Charles E. Argoff, MD, Responds

Living with chronic pain can be depressing and exhausting, and people often despair of finding adequate treatment. Given that, it's important to create an interdisciplinary plan for pain relief that includes exercise, non-prescription medication, cognitive behavioral therapy, treatment for depression and anxiety, sleep, diet, stress reduction, and therapies such as massage and acupuncture. In some cases, pain relief may also involve the use of prescription medications (both opioid and non-opioid), anti-seizure drugs, antidepressants, surgery, nerve blocks, or an intrathecal pump, which is placed internally and delivers medication directly to the spinal fluid.

Use Opioids Carefully

If your doctor prescribes opioids, you will want to work together to monitor effectiveness, side effects, and signs of dependence. Even in cases of severe chronic pain, your doctor may decide against prescribing opioids, at least initially. Opioids are not always more effective than non-opioid pain relievers, and they come with significant side effects such as constipation, possible hormonal changes, drowsiness, nausea, vomiting, and addiction.

A study published in the March 2018 issue of JAMA Network found that opioids were not more effective than non-opioid medication for people with chronic hip, back, or knee pain. The study was not designed to show which patients would benefit from which pain reliever—that's why it is so important to work with your doctor.

Consult a Specialist

Treatment for pain often depends on the cause. A migraine is treated differently than, say, chronic back pain or neuropathy. Ask your doctor to help you identify the source of the pain and then ask for a referral to a specialist who deals with that type of pain.

Ask How Much Relief to Expect

Unfortunately, successful pain relief doesn't always mean eliminating the pain entirely. Experts consider a 30 to 50 percent reduction in pain intensity a good outcome. With that amount of relief, you should be able to return to doing things you love. And returning to what you enjoy can improve your mood, which itself helps relieve pain.

Incorporate Exercise

Exercise prescribed by your doctor and guided by a physical therapist who specializes in pain can be helpful, especially if the pain is caused by atrophying muscles or limbs that need straightening.

Try Prescription Versions of OTC Pain Relievers

Talk to your doctor about prescriptions for naproxen (Aleve) and ibuprofen, which often contain higher doses than over-the-counter versions. Be sure to discuss how and when to take the medication.

Consider Alternative Therapies

Ask your doctor about massage therapy, which may provide short-term relief for certain types of pain, or biofeedback, which uses electrical sensors to help you learn to reduce your heart rate and relax your muscles. Another option is acupuncture—the expert placement of thin needles in specific pressure points to ease pain. This technique may be helpful for headache pain and other conditions, according to a 2018 meta-analysis in the Journal of Pain.

Treat Depression and Anxiety

Untreated anxiety and depression can complicate and impede treatment of chronic pain, and chronic pain can lead to significant depression and anxiety. Treatments include antidepressants, cognitive behavioral therapy, psychotherapy, hypnosis, and meditation. These can help you relax and possibly reduce your pain as well, often in combination with pain relievers.

Allow Time to Develop a Plan

When you're in chronic pain you want relief right away, but it can take doctors a few visits to get to know you and fully understand the underlying causes of pain and what might be effective. If the first or second treatment isn't effective enough, you and your doctor have other options and combinations you can try.

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For more information, read How to Manage Chronic Pain.