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KneePain

THE BURDEN OF CHRONIC PAIN: FIVE CAUSES AND TREATMENTS

Here are the top five causes of chronic pain and their respective treatments:

Spinal pain

Low back and neck pain are the most common cause of spinal pain. Spinal pain prevents people from being active and may interfere with their work and home life. It is the most common reason for GP visits in Australia.

Here are the treatments of chronic spinal pain:

  • Physical therapy
  • Patients need to focus on core strength, improved mobility, and flexibility. It is better for patients to see a physiotherapist who is an expert in the specific field of dealing with such patients.

  • Simple analgesics
  • Paracetamol is the usual first line treatment of mechanical spinal pain in the neck and back. Patients may need to take antineuropathic agents in case firsts line therapies fail. This is because, in case of persistent pain, a neuropathic component may not respond to simple paracetamol due to nerve involvement.

  • Pain interventions
  • Nerve blocks and radiofrequency neurotomy can contribute to the control of some spinal pain. These causes include facet-mediated pain and sacroiliac joint pain. However, this mode of treatment might not be applicable for all. Facet joint blocks only provide short-term relief. Patients would be assessed by the pain specialist or radiologist before having medial branch blocks which are the test injections. When the pain reduction is more than 60%, they can go for radiofrequency neurotomy (RFA).

  • Opioids
  • This mode of treatment should only be used as a last option. Opioids are compounds that reduce severe back or neck pain.

Chronic headaches

Headaches and migraines are very common in Australia. A headache can be categorized as a chronic one if it persists 15 days/month and for at least 3 months.

Here are the methods for diagnosis and treatments of chronic headaches:

  • MRI
  • MRI is the best imaging available. A CT scan is also very effective at excluding problems that could underlie the headaches.

  • General headache management
  • This includes maintaining headache diary, addressing co-morbid conditions such as depression and anxiety, making certain lifestyle changes like stopping caffeine, increasing exercise, stress management and improving sleep hygiene.

  • Prophylactic medications
  • These medications are the best when co-managed by a neurologist. These medications include anticonvulsants like topiramate, antidepressants like amitriptyline and neurotoxins like botulinum toxin A (Botox).

Joint pain

Joint pain includes osteoarthritis (OA), rheumatoid arthritis and repetitive strain injury in athletes. Osteoarthritis is the most common type of joint pain. It is often caused by genetics, female sex, past trauma, advancing age, and obesity.

Treatment of osteoarthritis might include:

  • Physical activity
  • This reduces pain and disability. Physiotherapy and occupational therapy involve treatment options that include ways to properly use joints, heat and cold therapies, range of motion and flexibility exercises, assistive devices.

  • Weight management
  • Following a controlled diet that has fewer calories and an increase in physical activity can successfully lead to weight loss.

  • Stretching
  • Stretching exercises usually improve flexibility, lessen stiffness and reduce pain. Yoga and tai chi are effective in stiffness management as well.

  • Pain medications
  • Patients should start with non-steroidal anti-inflammatories. The combined effect of supplements like glucosamine and chondroitin can be effective in the management of osteoarthritis.

  • Corticosteroid injections or (Durolane or Synvisc injections)
  • These injections provide temporary relief of osteoarthritis. Synvisc or Durolane injections can maintain symptom improvement for longer periods.

  • Total joint replacement
  • This option is recommended in case of the hip, knee, or shoulder. It is recommended for patients with chronic pain and disability despite maximal medical therapy.

Cancer pain

Pain is a major problem suffered by most people with cancer, especially if there is local or metastatic spread. Chemotherapeutic agents are a common cause of neuropathic pain in cancer survivors.

Here are some treatments of cancer pain:

  • Combination of opioid and antineuropathic therapies
  • These therapies involve the use of the mouth, clock, analgesic ladder, customized therapy, attention to details etc.

  • Non-opioid adjuvants
  • These adjuvants include bisphosphonates, radiotherapy and steroids and antineuropathic agents. Take the help of a team of specialists that should include oncologists, surgeons and pain specialists. It is crucial for the patient to consult with a pain specialist.

  • Other options
  • These include nerve blocks or ablation, coeliac plexus neurolytic blocks for pancreatic or abdominal cancer pain and a multidisciplinary approach. Spinal cord stimulation has been used successfully for some forms of neuropathic cancer pain in certain cases.

Neuropathic pain

It is the pain that is a direct consequence of a lesion or disease affecting the somatosensory system. This can affect the peripheral nervous system or the central nervous system. Examples of neuropathic pain are: Diabetic polyneuropathy (DPN), Postherpetic neuralgia (PHN), Trigeminal neuralgia etc.

There are more complex regional pain syndromes (CRPS). Make sure to go for an early diagnosis so that the patients go to their pain specialist soon.

Here are the methods for diagnosis and treatments of neuropathic pain:

The treatments for neuropathic pain vary with each form of the pain.

  • Nerve compression
  • An initial attempt at a nerve root sleeve injection (NRSI) may be appropriate if recommended by your GP or specialist. On some occasions it is necessary to have a surgical decompression of the nerve.

  • Injury to a nerve
  • Neuropathic pain caused by an injury to a nerve may get better with time. This is called neuropraxia and it may not need any specific treatment.

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