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There are three keys to treating chronic pain:

  • The method should be adequate to control pain.
  • The treatment should be provided continuously to keep pain under control.
  • Depression and other emotional aspects of living with pain should be treated. They can amplify the perception of pain.

Treating pain may involve many techniques and approaches including pain medications.


The most common treatment for chronic pain involves the use of analgesic medications -- drugs used to treat pain without resulting in loss of consciousness. Different medications are used for different degrees and types of pain. Doctors start with the mildest medicine. They only move on to heavier drugs if the intermittent drugs don't work.- ending in opiates (narcotics) such as morphine.

Pain medications can be delivered into the body in a variety of ways. If a particular method is difficult for you, it is likely the drug comes in another form with a different delivery method. If a different method isn't currently available, an alternative means of drug delivery can be made by a compounder.

All medications have the potential to cause side effects, especially when taken over a long period of time. However many side effects resolve as your body adjusts to the medications. Working closely with your doctor, most side effects can be adequately managed.

If alertness becomes a problem, you can decrease the dosage, understanding the trade off.

It's a myth to think that taking an opiate makes you addicted to it. People who take them for pain don't desire more.

Other Medical Alternatives

Pain caused by a condition such as cancer can be treated by treating the health condition. For instance with surgery, radiation and/or chemotherapy. The same techniques can also be used to relieve pain, incraese comfort and/or improve the patient's quality of life when curative therapies are no longer given.  In addition, cancer pain may be treated with hormonal therapy and treatment with bisphosphonates.

Non-Medical Alternatives

There are a variety of non-drug therapies can be used to treat pain either with or without pain medications. In addition to therapies such as massage and acupuncture, soothing music and spirituality have also been shown to be helpful to reduce pain.


  • If you don't get the pain relief you want, seek a Pain Specialist.
  • If pain is accompanied by depression and/or anxiety, there are treatments available.

For more information, see:

Pain Medications Used For Different Degrees and Types Of Pain

The type of pain medication useful for a particular type of pain depends on the severity and cause of the pain.

For mild to moderate pain control

Consider the following medications which can be purchased without a prescription. (A prescription may be required for higher doses.)

  • Over-the-counter drugs such as Acetaminophen (for example, Tylenol).
  • Anti-inflammatory drugs (such as aspirin and ibuprofen).

For moderate to severe pain control

Opioids (narcotics which are derived from opium) such as codeine, OxyContin, Dilaudid, hydrocodone (Vicodin), Methadone, Oxycodone, Percodan/Percocet, and Morphine.

A prescription from your doctor is required for these medications.

For tingling and burning pain

This type of pain is usually neurogenic -- it starts with or has to do with the nerves or nervous system.

Antidepressants (drugs to treat depression) and anticonvulsants (drugs to prevent seizures) have been found to assist with this type of pain symptom. The use of antidepressants for this purpose does not indicate that you are suffering from depression or mental illness. Use of an anticonvulsant for this purpose does not mean you are suffering from convulsions.

A prescription from your doctor is required.

Pain related to inflammation or swelling

Steroids which are often used to help build muscle mass, are useful in minimizing swelling. Because of the possible side effects this treatment is sometimes used sparingly. It's particularly important to follow the directions about how long to take a steroid.

Methods By Which Pain Medications Enter The Body

Most pain medications are provided using one of the following methods. If a particular method is difficult for you, it is likely the drug comes in another form with a different delivery method. If there is no choice currently available, an alternative means of drug delivery can be made by a compounder. (To learn more, see Compounding.)

Oral: (by mouth)

Most pain medications are taken by mouth. Oral medications include tablets, capsules and liquids.

Creams / Lotions

Medications in the form of a crème or lotion are rubbed on to the skin for absorption by the body. Creams and lotions are most often used to treat surface or muscle pain.

Rectal Suppositories

Suppositories are inserted into the rectum, where they dissolve and are absorbed by the body.

Suppositories may be recommended if you have difficulty swallowing pills, or are unable to keep down medication because of nausea and vomiting, or if the drug could be particularly harmful to the stomach.

A rectal suppository may not be your best choice if you are suffering from diarrhea, rectal pain, or find it difficult to administer the suppository.

Transdermal Patches

A transdermal patch is a patch with pain medication that sticks to your skin. The pain medication is absorbed through the skin over a period of time.


Often referred to as "shots," injections use a needle to administer medication directly into the body.

Injections can be given using several methods, including administration under the skin, in a muscle, or directly into a blood vein (IV).

Nerve Blocks are used to inject pain medicine directly around a nerve or into the spine to block pain.

If injections are a problem, these days morphine doesn't have to be given by injection. There's oral morphine, and long-acting preparations of morphine which can be given every 12 hours, or opiate skin patches which can be applied every 72 hours.

Patient-controlled Analgesia (PCA) Pump

A PCS pump that is connected to a small tube in the body operates continuously, dispensing frequent small doses of pain-relieving medication 24 hours a day. If more medication is needed for a flare-up of pain, the patient pushes a button to temporarily increase the dose for immediate relief.

Common Side Effects Associated With Pain Medications

All medications have the potential to cause side effects, especially when taken over a long period of time. However many side effects resolve as your body adjusts to the medications. Working closely with your doctor, most side effects can be adequately managed.

Not everyone will experience side effects.

The following are the most common complaints associated with pain medications.


Constipation is most commonly associated with the use of opioids.

Your doctor may recommend any of the following:

  • That you increase your fluid intake.
  • Eat more fiber, fruits and vegetables.
  • Use a laxative. (Stool softeners are generally not enough.)

For more information about constipation, click here.

Nausea and Vomiting

These symptoms are most common during the first day or two after starting a pain medication and then tend to become less severe. Your doctor can recommend a medicine to alleviate these symptoms. To learn how to cope with nausea and vomiting, click here.


A certain loss of motor control function is most commonly associated with the use of opioids. It can affect your ability to concentrate, drive a car, operate machinery, or perform other similar functions.


Opioids can cause itching, particularly on the scalp, head and neck. For most people itching is just a mild annoyance that does not last long. It is most likely to occur when the dosage of your medication has been increased.

If it becomes a problem and continues for more than a few days, it may be necessary to change opiates.

To learn how to relieve itching, cilck here.


Feeling drowsy, sleepy, or tired, is most commonly associated with opioids. These symptoms tend to become milder as your body adjusts to the medication, usually after a few days.

If sleepiness is a problem, non-opioid medications may help reduce the amount of opioid needed and reduce sleepiness. Other alternatives are stimulants or wake-promoting agents to help you stay awake during the day. Changing to a different pain medication or route of delivery may help.

Slowed breathing

Breathing is often affected by the use of opioids, and may be more likely to occur with an increase in dosage level.

If breathing is a concern for you, ask your doctor how to exercise your lungs.

Allergic Reaction

True allergic reactions to pain medications are rare. They are most likely to occur within a few hours of taking a medication.

Symptoms of allergic reaction may include:

  • Dizziness.
  • Difficulty breathing or shortness of breath.
  • A red rash that sometimes resembles sunburn. (For information about what to do about skin rashes, click here

If you experience any of these symptoms, immediately contact your doctor, or if necessary, obtain emergency care.

Addiction is not a common side effect when pain medications are taken as prescribed for pain

There are likely to be withdrawal symptoms if an opioid is stopped abruptly. These symptoms such as sweats, nausea, fatigue and emotional difficulties can be avoided through gradual reduction in dosage.

Addiction is likely to occur if pain medications are abused. Follow your doctor's instructions.

To Learn More

Non-Medical Therapies That Can Be Used To Treat Pain

The following treatments have been useful in relieving pain. They may be used along with medication to provide additional pain relief. Some of these treatments may even help to limit the amount of medication required to control your pain. It is advisable to check with your doctor before beginning a complementary therapy.

  • Acupressure Therapy
  • Acupuncture is a form of Chinese medicine that stimulates certain points on the body using small needles. It may help treat nausea and control pain. 
  • Art Therapy uses art for therapy.
  • Physical or rehabilitation therapy
  • Biofeedback is the use of a special machine to help the patient learn how to control certain body functions. These are things that we are normally not aware of (such as heart rate).
  • Breathing and relaxation exercises
  • Chiropractic helps relieve low back pain.
  • Distraction (for example, talking on the telephone, watching television or listening to relaxation tapes)
  • Exercise (through the production of endorphins - natural pain killers our bodies produce)
  • Hot and cold packs
  • Hypnosis is a state of relaxed and focused attention. One focuses on a certain feeling, idea, or suggestion.
  • Imagery is imagining scenes, pictures, or experiences to feel calmer or perhaps to help the body heal.
  • Massage therapy brings relaxation and a sense of well-being by the gentle rubbing of different body parts or muscles. 
  • Meditation
  • Music Therapy is the use of music to help relieve pain.
  • Pets. Yes, pets.  Pets can help in two ways. One is by starting the relaxation response (the same response that happens when people meditate). This can take your mind off of pain and elevate your mood. Second: through touch or physical contact, pets can block the transmission of pain from the periphery to the central nervous system.
  • Progressive Muscle Relaxation can help relieve pain in the body.
  • Rest
  • Soothing music may also be helpful in reducing pain. (What do you have to lose by trying it?)
    • Soothing music an hour a day has been shown to reduce pain in people with painful arthritis, herniated disks or fibromyalgia. Music listeners also improved on scores for depression and feelings of empowerment.
    • Researchers choose classical or meditative music, but other types of music that patients find relaxing works as well.
    • Researchers generally recommend listening 30 to 90 minutes a day while sitting or lying down.
    • You can assess your needs with a music therapist. You can find a music therapist through the American Music Therapy Association by e-mailing to:findMT at musictherapy dot org or call: 301.589.3300
  • Spirituality has been shown to help people with rheumatoid arthritis cope with their pain more effectively and lead happier and more successful lives. Spiritual people are also less likely to see themselves as victims and to see their condition as an opportunity for personal growth. For information about spirituality, including how to find it, click here
  • Visualization

NOTE: Some people have found that when they get depressed, their pain worsens. Anti-depressants can help deal with the pain, and sometimes even reduce the pain. For additional tips for coping with depression, click here.

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Surgery May Be Used To Treat Pain, Generally As A Last Resort

Surgery to treat pain is often only recommended after less invasive treatments have been exhausted. Examples might include hip or other joint replacement, or surgery to control back pain. Nerves (usually in the spinal cord) can also be cut to relieve pain.

Surgery can be very beneficial for some individuals. Others may experience a relief of pain, only to have it return some months or years later.

Major surgical treatments should always be given very careful consideration.

To Learn More

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Pain Specialists

Pain management as a specialty is a relatively new development in the field of medicine.

Although it is not a board certified specialty, some doctors and other health care professionals now concentrate their attention on the treatment of pain. Practitioners may include oncologists, rheumatologists, anesthesiologists, neurologists, surgeons, or other doctors. Pain management teams may also include nurses, physical therapists, psychologists, and social workers.

These specialized teams may work in private practice, hospitals, pain clinics or other pain treatment facilities.

The teams often use a multi-disciplinary approach, combining the use of pain medications with physical or rehabilitation therapy, relaxation techniques such as meditation or deep relaxation, and mental health counseling.

To locate a pain specialist, or hospital / clinic with a pain specialty department, click here.

To Learn More