Treating Chronic Pain Syndrome [CPS]

Just as in diagnosing chronic pain syndrome, treating CPS can also be quite complex, treatment generally being a combination of protocols for both physical and mental relief.

Since CPS typically does not respond to standard medicalcare, the condition is best managed by adopting a multidisciplinary approach across multiple systems. This can be rather confusing for the patient, who need to understand what each component is likely to produce in terms of results and side effects.

Care providers must understand that most suffers have already tried many different treatments, with limited success and often very unwelcome side effects, hence tolerance is required to ensure the patients fully understand each treatment proffered.

The most commonly asked questions by sufferers of CPS are:

1. What is causing the symptoms?
2. What type of treatment will you recommend to relieve the pain?
3. How effective is this treatment?
4. Can you explain how acupuncture and local electric stimulation work?
5. And how effective is each procedure?
   

Treatments

Treatment of CPS includes a rehabilitation program, pain relief and treatment of mental wellness and nerve [messaging] intervention.

Rehabilitation Program includes:

Physical Therapy | Occupational Therapy | Medical | Surgical | Consult | Other

Physical Therapy

Physical therapy - to increase strength and flexibility of the primary injury, as well as the total body. This should begin with gentle gliding exercises, as patients are often reluctant to participate due to intense pain.

Other PT treatments include hot or cold applications, positioning, stretching exercises, traction, massage, ultrasound therapy, transcutaneous electrical nerve stimulation (TENS), and manipulations.

Heat, massage, and stretching can be used to alleviate excess muscle contraction and pain. Other intervention should be offered to enable greater confidence and comfort when patients do not progress in a reasonable amount of time.

Occupational Therapy

OT gets the patient moving using gentle activites and also helps start desensitization by engaging in pleasurable activities that help decrease pain. Since many patients with chronic pain are depressed because of intense pain, OT plays an important role in helping them enable the patient to become active.

Medical Interventions

When a patient with CPS has multiple problems, treatment is morecomplex, usually requiring simultaneous psychological treatment, and physical therapy. A good relationship between the physician and patient is an essential part of the treatment protocol so that treatments can be tailored for each individual patient.

The treatment aims to simultaneously interrupt the reinforcement of the pain behaviour and modulation of the pain response, whilst also focusing on restoring normal function and quality of life. As the patient becomes more active, medication is reduced and steps are taken to prevent relapse of chronic symptoms.

Medication

Initially, pain may respond to simple over the counter analgesics, such as paracetamol, ibuprofen, aspirin, or naproxen. More severe pain will require prescription drugs, used for short term relief only to avoid the risk of dependence and abuse.

• Tizanidine may improve the inhibitory function in the CNS and can provide pain relief.
• Tricyclic antidepressants (TCAs) are frequently used to treat chronic pain – such as Amitriptyline (Elavil) and Nortriptyline (Pamelor)
• Selective serotonin reuptake inhibitors (SSRIs) - fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft) are commonly prescribed.
• Antidepressants such as doxepin, desipramine protriptyline, and buspirone also can be used. Antidepressants increase the synaptic concentration of serotonin and/or norepinephrine in the CNS by inhibiting their reuptake by the presynaptic neuronal membrane.

Caution must be exercised when medicating with both pain and antidepressant medications to avoid contr-indications.

• Anticonvulsants - certain antiepileptic drugs [such as GABA analogue gabapentin and pregabulin [Lyrica]) have proven helpful in some cases of neuropathic pain]. Other anticonvulsant used include clonazepam, topiramate, lamotrigine, zonisamide, tiagabine
• Analgesics – focus on restoring patient comfort for patients who have sustained traumatic injuries, and also help overcome increased pain during early physical therapy. In joint pain, steroid/analgesic injections provide relief for 2-3 months to allow more intensive exercise therapy.
• Nonsteroidal anti-inflammatory drugs - combine analgesic, anti-inflammatory, and antipyretic activities have proven helpful for some patients

Surgical Intervention

Where other treatments fail, more invasive surgical procedures may be needed. This includes:

• Nerve blocks - for diagnostic, prognostic, as well as therapeutic procedures. Sympathetic blocks are most effective chronic pain.
• Spinal cord stimulation - is used to treat neuropathic pain and for patients with a failed back syndrome with associated radiated pain.

Morphine pumps - either fully implantable pumps or external pumps, are used to treat chronic pain. This method of treatment should be considered very carefully for pain of non-malignant origin.

Consultations

Consultation with appropriate specialists is very important, especially before considering invasive or aggressive management.

A psychological evaluation should be performed to identify the stressor and to obtain information about the distress of the patient.

Other Treatment

• Hot and Cold Treatment - is used as a good home treatment for treatment of CPS; albeit, use of cold in neuropathic pain is controversial.
• TENS – most effective in the treatment of rheumatoid arthritis and osteoarthritis. Electrodes are applied over or near the area of pain. TENS should not be used near the carotid sinus, during pregnancy, and in patients with demand-type pacemakers. Some patients experience skin hypersensitivity with this treatment.
  Exercise groups – studies have shown that exercise has significant benefit over TENS.
• Psychophysiological therapy - includes counselling, relaxation therapy, stress management programs, and biofeedback techniques.
• Vocational therapy - should be initiated early to help maintain motivation to return to work. This includes setting realistic goals, changing work that is known to aggravate the condition and interspersing work with frequent periods of physical therapy exercises.

Psychological interventions, in conjunction with medical intervention, PT, and OT, increase the effectiveness of the treatment program. Family members are involved in the evaluation and treatment processes.

NEXT: Ongoing Care for Chronic Pain Syndrome

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CHRONIC PAIN SYNDROME | Causes | Symptoms | Diagnosis | Treatment | After Care