How is chronic pain treated?

Although no single cure is available for chronic pain, there are many ways to treat and manage it. The first step should be to treat any underlying conditions that may cause pain. These treatment methods will vary according to the specific disease or medical condition. The treatment also will depend on the type of chronic pain involved. It is recommended that a team of healthcare professionals work with the patient to develop a comprehensive plan for treating and managing pain, instead of relying solely on medications. The focus should be on development of self-management skills, along with lifestyle changes and efforts to improve physical and mental health. The plan should include psychological and behavioral therapy.

Drug treatments for chronic pain

  • Analgesics (pain relievers): The use of pain relievers is the most common method for treating chronic pain. These drugs do not work in all cases, however.
    • Non-narcotic pain relievers: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, naproxen, or COX-2 inhibitors may be useful when the pain is mild or moderate. There are many other types of NSAIDs. NSAIDS work by blocking pain near the pain site. Acetaminophen is a non-NSAID pain reliever that works by blocking pain in the brain.
    • Opioids, opioid-like agents, or combinations of opioids and non-narcotic analgesics: Any of these may be prescribed to reduce pain. Opioids work in the brain, central nervous system, and other areas of the body to block the sensation of pain. Because of the way they work, they have many negative side effects. Opioids are most useful with acute pain such as pain after surgery or trauma and are usually reserved for cases of chronic pain when other pain relievers are not effective and when the negative side effects are manageable.
  • Topical products: Over-the-counter creams and ointments containing capsaicin (a substance generating heat) may be applied directly to the skin three to four times per day. Lidocaine (a local anesthetic) creams or patches also can treat chronic pain.
  • Antidepressants: Many chronic pain patients may benefit from taking anti-depressant drugs. This is because the same chemicals linked to depression also play a role in chronic pain. Types of antidepressants prescribed include tricylic antidepressants, selective serotonin reuptake inhibitors (SSRIs), and others.
  • Anticonvulsants (anti-epileptics): These drugs may be used to treat various neuropathic pain conditions. Such conditions include nerve injuries and diabetic nerve pain.
  • Sedatives/anti-anxiety agents: These may be prescribed for short-term treatment of sleep problems including insomnia (sleeplessness).
  • Muscle relaxants.
  • Corticosteroids.
  • Antirheumatics/immunological agents.
  • Botulinum toxins.

Non-drug treatments for chronic pain

  • Exercise: Light to moderate exercise may help improve blood and oxygen flow to muscles and reduce stress. It may be especially helpful for people with low back pain, arthritis, psychogenic pain, and many others.
  • Heat and/or cold application: Applying heat and/or cold regularly to a sore area via a safe mechanism (such as hot or cold packs that have temperature limits built in to prevent burning or freezing skin) can be very effective for treating many types of pain.
  • Acupuncture: Acupuncture done by a trained therapist can provide relief for all types of chronic pain.
  • Massage: Massage therapy has been shown to be effective for muscle and mechanical pain and may be useful for other kinds of chronic pain as well.
  • Spinal cord stimulation: Electrodes are placed inside the epidural part of the spinal cord. The patient can send electrical pulses to the spinal cord using an implanted electrical pulse generator. The electrical impulses interrupt the pain signal to the brain providing relief.
  • Deep brain stimulation: This technique is only used to treat chronic pain in cases that do not respond to more conservative treatment. It requires surgical stimulation of areas of the brain, usually the motor cortex or thalamus.

Psychological and behavioral treatments for chronic pain

  • General mental health and behavioral counseling: Mental health professionals such as psychotherapists, psychologists, and social workers can work with patients. Goals are for the patients to improve coping skills and develop strategies to reduce stress, anxiety, depression, and sleep problems.
  • Cognitive behavioral therapy (CBT): This form of treatment focuses on gaining coping skills, such as how to identify and change negative thoughts and learning relaxation techniques. These, in turn, will help the person gain more control over his or her emotions and moods as well as more control over feelings of pain.
  • Fear-avoidance training: People with chronic pain may avoid movement and activity and not get enough activity due to their fear of re-injury or pain. Treatment includes education, instruction on active pain management techniques, and routine exposure to activities that the patient may have avoided in the past.

Mind-body treatments for chronic pain

  • Relaxation techniques: These include breathing exercises and other relaxation method.
  • Mindfulness training.
  • Meditation.
  • Biofeedback: Patients can learn this technique to control the body's functions, including heart rate and muscle tension.
  • Music: Listening to different types of music has been shown to change brain waves and can be very effective in treating pain.
  • Art therapy.
  • Pet therapy.
  • Reiki: A technique in which the therapist can channel energy into the patient by means of touch in order to activate the natural healing processes to help with pain.
  • Guided imagery: This self-care technique is highly effective in significantly reducing anxiety and pain.
  • Aromatherapy: Different aromas can be used to reduce pain and anxiety.
  • Healing Touch: A healing energy therapy that uses a practitioner’s hands to intentionally influence energy fields to promote healing through reduction of pain, anxiety, and fatigue and to improve overall emotional health. Has been used for abdominal pain as well as pain from cancer, sickle cell disease, and heart surgery.
  • Hypnosis.

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