Chronic pain is considered to be pain that lasts for more than three months (or six, depending on the source consulted), regardless of whether it occurs on an oscillating or continuous basis. There is usually no cure, but there are treatments that can help control it, including medication, physiotherapy, psychotherapy, acupuncture, electrical stimulation, and surgery. But the therapeutic option will depend in each case on the origin of the pain, the type, its intensity, and the response to treatment.
Medications for chronic pain
As far as the use of medication (analgesia) is concerned, the treatment of chronic pain has long been based on the so-called analgesic ladder, established in 1984 by the World Health Organization. The concept is still in force, although the model has undergone different modifications and proposals for change, based on the idea that the best medicine is not always the most potent, the one best suited to the characteristics of each patient.
It has even been proposed to add a further step, especially in the more advanced stages. In any case, it will be up to the physician in each case to determine, with reference to accumulated clinical experience, which is the most appropriate treatment.
The idea of the analgesic ladder, however, is simple. It is a ladder of three steps, the first being the lightest and the third the most severe. The first rung of this ladder corresponds to the best-known anti-inflammatory, such as ibuprofen or diclofenac, as well as Cox-2 inhibitors. The latter is particularly indicated in the treatment of chronic pain as they do not damage the gastric mucosa, although the others can be administered together with a gastric protector.
You move up to the next step when these drugs stop working and no longer relieve pain even if you increase the dose. Weak systemic opioids, such as tramadol, codeine, and hydrocodone, are then used. Beyond that, in the third step, are the strong opioids, such as morphine, fentanyl, and methadone. When these are no longer effective orally, they can be administered by injection into the spinal cord or, as a last resort, by means of an infusion pump (palliative care).
However, it should be borne in mind that at any of the three stages, the response to these drugs can be improved by using other drugs aimed at treating other symptoms likely to intensify pain: antidepressants, anticonvulsants, anxiolytics, corticosteroids, steroids, muscle relaxants, etc.
Complementary treatments for chronic pain
It should be noted that the treatment of chronic pain should not be limited to the use of analgesic drugs, but that there are other complementary therapies that can be used and that can even be applied following the concept of the analgesic ladder. The first level includes the modification of pain-causing behaviors (specific physical activity, stress, etc.), electrostimulation therapy (TENS), physiotherapy (rehabilitation), acupuncture, and electroacupuncture.
At the second level, complementary therapies can be the application of cold and/or heat, neurolysis (destruction of a nerve by injection of alcohol), or nerve blocking, either by pricking or burning.
At the third level, an electrode can be surgically introduced into the medulla in order to apply direct electrostimulation to the medulla. A surgical nerve block can also be used. For more information, visit Trendy Damsels, where they discuss various subjects such as chronic pain.
In any case, there are currently pain units in hospitals that specialize in the classification and treatment of chronic and acute pain, from a multidisciplinary perspective.
