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When Your Pain Medication Isn’t Working

(ĐTĐ) – More than 100 million Americans have chronic pain. If you’re one of them, controlling it will likely require searching for treatments beyond medication.

That’s because pain medication, while helpful, often cannot provide complete relief of pain. It may reduce but not eliminate pain.

Carla Ulbrich, 45, is willing to use medication to help control her chronic pain. But she sees it as just one piece of her overall plan. For the past 20 years, lupus and fibromyalgia have caused pain to smolder and flare around her body.

Pain medication offered varying degrees of relief, but also often led to side effects. She credits a mix of additional practices — acupuncture, massage, heat, and changing her diet — for much of her current success in controlling the pain.

“I’d say medication saved my life, but throwing medication at something never really gets to the root of it,” says Ulbrich, who lives in Somerset, N.J..

When Your Pain Medication Isn’t Working

No Quick Fixes for Chronic Pain

A broken leg, and the acute pain it causes, can often be treated relatively quickly, says Perry Fine, MD, a pain specialist at the University of Utah. But chronic pain is more akin to bigger problems like diabetes or advanced cancer, which can’t be so quickly or easily “fixed.”

The goal when treating chronic pain isn’t necessarily to become pain-free. Instead, the target is often a good quality of life while managing pain at a tolerable level.

“What’s important is for people in chronic pain to communicate … with their doctor, and let them know what their pain level is that keeps them from doing certain things,” Fine says. “For example, ‘My pain is keeping me from sleeping, going to work, and getting around and walking.’ Then talk to the practitioner about establishing specific, measurable goals such as being able to vacuum, go to work, have sex, and get to sleep.”;

To reach these goals, doctors may try:

  • Medication that address pain from different angles. For example, antidepressants can help “calm down” the nervous system and make it less sensitive to the pain, Fine says. The anti-seizure drugs gabapentin and pregabalin can also be effective for certain types of nerve pain.
  • Injecting anesthetic or steroids into injured areas..
  • Doing surgery to treat the source of pain. This includes joint replacements, repairing damaged discs in the spine, or taking pressure off a pinched nerve.

Your doctor may also suggest that you work with a physical or occupational therapist. You may also want to seek answers to the mental components of pain rather than just the physical side, Fine says..

Putting Your Mind to Work

“Most people with chronic pain are never ‘cured’ [of their pain], and that’s a difficult thing to be told. Our society tells us if you’re in pain, you shouldn’t be,” says Beverly Thorn, PhD, of the University of Alabama.

She’s a psychologist who works with people in chronic pain to help them find new ways to think about it. The brain can be a powerful ally — or enemy — during chronic pain. That’s because:

  • Your brain filters the pain signals coming from your body. Your thoughts and emotions play a role in this filtering. The brain can dampen the strength of these pain signals or ramp them up, Thorn tells WebMD..
  • Over time, the brain can become more sensitive to chronic pain. It may overreact to even less intense pain signals.

Cognitive-behavioral therapy (CBT), an approach that Thorn uses with patients, can address both issues, she says. CBT helps people:

Change their pain-related thoughts. “If the thought of a pain flare-up makes you say things to yourself like, ‘I’ll have to go to the ER for sure,’ or, ‘I can’t stand this anymore, this is ruining my life,’ it can really dig a hole for you,” Thorn says.

Pain control involves noting negative self-talk and replacing these thoughts with factual, positive options, like focusing on the good parts of your life.

Change their behaviors. “When they have a pain flare-up, many people go to bed, pull the covers up, and withdraw. This makes them more susceptible to pain, and it can make them depressed,” Thorn says. CBT can help people follow their usual routines even during flares.

A psychologist can also help you deal with your pain with a related technique: mindfulness. Instead of reacting when pain grabs your attention, mindfulness involves observing the pain with a neutral attitude. “When that reaction isn’t there anymore, pain is easier to manage,” Thorn says. “What people start to realize is that there’s a lot of variability in their pain. If they really pay attention to their moment-to-moment experiences, they realize that sometimes they’re pain-free.”

Seeking Other Alternatives

Unconventional treatments may also succeed when medication doesn’t provide the answer.

Lawrence Taw, MD, of the UCLA Center for East-West Medicine, often sees people with autoimmune diseases, some of which can cause chronic pain, such as lupus and MS.

Some people look to complementary medical approaches because medicines haven’t worked. Others just want natural solutions. “I’d rather not think of this as a medical option of last resort. I think it’s important to consider using these therapies earlier in the course of treatment, or in conjunction with mainstream medicine,” Taw tells WebMD..

These providers tend to develop specific approaches for each person’s needs, Taw says. Options may include:

  • Herbs and supplements. The herbs ginger and turmeric can reduce inflammation, for example. Always tell your doctor about any supplements you’re taking, even if they’re “natural,” so that your doctor can watch for any problems and has a complete record of what you’ve tried.
  • Acupuncture and acupressure. Surveys have found that painful conditions — including back and neck pain and headaches — are some of the most common reasons why people use acupuncture. Acupressure is a related treatment that uses focused pressure to stimulate certain spots on the body instead of the thin needles used in acupuncture.
  • Topical treatments. These include menthol rubs, capsaicin cream (for joint pain), and arnica cream.

These days, Carla Ulbrich works as a speaker, author, and musician who encourages audiences to approach their health problems with a sense of humor..

She says her pain-relieving strategies have left her “pretty happy and not having much pain. I have medication if I need it — I’m not against them. But I want to control this without medication if I can.”

Fine reports having received consultant fees from a number of pharmaceutical companies in the past year.

Reviewed by Laura J. Martin, MD – Source

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