There are several types of chronic pain relief

Drug intervention, non-drug physical intervention, behavioral cognitive adjustment, and invasive procedures. However, there is no absolute standard answer to this classification. Traditional Chinese medicine often categorizes special therapies such as acupuncture, moxibustion, and medicinal dietary conditioning separately. New technologies such as digital analgesia and neuromodulation that have emerged in recent years have not yet been included in a unified classification framework. In practical applications, there is no need to stick to the classification logic. Symptomatic relief is the core.

The most well-known drug intervention is drug intervention. When many people feel pain, their first reaction is to look for ibuprofen and Voltaren at home. These non-steroidal anti-inflammatory drugs do have good effects on most inflammation-related chronic pain, such as arthritis and muscle strain pain. However, I have come into contact with many patients who took painkillers for a year or two without seeing a doctor. In the end, they suffered from gastric ulcers and gastrointestinal bleeding. There is also a controversial point here. Should opioids be used for moderate to severe chronic pain, such as cancer pain and neuropathic pain? There was a period of excessive liberalization of opioid prescriptions in Europe and the United States, leading to addiction for many people. Domestic clinical guidelines are generally cautious. They will only be used when the benefits are assessed to far outweigh the risks. They are usually paired with nerve-regulating drugs such as gabapentin and pregabalin to reduce the dosage of opioids.

What many people don’t know is that for at least 30% of cases of chronic pain, the effect of taking medicine is far less effective than adjusting daily behavior and cognition. I met an aunt who suffered from fibromyalgia before. She suffered from pain all over her body for five or six years. She went to various major hospitals for examinations but could not find any organic problems. She took a lot of medicine and still felt nauseous. Later, she followed a psychotherapist in the pain department for three months of cognitive behavioral therapy, plus a 10-minute mindfulness body scan every day. Now the frequency of attacks has dropped from three or four times a week to once or twice a month, and even her sleep has improved a lot. Of course, some people think that this method is just "psychological suggestion" and useless. Current clinical data shows that for chronic pain without clear organic disease, the effective rate of cognitive behavioral intervention can reach 30% to 40%, which is no worse than conventional analgesics. However, many people cannot accept the fact that "pain is related to psychology".

If the side effects of taking medicine are severe, and adjusting habits does not work for a while, many people will try non-drug physical intervention first. This part is actually the most complicated to classify. Shock waves, ultrasound, hot compresses, cold compresses, and myotropic patches in modern rehabilitation, as well as acupuncture, moxibustion, cupping, and bone-setting massage in traditional Chinese medicine, are all included in this category. The controversy about acupuncture has never stopped. Western medicine has not yet fully understood its analgesic mechanism. Some studies even say that "there is no difference in the effect of real acupuncture and sham acupuncture." However, clinical guidelines for chronic low back pain and neck pain in the United States and China are now included. Acupuncture has been listed as the first-line recommended solution. I have a friend who runs marathons all year round. He suffered from patellar tendinitis in his knee for more than half a year. He tried medicine and physical therapy but it didn’t get better. After 5 times of acupuncture, he ran a half marathon normally. This kind of case is actually not uncommon in clinical practice. However, I would like to remind you that whether it is massage or bone setting, you must find a qualified institution. Last year, I treated a patient who had an acute attack of cervical disc herniation by pulling his neck out at a roadside shop. The pain was so painful that he could not even walk. The gain outweighed the gain.

If you have tried all of the previous methods and the pain is still so severe that you can't sleep or eat, you can consider invasive intervention. For example, nerve blocks for neuralgia, intrathecal drug infusion for cancer pain, and spinal cord electrical stimulation for intractable low back and leg pain all fall into this category. I previously managed a patient with advanced pancreatic cancer who was still in pain until he cried even though he was taking the maximum dose of opioids. His consciousness was blurred. Later, he underwent a celiac plexus block and he was able to sit up and chat with his family that afternoon. Of course, many people are afraid when they hear that "needle insertion into nerves" or "surgical electrode placement" is required. It is true that this type of operation has a very low probability of infection and nerve damage, so it must be strictly evaluated by professional doctors to confirm that the benefits far outweigh the risks. Currently, there are many opinions that the indications for invasive intervention should be relaxed, and patients should not be allowed to endure the pain until they are unbearable. There is currently no unified consensus in the industry.

To be honest, chronic pain relief methods are still constantly being updated. For example, I have seen hospitals using VR games to distract burn patients to relieve the pain of dressing changes, and there are also special anti-inflammatory diet plans to relieve the pain of rheumatoid arthritis. These have not yet been included in traditional classifications. There is no need to worry about how many types there are. After all, everyone’s pain causes and tolerance levels are different. What works for others may not work for you. If you are really troubled by chronic pain, don’t try blind remedies on your own. The most reliable option is to seek an evaluation from the pain department of a regular hospital first.