w/Codeine
- Cama Arthritis Pain Reliever
- Cardioprin
- Carisoprodol Compound
- Cope
- Coricidin
- Coryphen
- Coryphen-Codeine
- C2 Buffered
- Darvon Compound
- Dorect Fpr,I;aru As[orom
- Dristan
- Easprin
- Ecotrin
- 8-Hour Bayer
- Empirin
- Empirin w/Codeine No. 2,4
- Entrophen
- Excedrin
- Excedrin Extra Strength Geltabs
- Excedrin Migraine
- Fiorinal
- Firoinal-C
- Firoinal w/Codeine
- Genacote
- Genprin
- Goody's Headache Powder
- Halprin
- Hepto
- Lortab ASA
- Low Dose Adult Chewable Aspirin
- Marnal
- Maximum Bayer Aspirin
- Measurin
- Midol Caplets
- Momentum
- Norgesic
- Norgesic Forte
- Norwich Aspirin
- Mpvasem
- Orphenadrine
- PAP w/Codeine
- Percodan
- Percodan-Demi
- Phenaphen
- Phenaphen No. 2, 3, 4
- Propoxyphene Compound
- Riphen-10
- Robaxisal
- Robaxisal-C
- Roxiprin
- 692
- SK-65 Compound
- Soma Compound
- St. Joseph Children's Aspirin
- Supasa
- Synalgos
- Synalgos-DC Tablet
- Triaphen-10
- 217
- 217 Strong
- 292
- Vanquish
- Verin
- Wesprin
- Zorprin
- Clonidine - usually used as a combination treatment for cancer pain
- Apo-Clonidine - usually used as a combination treatment for cancer pain
- Catapres - usually used as a combination treatment for cancer pain
- Catapres-TTS - usually used as a combination treatment for cancer pain
- Combipres - usually used as a combination treatment for cancer pain
- Dixarit - usually used as a combination treatment for cancer pain
- Duraclon - usually used as a combination treatment for cancer pain
- Novo-Clonidine - usually used as a combination treatment for cancer pain
- Nu-Clonidine - usually used as a combination treatment for cancer pain
- Alamine Expectorant
- Ambenyl Expectorant
- Ambenyl Syrup
- Codeine
- A.B.C. Compound w/Codeine
- Accopain
- Actagen-C
- Actifed w/Codeine
- Alamine-C
- Anacin 3 w/Codeine #2-4
- Atasol-8,-15,-30
- Ban-Tuss
- Benylin Syrup w/Codeine
- Bitex
- Bromanyl Cough Syrup
- Bromotuss
- Bromphen DC
- Brontex
- Butalbital Compound
- Chemdal Expectorant
- Chem-Tuss NE
- Cheracol
- Chlor-Trimeton Expectorant
- Coactifed
- Codecon-C
- Codehist DH
- Codehist Elixir
- Codeine Contin
- Coricidin w/Codeine
- Co-Dimetane Cough Syrup-DC
- Dimetane Expectorant-C
- Dimetapp-C
- Dimetapp w/Codeine
- Empracet-30,-60
- Empracet w/Codeine No. 3,4
- Emtec-30
- Exdol-8,-15,-30
- Extra Strength Acetaminophen with Codeine
- Glydeine
- Isoclor Expectorant
- Lenoltec w/Codeine No. 1,2,3,4
- Mersyndol
- Naldecon-CS
- Normatane
- Novadyme DH
- Novahistex C
- Novo-Gesic
- Nucochem
- Nucofed
- Omni-Tuss
- Oridol-C
- Panadol w/Codeine
- Paveral
- Pediacof
- Penntuss
- Phenaphen w/Codeine No. 2,3,4
- Phenergan w/Codeine
- Poly-Histine
- Promethazine CS
- Pyra-Phed
- Robaxacet-8
- Rounox w/Codeine
- SK-Apap
- Tamine Expectorant DC
- Tecnal C
- Terpin Hydrate and Codeine
- 318 AC&C
- Triafed w/Codeine
- Triaminic Expectorant w/Codeine
- Triatec-8,30
- Tussaminic C Forte
- Tussaminic C Ped
- Tussi-Organidin
- Tylenol w/Codeine
- Tylenol w/Codeine No. 1,2,3,4
- Tylenol w/Codeine Elixir
- VC Expectorant w/Codeine
- Veganin
- Celecoxib - mainly used for nonarthritic pain
- Celebrex - mainly used for nonarthritic pain
- Rofecoxib - mainly used for nonarthritic pain
- Vioxx - mainly used for nonarthritic pain
- Valdecoxib - mainly used for nonarthritic pain
- Bextra - mainly used for nonarthritic pain
- Fenamate
- Meclofenamate
- Meclodium
- Meclofenaf
- Meclomen
- Mefenamic Acid
- Apo-Mefanamic
- Novo-Mefanamic
- Ponstel
- Ponstan
- Hydrocodone
- Dihydrocodeinone
- Allay
- Alor 5/500
- Anaplex
- Anexsia
- Anexsia 7.5
- Anolor
- Atuss
- Ban-Tuss-HC
- Biohisdex DHC
- Biohisdine DHC
- Chemdal-HD
- Codone
- Detussin
- DHC Plus
- Dicoril
- Dimetane Expectorant-DC
- Endal-HD
- Entuss-D
- Histinex-HC
- Histussin HC
- Hycodan
- Hycomine
- Hycomine Compound
- Hycomine Pediatric Syrup
- Hycomine-S
- Hycomine Syrup
- Hycotuss Expectorant
- Lorcet-HD
- Lorcet Plus
- Lortab
- Medipain 5
- Norcet 7
- Novahistex DH
- Novahistine DH
- Polygesic
- Protuss
- Robidone
- Ru-Tuss
- T-Gesic
- Triaminic Expectorant DH
- Tussaminic Expectorant DH
- Tussend
- Tussend Expectorant
- Tussionex
- Tycolet
- Vanex
- Vicodin
- Vicodin ES
- Vicoprofen
- Zydone
- Meperidine
- Demerol
- Demerol APAP
- Mepergan
- Pethadol
- Pethidine
- Morphine
- Astramorph
- Astramorph PF
- Avinza
- Duramorph
- Epimorph
- Infumorph
- Kadian
- M-Eslon
- Morphine H.P
- Morphitec
- M.O.S
- M.O.S.-S.R
- MS Contin
- MS-IR
- OMS Concentrate
- Opium Tincture
- Oramorph SR
- Paregoric
- RMS Uniserts
- Roxanol
- Roxanol 100
- Roxanol SR
- Statex
- Oxicams
- Alti-Piroxicam
- Apo-Piroxicam
- Brexidol
- Dom-Piroxicam
- Feldene
- Med-Pirocam
- Novo-Pirocam
- Nu-Pirox
- Oxycodone
- Endocet
- Endodan
- Oxycocet
- Oxycodan
- OxyContin
- Percocet
- Percocet-Demi
- Roxicet
- Roxicodone
- Roxilox
- SK-Oxycodone
- Supeudol
- Tylox
- Pentazocine
- Talacen
- Talwin
- Talwin Compound
- Talwin Compound-50
- Talwin Nx
- Propionic Acid
- Fenoprofen
- Nalfon
- Flurbiprofen
- Ansaid
- Apo-Flurbiprofen
- Froben
- Froben-SR
- Novo-Flurbiprofen
- Ocufen
- Ibuprofen
- Aches-N-Pain
- Actiprofen
- Advil
- Advil Migraine
- Amersol
- Apo-Ibuprofen
- Arthritis Foundation Pain Reliever/Fever Reducer
- Bayer Select
- Children's Advil
- Children's Motrin
- Children's Motrin Drops
- Children's Motrin Suspension
- CoAdvil
- Dimetapp Sinus
- Dologesic
- Dristan Sinus
- Excedrin IB
- Genpril
- Guildprofen
- Haltran
- Ibu
- Ibuprohm
- Junior Strength motrin Caplets
- Medipren
- Medi-Profen
- Profen-IB
- Rufen
- Superior Pain Medicine
- Supreme Pain Medicine
- Tab-Profen
- Ketoprofen
- Actron
- Apo-Keto
- Apo-Keto E
- Orudis
- Orudis E-50
- Orudis E-100
- Orudis KT
- Orudis SR
- Oruvail
- Oruvail ER
- Oruvail SR
- Rhodis
- Rhodis EC
- Rhodis EC Suppository
- Naproxen
- Aleve
- Anaprox
- Anaprox DS
- Apo-Naproxen
- Naprelan
- Naprelan Once Daily
- Naprosyn
- Naxen
- Neo-Prox
- Novo-Naprox
- Nu-Naprox
- Synflex
- Oxaprozin
- Daypro
- Tramadol
- Ultram
- Ultracet
- Direct Formulary Aspirin
- Halfprin
- Novasen
- Anacin 3 w/Codeine No. 2-4
- Acetaminophen
- Acephen
- Aspirin Free Anacin Maximum Strength
- Cetafen
- Cetafen Extra
- Comtrex Sore Throat Maximum Strength
- ElixSure Fever/Pain
- Fever ALL
- Genapap
- Genapap Children
- Genapap Extra Strength
- Genapap Infant
- Genebs
- Genebs Extra Strength
- Mapap
- Mapap Arthritis
- Mapap Children's
- Mapap Extra Strength
- Mapap Infants
- Redutemp
- Silapap Children's
- Silapap Infants
- Tylenol
- Tylenol 8 Hour
- Tylenol Arthritis Pain
- Tylenol Children's
- Tylenol Extra Strength
- Tylenol Infants
- Tylenol Junior Strength
- Tylenol Sore Throat
- Valorin
- Valorin Extra
- Abenol
- Apo-Acetaminophen
- Atasol
- Pediatrix
- Tempra
- Actafen
- Androx
- Datril
- Magnidol
- Neodol
- Neodolito
- Sedalito
- Sinedol
- Temperal
- Tylex
- Capital and Codeine
- Ratio-Emtec
- Ratio-Lenoltec
- Triatec-8
- Triatec-8 Strong
- Triatec-30
- Tylenol Elixir with Codeine
- Tylenol No. 1
- Tylenol No. 1 Forte
- Tylenol No. 2 with Codeine
- Tylenol No. 3 with Codeine
- Tylenol No. 4 with Codeine
- Acetaminophen and Pseudoephedrine
- Alka-Seltzer Plus Cold and Sinus Liqui-Gels
- Cetafen Cold
- Genapap Sinus Maximum Strength
- Mapap Sinus Maximum Strength
- Medi-Synal
- Omex
- Omex Maximum Strength
- Sinus-Relief
- Sinutab
- Sinutab Sinus
- Sudafed Sinus and Cold
- Sudafed Sinus Headache
- SudoGest Sinus
- Tylenol Cold, Infants
- Tylenol Sinus, Children's
- Tylenol Sinus Day Non-Drowsy
- Dristan N.D
- Dristan N.D., Extra Strength
- Sinutab Non Drowsy
- Sudafed Head Cold and Sinus Extra Strength
- Tylenol Decongestant
- Tylenol Sinus
- Acetaminophen, Aspirin and Caffeine
- Excedrin Extra Strength
- Fem-Prin
- Genaced
- Goody's Extra Strength Headache Powder
- Goody's Extra Strength Pain Relief
- Pain-Off
- Vanquish Extra Strength Pain Reliever
- Acetaminophen, Dextromethorphan and Pseudoephedrine
- Alka-Seltzer Plus Flu Liqui-Gels
- Comtrex Non-Drowsy Cold and Cough Relief
- Infants' Tylenol Cold Plus Cough Concentrated Drops
- Contac Severe Cold and Flu/Non-Drowsy
- Sudafed Severe Cold
- Triaminic Cough and Sore Throat Formula
- Tylenol Cold Day Non-Drowsy
- Tylenol Flu Non-Drowsy Maxium Strength
- Vicks DayQuil Multi-Symptom Cold and Flu
- Contac Cough, Cold and Flu Day & Night
- Sudafed Cold & Cough Extra Strength
- Tylenol Cold Daytime
- Aspercin
- Aspercin Extra
- Bayer Aspirin Regimen Adult Low Strength
- Bayer Aspirin Regimen Children's
- Bayer Aspirin Regimen Regular Strength
- Bayer Extra Strength Arthritis Pain Regimen
- Bayer Women's Aspirin Plus Calcium
- Buffinol
- Buffinol Extra
- Ecotrin Low Strength
- Ecotrin Maximum Strength
- Sureprin 81
- Asaphen
- Asaphen E.C
- ASA 500
- Coraspir
- Aspirin and Codeine
- Empirin with Codeine
- Cetacaine - mainly used as a topical anaesthetic
- Benzocaine, Butyl Aminobenzoate, Tetracaine and Benzalkonium Chloride - mainly used as a topical anaesthetic
- Orabase with Benzocaine - mainly used as a topical anaesthetic
- Benzocaine, Gelatin, Pectin and Sodium Carboxymethycellulose - mainly used as a topical anaesthetic
- Buprenorphine
- Buprenex
- Subutex
- Temgesic
- Butalbital, Aspirin, Caffeine and Codeine
- Fiorinal with Codeine
- Phrenlin with Caffeine and Codeine
- Fiorinal-C 1/2
- Fiorinal-C 1/4
- Tecnal C 1/2
- Tecnal C 1/4
- Butorphanol
- Stadol
- Apo-Butorphanol
- PMS-Butorphanol
- Stadol NS
- Diflunisal
- Dolobid
- Apo-Diflunisal
- Novo-Diflunisal
- Nu-Diflunisal
- Duloxetine - mainly used to treat pain associated with diabetic neuropathy
- Cymbalta - mainly used to treat pain associated with diabetic neuropathy
- Floctafenine
- Idarac
- Hydromorphone
- Dilaudid
- Dilaudid-HP
- Palladone
- Dilaudid-HP-Plus
- Dilaudid-XP
- Hydromorph Contin
- Hydromorphone HP
- PMS-Hydromorphone
- PlusDilaudid Sterile Powder
- Levorphanol
- Levo-Dromoran
- Magnesium Salicylate
- Doan's Doan's Extra Strength
- Keygesic
- Methadone - Severe pain
- Dolophine - Severe pain
- Methadone Intensol - Severe pain
- Methadose - Severe pain
- Metadol - Severe pain
- Methotrimeprazine
- Apo-Methoprazine
- Novo-Meprazine
- Nozinan
- Levocina
- Sinogan
- Nalbuphine
- Nubain
- Bufigen
- Nalcryn
- Oxymorphonement
- Numorphan
- Pentazocine Compound
- Piroxicam and Cyclodextrin
- Brexidol 20
- SalsalateAmigesic
- Mono-Gesic
- Salflex
- Amigesic
- Sodium Salicylate
- Ziconotide
- Prialt
- Alfentanil
- Rapifen
- Palfium
- Dextromoramide
- Dextropropoxyphene
- Doloxene
- Capadex
- Digesic
- Paradex
- Rubesal
- Diethylamine Salicylate
- Aceta
- Anacin-3
- Apacet
- Banesin
- Dapa
- Dorcol
- Halenol
- Neopap
- Valadol
- 222 AF
- Tantaphen
- Algitrin
- Analphen
- Febrin
- Minofen
- Sinedol 500
- Cilag
- Winasorb
- Tylex 750
Unlabeled Drugs and Medications to treat Pain:
Unlabelled alternative drug treatments for Pain include:
- Alprazolam - mainly used in combination with various narcotics to treat cancer pain
- Alprazolam Intensol - mainly used in combination with various narcotics to treat cancer pain
- Apo-Alpraz - mainly used in combination with various narcotics to treat cancer pain
- Med-Alprazolam - mainly used in combination with various narcotics to treat cancer pain
- Novo-Alprazol - mainly used in combination with various narcotics to treat cancer pain
- Nu-Alpraz - mainly used in combination with various narcotics to treat cancer pain
- Xanax - mainly used in combination with various narcotics to treat cancer pain
- Carbamazepine - mainly for pain associated with depression
- Apo-Carbamazepine - mainly for pain associated with depression
- Carbitrol Extended Release - mainly for pain associated with depression
- Domcarbamazepine-CR- mainly for pain associated with depression
- Epitol - mainly for pain associated with depression
- Gen-Carbamazepine CR - mainly for pain associated with depression
- Mazepine - mainly for pain associated with depression
- Novo-Carbamaz - mainly for pain associated with depression
- PMS Carbamazepine - mainly for pain associated with depression
- Taro-carbamazepine CR - mainly for pain associated with depression
- Tegretol - mainly for pain associated with depression
- Tegretol Chewable Tablet - mainly for pain associated with depression
- Tegretol-CR - mainly for pain associated with depression
- Tegretol-XR - mainly for pain associated with depression
- Clonidine - mainly used to treat cancer pain
- Apo-Clonidine - mainly used to treat cancer pain
- Catapres - mainly used to treat cancer pain
- Catapres-TTS - mainly used to treat cancer pain
- Combipres - mainly used to treat cancer pain
- Dixarit - mainly used to treat cancer pain
- Duraclon - mainly used to treat cancer pain
- Novo-Clonidine - mainly used to treat cancer pain
- Nu-Clonidine - mainly used to treat cancer pain
- Methylphenidate - mainly used to treat chronic pain
- Concerta - mainly used to treat chronic pain
- Metadate CD and ER - mainly used to treat chronic pain
- PMS-Methylphenidate - mainly used to treat chronic pain
- Methylin ER - mainly used to treat chronic pain
- Ritalin - mainly used to treat chronic pain
- Ritalin-SR - mainly used to treat chronic pain
- Nefazodone
- Lin-Nefazodone
- Serzone
- Serzone 5HT2
- Nortriptyline
- Aventyl
- Pamelor
- Baclofen
- Lioresal
- Apo-Baclofen
- Gen-Baclofen
- Liotec
- Nu-Baclo
- PMS-Baclofen
- Maprotiline
- Novo-Mapritiline
- Ludiomil
Medical news summaries about treatments for Pain:
The following medical news items
are relevant to treatment of Pain:
Discussion of treatments for Pain:
Pain - Hope Through Research: NINDS (Excerpt)
The goal of pain management is to improve function, enabling
individuals to work, attend school, or participate in other day-to-day
activities. Patients and their physicians have a number of options for the
treatment of pain; some are more effective than others. Sometimes,
relaxation and the use of imagery as a distraction provide relief. These
methods can be powerful and effective, according to those who advocate
their use. Whatever the treatment regime, it is important to remember that
pain is treatable. The following treatments are among the most
common.
Acetaminophen is the basic ingredient found in Tylenol® and its
many generic equivalents. It is sold over the counter, in a
prescription-strength preparation, and in combination with codeine (also
by prescription).
Acupuncture dates back 2,500 years and involves the application
of needles to precise points on the body. It is part of a general category
of healing called traditional Chinese or Oriental medicine. Acupuncture
remains controversial but is quite popular and may one day prove to be
useful for a variety of conditions as it continues to be explored by
practitioners, patients, and investigators.
Analgesic refers to the class of drugs that includes most
painkillers, such as aspirin, acetaminophen, and ibuprofen. The word
analgesic is derived from ancient Greek and means to reduce or stop pain.
Nonprescription or over-the-counter pain relievers are generally used for
mild to moderate pain. Prescription pain relievers, sold through a
pharmacy under the direction of a physician, are used for more moderate to
severe pain.
Anticonvulsants are used for the treatment of seizure disorders
but are also sometimes prescribed for the treatment of pain. Carbamazepine
in particular is used to treat a number of painful conditions, including
trigeminal neuralgia. Another antiepileptic drug, gabapentin, is being
studied for its pain-relieving properties, especially as a treatment for
neuropathic pain.
Antidepressants are sometimes used for the treatment of pain
and, along with neuroleptics and lithium, belong to a category of drugs
called psychotropic drugs. In addition, anti-anxiety drugs called
benzodiazepines also act as muscle relaxants and are sometimes used as
pain relievers. Physicians usually try to treat the condition with
analgesics before prescribing these drugs.
Antimigraine drugs include the triptans- sumatriptan (Imitrex®),
naratriptan (Amerge®), and zolmitriptan (Zomig®)-and are used specifically
for migraine headaches. They can have serious side effects in some people
and therefore, as with all prescription medicines, should be used only
under a doctor's care.
Aspirin may be the most widely used pain-relief agent and has
been sold over the counter since 1905 as a treatment for fever, headache,
and muscle soreness. Biofeedback is used for the treatment of
many common pain problems, most notably headache and back pain. Using a
special electronic machine, the patient is trained to become aware of, to
follow, and to gain control over certain bodily functions, including
muscle tension, heart rate, and skin temperature. The individual can then
learn to effect a change in his or her responses to pain, for example, by
using relaxation techniques. Biofeedback is often used in combination with
other treatment methods, generally without side effects. Similarly, the
use of relaxation techniques in the treatment of pain can increase the
patient's feeling of well-being.
Capsaicin is a chemical found in chili peppers that is also a
primary ingredient in pain-relieving creams (see Chili
Peppers, Capsaicin, and Pain in the Appendix).
Chemonucleolysis is a treatment in which an enzyme, chymopapain,
is injected directly into a herniated lumbar disc (see Spine
Basics in the Appendix) in an effort to dissolve material around the
disc, thus reducing pressure and pain. The procedure's use is extremely
limited, in part because some patients may have a life-threatening
allergic reaction to chymopapain.
Chiropractic refers to hand manipulation of the spine, usually
for relief of back pain, and is a treatment option that continues to grow
in popularity among many people who simply seek relief from back
disorders. It has never been without controversy, however. Chiropractic's
usefulness as a treatment for back pain is, for the most part, restricted
to a select group of individuals with uncomplicated acute low back pain
who may derive relief from the massage component of the therapy.
Cognitive-behavioral therapy involves a wide variety of coping
skills and relaxation methods to help prepare for and cope with pain. It
is used for postoperative pain, cancer pain, and the pain of
childbirth.
Counseling can give a patient suffering from pain much needed
support, whether it is derived from family, group, or individual
counseling. Support groups can provide an important adjunct to drug or
surgical treatment. Psychological treatment can also help patients learn
about the physiological changes produced by pain.
COX-2 inhibitors ("superaspirins") may be particularly effective
for individuals with arthritis. For many years scientists have wanted to
develop the ultimate drug-a drug that works as well as morphine but
without its negative side effects. Nonsteroidal anti-inflammatory drugs
(NSAIDs) work by blocking two enzymes, cyclooxygenase-1 and
cyclooxygenase-2, both of which promote production of hormones called
prostaglandins, which in turn cause inflammation, fever, and pain.
Newer drugs, called COX-2 inhibitors, primarily block cyclooxygenase-2 and
are less likely to have the gastrointestinal side effects sometimes
produced by NSAIDs. On 1999, the Food and Drug Administration approved two
COX-2 inhibitors-rofecoxib (Vioxx®) and celecoxib (Celebrex®). Although
the long-term effects of COX-2 inhibitors are still being evaluated, they
appear to be safe. In addition, patients may be able to take COX-2
inhibitors in larger doses than aspirin and other drugs that have
irritating side effects, earning them the nickname "superaspirins."
Electrical stimulation, including transcutaneous electrical
stimulation (TENS), implanted electric nerve stimulation, and deep brain
or spinal cord stimulation, is the modern-day extension of age-old
practices in which the nerves of muscles are subjected to a variety of
stimuli, including heat or massage. Electrical stimulation, no matter what
form, involves a major surgical procedure and is not for everyone, nor is
it 100 percent effective. The following techniques each require
specialized equipment and personnel trained in the specific procedure
being used:
- TENS uses tiny electrical pulses, delivered through the skin
to nerve fibers, to cause changes in muscles, such as numbness or
contractions. This in turn produces temporary pain relief. There is also
evidence that TENS can activate subsets of peripheral nerve fibers that
can block pain transmission at the spinal cord level, in much the same
way that shaking your hand can reduce pain.
- Peripheral nerve stimulation uses electrodes placed
surgically on a carefully selected area of the body. The patient is then
able to deliver an electrical current as needed to the affected area,
using an antenna and transmitter.
- Spinal cord stimulation uses electrodes surgically inserted
within the epidural space of the spinal cord. The patient is able to
deliver a pulse of electricity to the spinal cord using a small box-like
receiver and an antenna taped to the skin.
- Deep brain or intracerebral stimulation is considered an
extreme treatment and involves surgical stimulation of the brain,
usually the thalamus. It is used for a limited number of conditions,
including severe pain, central pain syndrome, cancer pain, phantom limb
pain, and other neuropathic pains.
Exercise has come to be a prescribed part of some doctors'
treatment regimes for patients with pain. Because there is a known link
between many types of chronic pain and tense, weak muscles, exercise-even
light to moderate exercise such as walking or swimming-can contribute to
an overall sense of well-being by improving blood and oxygen flow to
muscles. Just as we know that stress contributes to pain, we also know
that exercise, sleep, and relaxation can all help reduce stress, thereby
helping to alleviate pain. Exercise has been proven to help many people
with low back pain. It is important, however, that patients carefully
follow the routine laid out by their physicians.
Hypnosis, first approved for medical use by the American Medical
Association in 1958, continues to grow in popularity, especially as an
adjunct to pain medication. In general, hypnosis is used to control
physical function or response, that is, the amount of pain an individual
can withstand. How hypnosis works is not fully understood. Some believe
that hypnosis delivers the patient into a trance-like state, while others
feel that the individual is simply better able to concentrate and relax or
is more responsive to suggestion. Hypnosis may result in relief of pain by
acting on chemicals in the nervous system, slowing impulses. Whether and
how hypnosis works involves greater insight-and research-into the
mechanisms underlying human consciousness.
Ibuprofen is a member of the aspirin family of analgesics, the
so-called nonsteroidal anti-inflammatory drugs (see below). It is sold
over the counter and also comes in prescription-strength preparations.
Low-power lasers have been used occasionally by some physical
therapists as a treatment for pain, but like many other treatments, this
method is not without controversy.
Magnets are increasingly popular with athletes who swear by
their effectiveness for the control of sports-related pain and other
painful conditions. Usually worn as a collar or wristwatch, the use of
magnets as a treatment dates back to the ancient Egyptians and Greeks.
While it is often dismissed as quackery and pseudoscience by skeptics,
proponents offer the theory that magnets may effect changes in cells or
body chemistry, thus producing pain relief.
Narcotics (see Opioids, below).
Nerve blocks employ the use of drugs, chemical agents, or
surgical techniques to interrupt the relay of pain messages between
specific areas of the body and the brain. There are many different names
for the procedure, depending on the technique or agent used. Types of
surgical nerve blocks include neurectomy; spinal dorsal, cranial, and
trigeminal rhizotomy; and sympathectomy, also called sympathetic blockade
(see Nerve
Blocks in the Appendix).
Nonsteroidal anti-inflammatory drugs (NSAIDs) (including aspirin
and ibuprofen) are widely prescribed and sometimes called non-narcotic or
non-opioid analgesics. They work by reducing inflammatory responses in
tissues. Many of these drugs irritate the stomach and for that reason are
usually taken with food. Although acetaminophen may have some
anti-inflammatory effects, it is generally distinguished from the
traditional NSAIDs.
Opioids are derived from the poppy plant and are among the
oldest drugs known to humankind. They include codeine and perhaps the most
well-known narcotic of all, morphine. Morphine can be administered
in a variety of forms, including a pump for patient self-administration.
Opioids have a narcotic effect, that is, they induce sedation as well as
pain relief, and some patients may become physically dependent upon them.
For these reasons, patients given opioids should be monitored carefully;
in some cases stimulants may be prescribed to counteract the sedative side
effects. In addition to drowsiness, other common side effects include
constipation, nausea, and vomiting.
Physical therapy and rehabilitation date back to the ancient
practice of using physical techniques and methods, such as heat, cold,
exercise, massage, and manipulation, in the treatment of certain
conditions. These may be applied to increase function, control pain, and
speed the patient toward full recovery.
Placebos offer some individuals pain relief although whether and
how they have an effect is mysterious and somewhat controversial. Placebos
are inactive substances, such as sugar pills, or harmless procedures, such
as saline injections or sham surgeries, generally used in clinical studies
as control factors to help determine the efficacy of active treatments.
Although placebos have no direct effect on the underlying causes of pain,
evidence from clinical studies suggests that many pain conditions such as
migraine headache, back pain, post-surgical pain, rheumatoid arthritis,
angina, and depression sometimes respond well to them. This positive
response is known as the placebo effect, which is defined as the
observable or measurable change that can occur in patients after
administration of a placebo. Some experts believe the effect is
psychological and that placebos work because the patients believe or
expect them to work. Others say placebos relieve pain by stimulating the
brain's own analgesics and setting the body's self-healing forces in
motion. A third theory suggests that the act of taking placebos relieves
stress and anxiety-which are known to aggravate some painful
conditions-and, thus, cause the patients to feel better. Still, placebos
are considered controversial because by definition they are inactive and
have no actual curative value.
R.I.C.E.-Rest, Ice, Compression, and
Elevation-are four components prescribed by many orthopedists,
coaches, trainers, nurses, and other professionals for temporary muscle or
joint conditions, such as sprains or strains. While many common orthopedic
problems can be controlled with these four simple steps, especially when
combined with over-the-counter pain relievers, more serious conditions may
require surgery or physical therapy, including exercise, joint movement or
manipulation, and stimulation of muscles.
Surgery, although not always an option, may be required to
relieve pain, especially pain caused by back problems or serious
musculoskeletal injuries. Surgery may take the form of a nerve block (see
Nerve
Blocks in the Appendix) or it may involve an operation to relieve pain
from a ruptured disc. Surgical procedures for back problems include
discectomy or, when microsurgical techniques are used,
microdiscectomy, in which the entire disc is removed;
laminectomy, a procedure in which a surgeon removes only a disc
fragment, gaining access by entering through the arched portion of a
vertebra; and spinal fusion, a procedure where the entire disc is removed
and replaced with a bone graft. In a spinal fusion, the two
vertebrae are then fused together. Although the operation can cause the
spine to stiffen, resulting in lost flexibility, the procedure serves one
critical purpose: protection of the spinal cord. Other operations for pain
include rhizotomy, in which a nerve close to the spinal cord is
cut, and cordotomy, where bundles of nerves within the spinal cord
are severed. Cordotomy is generally used only for the pain of terminal
cancer that does not respond to other therapies. Another operation for
pain is the dorsal root entry zone operation, or DREZ, in which
spinal neurons corresponding to the patient's pain are destroyed
surgically. Because surgery can result in scar tissue formation that may
cause additional problems, patients are well advised to seek a second
opinion before proceeding. Occasionally, surgery is carried out with
electrodes that selectively damage neurons in a targeted area of the
brain. These procedures rarely result in long-term pain relief, but both
physician and patient may decide that the surgical procedure will be
effective enough that it justifies the expense and risk. In some cases,
the results of an operation are remarkable. For example, many individuals
suffering from trigeminal neuralgia who are not responsive to drug
treatment have had great success with a procedure called microvascular
decompression, in which tiny blood vessels are surgically separated from
surrounding nerves. (Source: excerpt from Pain - Hope Through Research: NINDS)
Pain - Hope Through Research: NINDS (Excerpt)
In 1998, the American
Geriatrics Society (AGS) issued guidelines* for the management of pain in
older people. The AGS panel addressed the incorporation of several
non-drug approaches in patients' treatment plans, including exercise. AGS
panel members recommend that, whenever possible, patients use alternatives
to aspirin, ibuprofen, and other NSAIDs because of the drugs' side
effects, including stomach irritation and gastrointestinal bleeding. For
older adults, acetaminophen is the first-line treatment for
mild-to-moderate pain, according to the guidelines. More serious chronic
pain conditions may require opioid drugs (narcotics), including codeine or
morphine, for relief of pain. (Source: excerpt from Pain - Hope Through Research: NINDS)
Pain - Hope Through Research: NINDS (Excerpt)
Pain in younger patients also requires special attention, particularly
because young children are not always able to describe the degree of pain
they are experiencing. Although treating pain in pediatric patients poses
a special challenge to physicians and parents alike, pediatric patients
should never be undertreated. Recently, special tools for measuring pain
in children have been developed that, when combined with cues used by
parents, help physicians select the most effective treatments.
Nonsteroidal agents, and especially acetaminophen, are most often
prescribed for control of pain in children. In the case of severe pain or
pain following surgery, acetaminophen may be combined with codeine. (Source: excerpt from Pain - Hope Through Research: NINDS)
Pain - Hope Through Research: NINDS (Excerpt)
As a painkiller, marijuana or, by its Latin name, cannabis,
continues to remain highly controversial. In the eyes of many individuals
campaigning on its behalf, marijuana rightfully belongs with other pain
remedies. In fact, for many years, it was sold under highly controlled
conditions in cigarette form by the Federal government for just that
purpose. (Source: excerpt from Pain - Hope Through Research: NINDS)
Pain - Hope Through Research: NINDS (Excerpt)
Nerve blocks may involve local anesthesia, regional anesthesia or
analgesia, or surgery; dentists routinely use them for traditional dental
procedures. Nerve blocks can also be used to prevent or even diagnose
pain. (Source: excerpt from Pain - Hope Through Research: NINDS)
Pain: NWHIC (Excerpt)
Over-the-counter drugs like aspirin, acetaminophen
(Tylenol), and ibuprofen (Advil) are all marketed as pain-relief
medications. To decide which of these FDA-approved drugs is best for you,
you may consult with your physician and read the label for side effects.
(Source: excerpt from Pain: NWHIC)
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Low Back Pain/Swelling:
Treatment
(In a Page: Signs and Symptoms)
-
In absence of red flag symptoms, return to activity as soon as possible; rest has not been shown to improve recovery
-
Acetaminophen, NSAIDs, opioids, and/or muscle relaxants for pain; epidural corticosteroid injections may be indicated for resistant pain
-
Patient education (weight loss, exercise, proper back biomechanics and ergonomics)
-
Physical therapy, including pain relief modalities (ice, heat, ultrasound), stretching, strengthening, aerobic conditioning, and relaxation therapy
-
Surgery may be indicated for refractory disease, large neurologic deficits, unbearable pain, or significant limitations
'>>'>
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Chronic Pain:
Treatment
(In a Page: Signs and Symptoms)
-
NSAIDs are often used, especially for inflammation
-
Narcotics are usually reserved as adjuvant therapy after more conservative measures have failed; concern about addiction is a common barrier to use
-
Tricyclic antidepressants and anticonvulsants are useful for neuropathic pain
-
SSRIs are effective for fibromyalgia
-
Spinal delivery of pain medication may be useful for radicular pain and reflex sympathetic dystrophy
-
Tramadol is often used as a bridge between NSAIDs and narcotics
-
Physical/occupational therapy is often very useful in a variety of conditions, especially reflex sympathetic dystrophy, low back pain, and fibromyalgia
-
Alternative therapies may be useful as primary treatment or adjuvant therapy for chronic pain syndromes
-
Psychiatric evaluation may be indicated for potential primary psychiatric conditions and co-morbidities
-
Consider referral to a pain specialist
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Abdominal Pain in Lower Quadrants:
Treatment
(In a Page: Signs and Symptoms)
-
Hemodynamically unstable patients require immediate resuscitation
–Replace volume with normal saline and possibly a blood transfusion
–Evidence of hemorrhage (e.g., ruptured AAA, ruptured ectopic pregnancy) or early sepsis (e.g., perforated diverticulitis, perforated bowel) may be a life-threatening emergency that requires urgent surgical intervention
-
Place nasogastric tube for obstruction or persistent vomiting
-
Administer broad-spectrum empiric antibiotics if a perforated viscus or intra-abdominal infection is suspected
-
Direct treatment toward the specific condition
-
Consider gynecology or surgery referral
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Abdominal Pain in Upper Quadrants:
Treatment
(In a Page: Signs and Symptoms)
-
Rule out or treat serious causes of pain (e.g., bowel obstruction, cholangitis, MI, PE)
-
Urgent surgical intervention may be indicated for aortic aneurysm, splenic infarct, perforated viscus, and intestinal obstruction or infarct
-
Esophagitis, gastritis, PUD, and GERD are primarily treated with lifestyle changes (e.g., avoid causative foods or medications) and PPIs or H2 blockers
–Rule out malignancies in older patients or those with suggestive histories
-
Pancreatitis: Aggressive IV hydration for lost fluids and third spacing; antibiotics; nasogastric tube insertion if vomiting; bowel rest; and narcotics for pain
-
Gastroenteritis: Rehydration, correct electrolytes
-
Intestinal obstruction: Bowel rest, surgery
-
Cardiac and pulmonary etiologies are treated per protocols (e.g., supplemental O2, aspirin, β-blocker, nitrates for MI;
O2, heparin and/or thrombolytics for PE; O2, appropriate
antibiotics for pneumonia)
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Abdominal Pain with Rebound Tenderness:
Treatment
(In a Page: Signs and Symptoms)
-
Hemodynamically unstable patients require immediate resuscitation
–Replace volume with normal saline and/or blood transfusion
–Evidence of hemorrhage (e.g., ruptured AAA, ruptured ectopic pregnancy) or early sepsis (e.g., perforated diverticulitis, perforated bowel) may represent a life-threatening emergency that requires urgent surgical intervention
Place nasogastric tube for obstruction or persistent vomiting
Administer broad-spectrum empiric antibiotics if a perforated viscus or intra-abdominal infection is suspected
Direct treatment toward the underlying condition
–Definitive surgical repair of ruptured aneurysm, bowel perforation, ectopic pregnancy, or other pathology
–Bowel rest and possible colon resection for diverticulitis or bowel obstruction
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Breast Pain & Discharge:
Treatment
(In a Page: Signs and Symptoms)
-
Fibrocystic changes
–Caffeine avoidance is often effective in decreasing pain
–Aspirate cysts or medical therapies (e.g., danazol, oral contraceptives, tamoxifen, bromocriptine, evening primrose oil, GnRH agonists, vitamin E) for pain relief
–Routine follow up is sufficient unless cytologic atypia is present
Breast cancer: Surgery, radiation, chemotherapy, and/or hormonal therapy as indicated by stage
Mastitis: Warm compress, antibiotics to cover Staphylococcus aureus and streptococci (e.g., cephalexin); consider inflammatory breast cancer if no response after 5 days in a nonlactating female
Abscess: Incision and drainage, antibiotics
Cyst: Aspiration; cytology of aspirated fluid if bloody or recurrent
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Elbow Pain/Swelling:
Treatment
(In a Page: Signs and Symptoms)
-
General principles of fracture management include immobilization, analgesia, NSAIDs, and elevation
-
Immediate anatomic reduction is required in cases of neurovascular compromise
-
Nondisplaced fractures should be immobilized with the elbow flexed at 90°
-
Displaced or intra-articular fractures usually require open reduction with internal fixation
-
Joint aspiration may relieve pain if effusion is present
-
Epicondylitis is treated with rest, NSAIDs, and physical therapy
-
Elbow dislocation requires reduction followed by splint immobilization
-
Splinting may be beneficial
-
Reduction of a subluxed radial head (nursemaid's elbow) is performed by placing the thumb over the radial head while supinating, then flexing, the forearm
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Flank Pain/CVA Tenderness:
Treatment
(In a Page: Signs and Symptoms)
-
Disk disease: NSAIDs and physical therapy; surgery is rarely indicated
-
Muscle spasm: Rest, physical therapy, analgesics
-
Renal calculi: Increased fluid intake, analgesics, consider surgery
-
Pyelonephritis, cystitis, and perirenal abscess: Antibiotics and increased fluid intake
-
Pancreatitis: Analgesics, antibiotics, consider surgery
-
Glomerulonephritis: Antibiotics (if poststreptococcal), loop diuretics, antihypertensive agents
-
Polycystic kidney disease: Manage blood pressure
-
Renal infarction: Surgery, antihypertensive, streptokinase
-
Papillary necrosis: Dialysis, treat underlying cause
-
Cholelithiasis: Cholecystectomy, analgesics
-
Appendicitis and ectopic pregnancy: Surgery
-
Renal and bladder cancer: Surgical resection, chemotherapy, and radiation
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Jaw Pain/Swelling:
Treatment
(In a Page: Signs and Symptoms)
-
Dental or periodontal pathology, oral lesions, salivary pathology, and oral neoplasms require specialized treatment by dental specialist or oral surgeon
-
TMJ: Initial treatment includes pain management, bite block (night guard), cold/warm compresses, intra-articular steroid/lidocaine injections, and avoidance of jaw clenching and gum chewing
-
Temporal arteritis: Temporal artery biopsy and high- dose steroids
-
Headache: Pain relievers, stress reduction, migraine-specific therapy (e.g., triptans), and manipulation
-
Neuralgia and neuropathies may be treated with NSAIDs, anticonvulsants (e.g., valproic acid, gabapentin), medical pain management and/or directed therapy (e.g., nerve block)
-
Treat underlying systemic etiologies and behavioral disease as necessary
'>
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Knee Pain/Swelling:
Treatment
(In a Page: Signs and Symptoms)
-
Conservative therapy is usually sufficient
-
OA: Lifestyle modification (e.g., weight loss, exercise); anti-inflammatory medications (e.g., NSAIDs, COX-2 inhibitors); joint injections may benefit some people (e.g. corticosteroids, hyaluronic acid); surgery may be necessary for those who fail conservative treatment
-
Ligamentous injuries: ACL injuries may require definitive treatment via reconstructive surgery; PCL injuries are usually not repaired
-
Meniscal tears may require repair or excision; however, most meniscus injuries are asymptomatic or mild and require no treatment
-
Patellofemoral syndrome often responds to physical therapy and exercise
-
Joint infection (e.g., septic arthritis) is a surgical emergency; irrigation, debridement, and antibiotic administration should be considered
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Neck Stiffness/Pain:
Treatment
(In a Page: Signs and Symptoms)
- Trauma: Soft-collar immobilization is no longer routinely recommended
–Cervical spine fractures may be treated with surgical fixation, halo brace immobilization, or careful observation
–Soft-tissue injuries to the neck and torticollis are treated symptomatically with NSAIDs and muscle relaxants (e.g., benzodiazepines, cyclobenzaprine)
–Subarachnoid hemorrhage is often treated surgically
- Infection
–Bacterial meningitis requires immediate broad-spectrum antibiotics (e.g., ceftriaxone and vancomycin); steroids may decrease the morbidity associated with the inflammatory response to infection
–Viral meningitis is treated supportively (IV fluids, NSAIDs)
–Abscess requires antibiotics and drainage
- Inflammatory arthropathies typically respond to NSAIDs, steroids, or antirheumatic agents
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Pelvic Pain - Female:
Treatment
(In a Page: Signs and Symptoms)
-
Primary dysmenorrhea: NSAIDs; consider oral contraceptives to suppress ovulation in severe disease
-
Positive pregnancy test: Determine last menstrual period; obtain quantitative β-hCG; confirm intrauterine pregnancy
-
In patients at high risk for STDs, treat empirically for PID (to cover gonorrhea and Chlamydia)
–Ofloxacin 400 mg PO BID for 14 days plus metronidazole 500 mg PO BID for 14 days, or
–Ceftriaxone 250 mg IM single dose plus doxycycline 100 mg PO BID for 14 days
-
Endometriosis: Treat with hormonal medications or surgical
laparoscopy
–Oral contraceptives for 3–4 months, or
–Provera 39 mg QD for 2 months, or
–Danazol 200–800 mg QD for 6 months, or
–GnRH agonist (e.g., leuprolide)
'>>
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Shoulder Pain/Swelling:
Treatment
(In a Page: Signs and Symptoms)
-
Slings may be used for comfort but early range of motion (24–48 hours) is necessary to prevent adhesive capsulitis
-
Conservative therapy is beneficial for most cases of shoulder pain: Rest, ice, NSAIDs, and opioid narcotics
-
Subacromial cortisone injection if other anti-inflammatory methods fail; however, multiple injections are discouraged because of possible tissue atrophy
-
Physical therapy is generally the mainstay of treatment
–Conditioning and strengthening
–Progressive range of motion exercises for adhesive capsulitis
-
Full thickness rotator cuff tears may require surgical repair
-
Adhesive capsulitis may require surgical lysis of adhesions
-
Prevent future injuries by promoting strength and flexibility
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Wrist & Hand Pain/Swelling:
Treatment
(In a Page: Signs and Symptoms)
-
Corticosteroid injection for carpal tunnel improves symptoms in more than half of patients; surgical intervention to release the transverse ligament and decompress the nerve entrapment may be indicated
-
NSAIDs reduce inflammation and use of cock-up splints applied during activities and while sleeping reduces strain from repetitive use and reduces symptoms
-
Corticosteroid injection along tendon sheaths and wearing a thumb spica splint treat tenosynovitis
-
Ganglion cysts are treated by draining the thick fluid and injecting with steroid; surgical removal is occasionally necessary
-
Casting of suspected fractures and repeat X-ray in 7–9 days prevents complications of occult fracture
-
Antihistamines and steroids treat swelling from stings
-
Treat rheumatologic and medical causes
-
Biofeedback and relaxation may be beneficial in selected cases
