Mayo Clinic Q&A
DEAR MAYO CLINIC: I’ve had persistent headaches for about six months. Medication sometimes helps, but not always, and the pain just keeps coming back. My doctor checked to see if another medical problem could be causing the headaches, but she didn’t find anything. She now recommends I see a pain management specialist. What can they offer other than more medication? I’m missing a lot of work, and I’m afraid I’ll never get this under control.
ANSWER: Chronic pain such as yours can be debilitating and, as you’ve seen, pain relievers aren’t always the solution. A specialist in pain management can assess your situation, give you alternative treatment options, and help you find ways to cope with the chronic headaches, so you can get back to living your life the way you want.
As in your situation, when no underlying condition is found that’s causing chronic headaches, then treatment focuses on lowering the frequency and severity of the headaches, as well as reducing the disruption they cause in your daily life. One of the best ways to identify the type of headache you have, along with examining specific headache therapies, may be to consider seeing a headache specialist such as a neurologist.
The first line of treatment for chronic pain, including headaches, is usually medication. Specific types of primary headache may respond to unique medication therapy, so it is important to have the right diagnosis. Pain-relieving medication management may also include a wide range of other potential drug therapies — from over-the-counter options like nonsteroidal anti-inflammatories such as ibuprofen, to neuropathic medications such as gabapentin, to strong prescription opioids such as morphine, oxycodone, hydrocodone and fentanyl.
Medications may be a viable ongoing treatment for chronic pain, but their use needs to be balanced with the risk of side effects, especially if they are used long-term. Opioids in particular should only be used for severe pain that doesn’t respond to other medications, and the amount of time opioids are used should be limited. Research shows little benefit with long-term use of opioid drugs, but significant risk for complications. Those complications include decreased ability to function, increased tendency for depression, hormonal dysregulation and risk of addiction, among others.
There are other choices for controlling pain beyond medication. A number of minimally invasive procedures can be used to treat pain. They include trigger-point injections, peripheral nerve blocks, image-guided spine procedures and implantable medical devices, such as spinal cord stimulators.
Less-invasive procedures such as acupuncture — a procedure that uses hair-thin needles inserted into areas of your skin at specific points — can sometimes be useful in reducing the intensity and frequency of headaches. Learning biofeedback can be helpful, too. With this technique, you may be able to lessen headache pain by becoming more aware of and then changing your bodily responses to pain, such as muscle tension and heart rate.
Some pain management strategies don’t get rid of pain. Instead, they help you learn how to better cope with it. For example, a type of counseling called cognitive behavioral therapy can often be beneficial for people dealing with chronic pain. With this therapy, you examine the negative ways you may be thinking about or reacting to pain. You then learn how to reframe your thoughts and behaviors so you can better manage your life, despite the pain, and move forward in productive, healthy ways. There is clear evidence that cognitive behavioral therapy can provide meaningful, long-term improvement of chronic pain while also improving daily functioning.
Additional techniques that may help reduce pain include stress management, relaxation strategies, physical and occupational therapy, sleep therapy and lifestyle management.
Pain management specialists are physicians familiar with these and other pain treatments. They typically are members of larger teams of professionals from diverse backgrounds who work with people to manage chronic pain. Neurologists, physical therapists, occupational therapists, acupuncturists, psychiatrists and other mental health specialists often collaborate as part of the multidisciplinary pain management groups.
Working with a pain management specialist, along with other members of the team, you can create a pain management plan that fits your needs, allowing you to gain control over chronic pain and return to your normal routines. — Jason Eldrige, M.D., Pain Clinic, Mayo Clinic, Rochester, Minn.
(Mayo Clinic Q & A is an educational resource and doesn’t replace regular medical care. E-mail a question to MayoClinicQ&A@mayo.edu. For more information, visit www.mayoclinic.org.)