Most chronic pain conditions have an organization that is designed to provide specific information about cause, treatment, and research. The Resources section of this site can link you to many of them.

There is no way for another person to feel your pain. It is more important for them to understand what their role is in helping you manage the pain. The ACPA Family Manual is an excellent resource for family members. It can help them realize that, while family members don't feel the physical pain, their lives are affected in much the same way as that of the person with pain. Throughout the book they may read what others who live with a person with pain have to say and learn how to cope with the changes in their life and yours.

A MPP offers a variety of skills taught by trained staff to help a person better manage his or her pain. These programs may not offer a cure, but they can help to improve the quality of life and at the same time reduce the overwhelming control that pain can have of daily life. Visit the section titled Choosing a Multidisciplinary Pain Program on our web site.

Chronic pain is pain that continues a month or more beyond the usual recovery period for an injury or illness or that goes on for months or years due to a chronic condition. The pain is usually not constant but can interfere with daily life at all levels.

As a start, you can visit the following sites:

• American Academy of Pain Medicine
• American Board of Pain Medicine

And visit the section titled Pain Management Programs on our web site.

A MPP offers a variety of skills taught by trained staff to help a person better manage his or her pain. These programs may not offer a cure, but they can help to improve the quality of life and at the same time reduce the overwhelming control that pain can have of daily life. Visit the section titled Choosing a Multidisciplinary Pain Program on our web site.

This question is often asked by people who have been told that they will have to learn to live with their pain. At times, it is difficult to pin down a specific physical cause for the pain. But that does not lessen the suffering. When we experience any pain, it is in both our bodies and minds. We cannot separate the physical and psychological affects any situation has on us.

It’s very common for people to be confused about the difference between physical dependence and addiction.  The main difference is that addiction includes a psychological (or mental) craving for the medication that can lead to self-destructive behavior.  Physical dependence only means that your body needs the medication and you have symptoms when you do not take it.  People become physically dependent on many kinds of medicines, including insulin, antidepressants, and others.  It is a normal part of using some medications.

When you use a pain medication, after a while your body becomes used to having that chemical on a regular basis.  Your body needs that medication to function normally.  If you stop taking it or lower the dose, your body reacts badly, with physical withdrawal symptoms like headaches, nausea, shakes, and other more serious problems.  This is physical dependence, and it is not at all the same as addiction.

Addiction is a psychological problem that causes people to lose control over their use of a medication.  People with this problem sometimes think the drug is the most important thing in their lives.  They might raise their dosage or continue using the medication without their doctors’ permission, or seek other sources of medication that their doctors don’t know about.  They take the medication even when they know it is not good for them, and they might do risky and irresponsible things to get the medication.

Depending on the type of medication you use, physical dependence might be unavoidable.  Talk to your health care professional if you are concerned about dependence or if you feel you might need to increase or decrease your dosage. 

Addiction is avoidable.  If you think that you might be taking a pain medication that you do not need for pain, talk to your doctor about safely reducing the dose.  Also, if you become preoccupied with the medication, thinking about how soon you can take more or worrying excessively that you might run out, that can be a warning sign to talk to a health care professional about changing your treatment.

It is a little confusing, but a number of antidepressants have actually been found to help ease chronic pain. The effect these medicines have on pain is separate from their effect on mood.  There are many things about chronic pain that we do not understand.  However, it seems that imbalances in chemicals involved in pain perception and transmission may play a role.  In low doses antidepressants seem to adjust these chemicals. As a result, they are a common and useful way to treat chronic pain.  As with all medicines, unwanted side effects can occur.  For this reason you should always talk with your doctor about how well the medicine is working in your body and any side effects you may have.

References

Dworkin, R. H., O'Connor, A. B., Backonja, M., Farrar, J. T., Finnerup, N. B., Jensen, T. S., et al. (2007). Pharmacologic management of neuropathic pain: Evidence-based recommendations. Pain, 132(3), 237-251.

McCleane, G. (2008). Antidepressants as analgesics. CNS Drugs, 22(2), 139-156.

Moulin, D. E., Clark, A. J., Gilron, I., Ware, M. A., Watson, C. P. N., Sessle, B. J., et al. (2007). Pharmacological management of chronic neuropathic pain--consensus statement and guidelines from the Canadian pain society. Pain Research & Management, 12(1), 13-21.

Biofeedback is a method used to raise a person’s awareness of physical processes that the body usually controls on its own.  A computer is used to take measurements of your body’s functioning.  It tracks things like blood pressure, heart rate, skin temperature, sweat gland activity, or muscle tension.  The computer also shows you the information it is gathering in real-time as a picture or a sound.  You can then use the feedback from the computer to build skill in controlling your body’s state in ways that may be helpful.  For instance, muscle tension can be a problem for people with chronic pain.  Learning to relax specific muscles can be helpful.  Learning to do this may be easier if you have computer feedback about the tension in that area.  Similarly, we know that anxiety can make pain feel worse.  So, a person with pain might use biofeedback to learn to control physical aspects of anxiety.  This, in turn, may help decrease the problems with physical pain.

Basically, biofeedback is a way to learn helpful skills.  Ideally these skills allow people with pain to become actively involved in their own treatment.  While biofeedback may be helpful, it is important to know that it requires special technology.  As a result, it can be costly.  Depending on which skills you and your care provider think you need there may be less expensive ways of learning the same thing.

References

Cooperstein, M. A. (1998, November). Biofeedback Technology: A Prospectus. Pennsylvania Psychologist Quarterly, 58(9), 17,27.

Corrado, P. E. (1998). The effect of biofeedback training on locus of control in chronic pain patients. ProQuest Information & Learning). Dissertation Abstracts International: Section B: The Sciences and Engineering, 58 (9-B), 5110.

Feliu, M. H. (2005). Neurobehavioral rehabilitation: A program design. ProQuest Information & Learning). Dissertation Abstracts International: Section B: The Sciences and Engineering, 65 (10-B), 5429. (Electronic; Print)

Hernandez, A. F. (1999). Effectiveness of a biofeedback protocol in the management of pediatric and adolescent headaches. ProQuest Information & Learning). Dissertation Abstracts International: Section B: The Sciences and Engineering, 60 (3-B), 1301.

Trifiletti, R. J. (1984). The psychological effectiveness of pain management procedures in the context of behavioral medicine and medical psychology. Genetic Psychology Monographs, 109(2), 251-278.

Uslan, D. (2003). Rehabilitation counseling. In L. A. Jason, P. A. Fennell & R. R. Taylor (Eds.), Handbook of chronic fatigue syndrome. (pp. 654-690). Hoboken, NJ, US: John Wiley & Sons Inc.

Fibromyalgia is a chronic condition that causes pain, stiffness, and tender spots on the body.  It also makes people tire quickly.  It involves muscles, ligaments, and tendons, and it is difficult to diagnose because there is no definitive test for fibromyalgia.  Muscle and body stiffness are usually worse in the morning and improve as the day goes on.  Back, neck, or shoulder pain is common.  Many people with fibromyalgia also have trouble sleeping and some have depression or anxiety.

We don’t know what causes fibromyalgia, and even the risk factors are not entirely clear.  More women than men get fibromyalgia, and it usually develops in adulthood or middle age.  A family history of fibromyalgia and a personal history of rheumatoid disease (such as arthritis or lupus) increase your risk.  Some people believe that poor sleeping habits, mental or physical trauma, and repetitive activities (such as difficult physical labor or intense sports) increase the risk.  Some research suggests a connection between Lyme disease and fibromyalgia, two conditions that are often confused because they have similar symptoms.

Treatment is aimed at controlling fibromyalgia’s symptoms, since there is no cure for the condition.  The treatments you should have depend on your symptoms.  Usually, muscle aches and stiffness are treated with heat, massage, stretching, and exercise.  If those non-drug treatments don’t do the job, pain medications or steroid injections can be used.  Relaxation and stress relief techniques can help reduce aches and pains and also lessen sleep problems, depression, and anxiety.  Acupuncture gives some people relief from stiffness and pain.  Also, medication can be used to treat sleep problems, depression, and anxiety.

You would likely benefit from seeing a team of health care professionals, including:

• A doctor (MD or DO) or physician assistant to keep track of your overall health and prescribe medications as needed
• A physical therapist to teach and oversee your exercise and stretching plan
• A mental health counselor (optional) to help you manage sleep or mood problems
• A licensed acupuncturist (optional) if acupuncture is helpful for you

Beyond your medical team, there are many self-help groups and other peer organizations that support people living with fibromyalgia.  Although fibromyalgia treatment is different for every individual, these groups can be helpful with common-sense tips and advice on how to manage your own care and find what works for you. Good luck!

Narcotic pain medications (also known as opioids) tend to make people dizzy and drowsy.  That is why people taking them are warned not to do things that could be dangerous if you were not 100% alert.  Many people who use narcotic medications for chronic pain report that these side effects lessen or go away after a few days or weeks on the medication.  However, even if you feel alert, driving might not be safe or legal in your area.  Consult your health care team about whether you should restrict your activities while taking narcotics.

You should avoid other things that can make you sleepy or dizzy while taking this medication.  Sleeping pills, tranquilizers, muscle relaxants, antihistamines, and even alcohol can make the side effects worse.  Even if you usually do not have these side effects, you can get them when you add another medication or alcohol to your routine.  Also remember that even over-the-counter medications and herbal supplements might cause these problems when taken with narcotic medications.

In particular, the herbal supplements kava and valerian should not be used with narcotic medications.  Kava is typically used as a pain reliever, muscle relaxant, anti-anxiety treatment, or anticonvulsant.  Valerian has similar uses as a mild sleep aid, pain reliever, and muscle relaxant.  Both of these supplements can intensify the drowsiness and dizziness of narcotic medications.

Tell your doctor about all medications and herbal supplements you take, including over-the-counter medications and vitamins.  Read the labels of your medications and consult your health care team if you have concerns.  If you have any side effects, be sure to tell your doctor—you might just need a different dose of the medication.

Methadone is a medication which has  two FDA approved uses:

1. Management of moderate to severe pain
2. Detoxification and management of opioid addiction

While it is true methadone can be used to help individuals addicted to opiates, including prescription medications (e.g., oxycodone, fentanyl, morphine) and non-prescription (e.g., heroin), it is also a very powerful pain reliever. As a pain reliever, your doctor may have you take it every 6-8 hours (for treatment of dependence it is taken one time every day).

Many side effects of methadone are similar to other opioids including constipation, nausea, and respiratory depression (trouble breathing).  With prolonged use, you may become tolerant, meaning you may require higher doses to achieve the same analgesic effect.  Methadone, especially at higher doses, can cause irregular heartbeats (arrhythmias).  Much of the negative press surrounding methadone in recent years is related to the potential to cause arrhythmias. Current research indicates that your risk of developing arrhythmias may be predictable.  Your doctor may perform tests (like an ECG) prior to initiating therapy to help determine if you are at risk for developing this complication.  In addition, your doctor may perform follow up monitoring of your heart’s response to the medication.  While you are taking methadone, it is important to have your prescriptions filled at a pharmacy which is aware you are taking methadone: there are medications that can increase the likelihood of developing arrhythmias which you should avoid while taking methadone.  In addition, it is important to let your doctor know what medications you are already taking to determine if methadone is an appropriate medication for you.

There are benefits to using methadone as an analgesic. Methadone may offer benefits in the treatment of chronic pain over other opioid medications. While most opioids offer pain relief by acting at “mu” receptors, methadone is also thought to act at “NMDA” receptors. By also working at the NMDA receptor, methadone may offer these benefits:

1. Suppress nerve sensitization which helps to decrease your response to painful stimuli
2. Help to prevent tolerance to the pain relieving effects of opioids

It is important to take this medication as your doctor prescribes it.  The full effects of this medication may not be apparent immediately; do not take additional doses if you do not think it is providing adequate relief.  If you miss a dose, do not take an extra dose. Your doctor will adjust your dose slowly to make sure that you tolerate it well. This medication is generally safe to use to treat chronic pain conditions, however, you must

1. Make sure your health care provider is aware of your entire medical history
2. Make sure your pharmacy is aware of all medications you are taking so they can perform a complete check for potential drug interactions
3. Keep this medication away from children and pets and never give your medication to anybody for whom it was not prescribed
4. Seek medical attention if you believe you are experiencing any side effects

There are a number of symptoms associated with nerve pain. A common symptom is often described as a burning, stabbing, or tingling pain. Nerve pain, if untreated, may get worse. Sometimes it starts with numbness and pins and needles and develops into stabbing and burning sensations. With time, nerve pain can spread up the legs from the feet or up the arms from the hands.

Nerve pain results from damaged nerves inside your body. You can think of your central nervous system as a series of electrical wires that connect your brain to the rest of your body, allowing both to communicate. An injured nerve is like a short-circuited wire in the central nervous system - it stops working properly and sends the wrong signals to the brain.

As a result, people feel uncomfortable and experience symptoms that they might describe as tingling or pins and needles or more painful symptoms like burning and stabbing. Nerve pain can be related to a number of medical conditions such as diabetes, shingles, cancer and its treatments, carpal tunnel syndrome, or a spinal injury.

The tingling and burning sensations of nerve pain are very different from the soreness and aches you might feel from muscle pain. Muscle pain is caused by a physical injury, such as a fall, and disappears once the injury has healed. It can also be treated with many common pain medications, including medicine you buy over the counter.

On the other hand, nerve pain doesn't seem to be caused by any event or trauma and often results in a constant or recurring pain. Over-the-counter pain medicine isn't strong enough to make nerve pain go away.

Neuropathic pain - otherwise known as nerve pain - is a type of chronic pain that occurs when nerves in the central nervous system become injured or damaged.

As a person experiencing pain, you have the right to have your condition taken seriously. Nerve pain is a medical condition that affects more than four million Americans. It is often under-diagnosed and many people go on living their lives in pain.

When not properly managed, pain can seem to take over your life. People often have problems concentrating during the day and sleeping at night. Even simple acts, like walking or putting on socks, are agonizing. People with nerve pain may become reclusive and isolated from other people.

Your primary care physician will be able to address your needs. He/she will be able to tell you if you need further consultation or if medication can be prescribed. A medical specialist, such as a neurologist or pain specialist, may be able to help manage chronic pain more effectively should symptoms persist and your pain develop into a chronic condition.

Effectively managing nerve pain requires taking an active role in your health care and recovery process. Be open with your doctor about the pain you are experiencing and ask about ways to manage it, including medicines that specifically treat nerve pain. Also remember to relax and set realistic goals-sound pain management skills take time to develop.

There are many things you can do to manage the symptoms of nerve pain, including stress management, meditation, and mild exercise. However, the most important step is to see your doctor and include him/her in your overall pain management program. Take time to understand your symptoms and describe them to your doctor, so that he/she will be able to clearly identify the pain that you are experiencing. Ask your doctor about medications currently available to treat nerve pain. There are no medicines you can get without a prescription that will be strong enough to effectively manage your pain.

There is no cure for the damaged nerves that cause nerve pain. But with an effective pain management program that might include exercise, stress management, and medicine, you can do something to relieve your pain. By getting actively involved you can reduce your sense of suffering and improve the quality of your life.

Shingles, or herpes zoster, is a very painful infection caused by the varicella zoster virus. This virus also causes chicken pox (varicella) and can stay dormant in your nervous system for years between outbreaks.

Although the skin blisters from shingles usually heal in one to three weeks, pain can persist because the virus is still active in the nerves of the skin.

To help with pain, try over-the-counter pain relievers like ibuprofen; cold compresses; oatmeal baths; or anti-itch cream. Also be sure to get plenty of rest and fluids, as with any other viral infection. If your pain is severe or lasts more than a few weeks, talk to your doctor about whether an antiviral medication might help your symptoms. You also should talk to your doctor about your risk of having another outbreak and whether the varicella zoster vaccine might be useful.

Yes, carbamazepine (Tegretol®) is classified as an anticonvulsant and used to treat seizures, but it is also approved by the FDA to treat neuralgia pain.  It does not mean that you are at risk for seizures.  This medication works on both seizures and trigeminal neuralgia pain because both of these symptoms are caused by overactive neurons, the cells that conduct electrochemical impulses in your nerves.  

The word “neuralgia” means pain caused by a nerve.  The trigeminal nerve is one of the main nerves in your face; it has branches that carry sensory information from your forehead, eye, cheek, and jaw.  There is one trigeminal nerve on each side of your face. With trigeminal neuralgia, the nerve does not work correctly, and you experience sharp pain instead of regular sensation.

Carbamazepine blocks some of the signals in the nerve, in effect “calming it down.” With trigeminal neuralgia, reducing the nerve’s activity reduces the sensation of pain.

Traditional pain medications like the ones you listed are not very effective at treating pain from trigeminal neuralgia. Those analgesic (pain-fighting) medications are better for pain that increases gradually and persists for hours, but trigeminal neuralgia pain comes on suddenly and is very intense for a shorter time.  Also, traditional pain medications do not block the trigeminal nerve’s signals like carbamazepine does.

Carbamazepine (Tegretol®) has some troubling side effects and it is not well tolerated by everyone. For those reasons, it usually is prescribed in a low dose at first. If you can do not have side effects, the dose can be increased gradually to a level that gives you enough pain relief. Over time, your doctor should adjust the dosage to the lowest possible amount that works for you.

There are many pain management techniques that you can try to help you get relief with lower doses of any medication.  These include relaxation, pacing, distraction, and more.  You can learn more about them on the ACPA web site or through our materials.