chronic non-malignant pain treatment options

Chronic non-malignant pain is often treated with oral medication and pain-relieving techniques such as relaxation and exercise. Sometimes, these options cause side effects or don’t relieve the pain. If that’s true for you, your doctor may prescribe interventional pain therapy such as using a drug pump to deliver your medication1.

The choice for your treatment depends on your specific needs. This includes the type and severity of the pain you experience, as well as how you respond to pain treatment. Not all treatments may be applicable to your type of pain. Treatments for the management of chronic non-malignant pain include the following approaches.

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NON-DRUG TREATMENTS

With a chronic non-malignant pain diagnosis, techniques such as relaxation, biofeedback, imagery, hypnosis, acupuncture, exercise and counselling help many people use less pain medication. Your doctor can help you contact healthcare professionals who may teach you useful techniques or chronic non-malignant pain management strategies. 

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PHYSIOTHERAPY, OCCUPATIONAL THERAPY AND PSYCHOLOGICAL THERAPY

Physiotherapy, occupational therapy and psychological therapy can all help reduce the long-term effects of chronic non-malignant pain. These can be combined with other treatments such as chronic non-malignant pain management medications.

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NON-OPIOID ORAL MEDICATIONS (PILLS)

If you have a chronic non-malignant pain diagnosis, oral medication is often the first therapy that doctors use to manage it. Each patient will have a unique response to any medication, so your doctor may need to try a variety of drugs and dosages to find the most effective combination.

Your treatment will depend on the type and severity of your pain, along with how well your pain responds to that treatment.
Non-opioid oral medications include mild pain relievers such as acetaminophen and non-steroidal anti-inflammatory drugs like ibuprofen.

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OPIOIDS

If non-opioid medications are not effective in managing your chronic non-malignant pain, the next step could be to use opioids such as oral morphine or an analgesic patch. Opioids are similar to natural substances called endorphins, which are produced by the body to control pain.

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SURGERY

To reduce the long-term effects of chronic non-malignant pain, doctors may choose to carry out surgery. There are certain spinal surgeries which can help with chronic non-malignant pain management such as lumbar fusion, discectomy and decompressive laminectomy.1,2

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STIMULATION

Stimulation is sometimes used to manage chronic non-malignant pain. The most common forms of stimulation used are:

  • Spinal cord stimulation (SCS) 
  • Transcutaneous electrical nerve stimulation (TENS)

 There are also rarer forms such as: 

  • Repetitive transcranial magnetic stimulation (rTMS) 
  • Transcranial direct current stimulation (tDCS)
  • Deep brain stimulation (DBS) 
  • Percutaneous electrical nerve stimulation (PENS)1,2
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DRUG PUMP: INTRATHECAL DRUG DELIVERY SYSTEM

If your oral medication no longer provides pain relief or causes uncomfortable side effects, your doctor may consider an approach using a drug pump implanted in the body to deliver medication.

The pump is surgically placed in the abdomen, sending pain medication through a thin, flexible catheter (silicone tube) to the area around your spinal cord called the intrathecal space. Therefore, this system is called an intrathecal drug delivery (IDD) system.

Because in this system pain medication goes directly to the area around the spinal cord, the drug pump can offer significant pain relief with a small fraction of the medication used in other treatments.3,5

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NEUROLYTIC BLOCKS

Neurolytic blocks are injections directly into certain nerves that destroy them or stop the nerves from sending pain messages.

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NEUROABLATION

With neuroablation, doctors destroy (usually with heat) the nerves that serve as pathways to the brain.

“Besides pain killers, I have tried shots, nerve burnings, triggers, and multiple injections, but I was still in agony. I couldn’t vacuum or walk. I just sat in a chair. Now, I can finally go shopping again and do the things I want to do.”

Tami*

Lady walking outside with shopping

*Every patient experience is unique. Not everyone who receives Medtronic Intrathecal Drug Delivery therapy will experience the same results.

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1

Hylands-Whites et al. An overview of treatment approaches for chronic pain management. Rheumatol Int. 2017 Jan;37(1):29-42.

2

Dennis et al. Treatment of chronic non-cancer pain. Lancet 2011; 377: 2226–35.

3

Hamza M, Doleys D, Wells M, et al. Prospective study of 3-year follow-up of low dose intrathecal opioids in the management of chronic nonmalignant pain. Pain Med. 2012;13:1304-1313.

4

Advancing Pain Research, Care, and Education, Institute of Medicine, Board on Health Sciences Policy. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press; 2011.

5

Grider JS, Etscheidt MA, Harned ME, et al. Trialing and maintenance dosing using a low-dose intrathecal opioid method for chronic nonmalignant pain: a prospective 36-month study. Neuromodulation. 2016;19(2):206-219.