How to manage and treat chronic pain


Ways to Manage Chronic Pain I have developed a theory (or maybe it is just a hypothesis or supposition) that the treatments of almost every ailment, malady, illness or disease can be classified as being diet (including medication), exercise or therapy.

I have recently written an article about the causes of chronic pain and in which I expounded my theory. Two of the causes were a deficiency of Vitamin D and of the mineral magnesium in a person’s diet. Thus, the way to manage this would be to do its opposite: to ensure that you can sufficient Vitamin D and magnesium.

Many of the other causes can be managed in this way. I have also written an article about ways to manage back pain, which was also formulated using my theory. For those who have not read those articles, I will reiterate those recommendations here and attempt to find and describe other ways to manage chronic pain.

Diet Anticonvulsant and antidepressant medication

It may seem to be strange and even counter-intuitive for medication for seizures and for removing depression, stress or anxiety but this does seem to be the way for very many medications. It is not outside the realm of possibility and may, in fact, be true (I do not know absolutely everything about absolutely every medication and drug) but there may be medication for cancer that also helps in healing a stubbed toe.

Regardless, anticonvulsants and antidepressants do work on very many types of pain and of chronic pain. The anticonvulsant brand names of Lyrica, Neurontin and Tegretol are especially effective on shingles or other nerve-related chronic pain disorders. There are also several in the pipeline which have far fewer side effects than the current brands of medication.

Antidepressant medications work more effectively on pain than they do on depression itself; smaller doses are required for pain relief than for relief from depression. Elavil, Pamelor and Norpramin are tricyclic antidepressants which are especially helpful in treating cancer pain, fibromyalgia, osteoporosis, chronic low back pain, nerve pain from diabetic neuropathy, and shingles. They all affect the levels of the brain chemicals serotonin and norepinephrine.


This is, more or less, another word for opioids or “prescription pain medicine” (see below). However, I am providing a different heading to allow for additional information. Narcotics or opioids work by binding to the opioid receptors, inhibiting the message of pain, but which are usually very addictive.

There are now “non-narcotics”–or perhaps “synthetic narcotics”–which also work on the opioid receptors, but which have not been found to be addictive.

Ultram ER is an example of this. It is used for moderate to moderately severe chronic pain, and when continuous pain treatment is warranted. Other examples contain fentanyl. Duragesic is a skin patch treatment for moderate to severe chronic pain and provides fentanyl continuously for 72 hours.

Actiq is in the form of a lollipop, and Fentora is a tablet which dissolves in the mouth.

Prescription pain medicine (hydrocodone, hydromorphone, oxycodone, morphine)

These are both a treatment and a cause of chronic pain, as I wrote in my recent article. They are much like society’s need to find stronger and stronger antibiotics to combat stronger and stronger viruses and bacteria.

They are also much like chemotherapy and radiation therapy which damages your body’s natural immune fighting system, leaving you open to getting cancer again in the future. They also tend to be less effective the longer you use them (especially if you use them for several years). Of course, biochemistry is a constantly evolving science and the opioids of tomorrow may rectify these current shortcomings.

They also tend to be highly addictive. However, if you have not been addicted to other medicines or drugs (legal or otherwise) and if you do not have an addictive type of personality, then a study did report that there is a less than 1% chance that you will be addicted to opioids.

Raw foods

As I was writing this article, I found this article in my Google+ inbox. It describes one woman’s overcoming 17 years of living with the pain of fibromyalgia by adhering to a raw foods diet, which is described as consisting of lettuce, kale, fruits and vegetables, nuts and seeds, seaweed, wheatgrass, superfoods, sprouts, kimchis, sauerkrauts. (Although I detest the taste of kimchi and I cannot imagine myself eating a lot of sauerkraut, I have read nothing but good things about wheatgrass.)

The article also mentions this as making the body more alkaline (in contradistinction to the sodas and other acids we ingest). About a decade ago, I read a book that advocated making the body more alkaline in order to extend one’s life. The truth is that–regardless of whether or not you have fibromyalgia or other forms of chronic pain–you have to eat something. You may want to explore this diet; you may not have to suffer for years, or for the rest of your life, with debilitating pain.

Vitamin D and Magnesium

WebMD says that there may not be a causal connection between Vitamin D intake and chronic pain. The Mayo Clinic says that there is just a correlation. Regarding magnesium, WebMD does report that studies have found that magnesium can alleviate migraines, muscle spasms and fibromyalgia.

LiveStrong indicates that a deficiency of magnesium leads to twitches, cramps, muscle tension and soreness, back aches, neck pain, jaw pain and tension headaches. Regardless, there is a great deal of anecdotal evidence showing that very many people with such deficiencies (often not diagnosed) develop chronic pain and other ailments and maladies, and that very many people have these symptoms eradicated once they get sufficient amounts of these. (The U.S. recommended daily allowance for Vitamin D is 600mg for healthy people aged 9 to 70 and 800mg for people aged 71 and over.

The RDA for magnesium is more complex, with a differentiation between males and females, whether you are pregnant or lactating, and a greater breakdown of age. Regardless, the chart can be found here. You may want to be tested for your levels of these items, or ensure that you maintain the proper levels. If you do not have them and if you are suffering from chronic pain then you just may want to try this before any other treatment; it just may be the simplest, quickest and cheapest treatment available.

Exercise Strength training

An article published by the Harvard Medical School reported on a Danish study of women (primarily office workers) who experienced chronic neck pain (specifically, trapezius myalgia). One third of this admittedly small group (48 women) received strength training. Of this group, there was a 75% decrease in the level of pain.

It must be emphasized that this regimen is an intensive program, the women in the group were generally younger and active, and that they were supervised. Even if all of these do apply to you, you still need to consult a physical therapist to determine whether or not strength training is right for you based on your age, condition, level of pain and other factors.

If the following exercises are deemed to be appropriate for you then start with a weight that allows for a repetition of 8 to 12 times.

1) Dumbbell shrug: Stand straight with your feet shoulder-width apart and your knees slightly bent. Hold a weight in each hand, and allow your arms to hang down at your sides, with your palms facing your body. Shrug your shoulders upward, contracting the upper trapezius muscle, hold for one count, and lower. The starting weight should be 17 to 26 pounds.

2) One-arm row: Stand with your left knee on a flat bench and your right foot on the floor. Hold a weight in your right hand. Bend your torso forward, placing your left hand on the bench for support. Allow the weighted hand to hang down toward the floor. Pull the weight up until your upper arm is parallel with your back, pause, and then lower it. Switch to the left side, and repeat. The starting weight should be 13 to 22 pounds.

3) Upright row: Stand straight with your feet shoulder-width apart. Hold the weights down in front of your thighs, with your palms facing your body. Slowly bring the weights straight up, as if you were zipping up a jacket. Slowly lower the weights to their original position. The starting weight should be 4 to 11 pounds.

4) Reverse fly: Lie on a bench at a 45-degree angle. Hold a weight in each hand and allow your arms to extend down toward the floor. Keeping your elbows slightly bent, lift the weights up and out to the side to about shoulder level. Slowly lower the weights. The starting weight should be 2 to 6 pounds

5) Lateral raise: Stand straight with your feet shoulder-width apart and your knees slightly bent. Lift your arms up to the sides until they are parallel with the floor. Your elbows should be slightly bent. Slowly lower your arms. The starting weight should be 4 to 9 pounds.


Below, I wrote that Americans turn to acupuncture. They turn also to yoga. A study done in 2012 shows that 8.7% of adults in the United States practice yoga and that almost half of the rest (44.4%) wished to practice yoga. Virtually a third (32.7%) of those who practice yoga have practiced it for three years or more.

A report published in the Harvard Health Publications specifically regarding Iyengar Yoga (one of the best forms of yoga to alleviate back pain) and specifically regarding lower back pain stated that there was a 42% reduction in pain, a less need for medication, and no reports of adverse effects.

Therapy Acupuncture

With the exception of Western medicine, there are two things that very many Americans turn to. One of them is acupuncture. A slightly old (2007) National Health Interview Survey found that 6.5% of Americans have gone to an acupuncturist. The percentage is most likely higher now, given that acupuncture was virtually unheard of just 40 years, given the increased expenses of the “Affordable” Care Act, and given that acupuncture has little, if any side effects. (A skilled practitioner can even insert the needles with no pain felt to the patient.) If the percentage has now climbed to 8% then that means that over 25 million Americans have used acupuncture.

Many of these people have used it for things other than pain or chronic pain, but an analysis of almost 18 thousand patients by the National Institute of Health concluded that acupuncture is indeed an effective treatment for chronic pain. Biofeedback I have been hesitant in mentioning this because, although it is indeed very effective, it is also very time consuming. It is analogous to training to win a marathon.

If you have already won or done very well in a 10K run or a half-marathon then you are already close to your objective. However, if all you have done is to become winded after running a 200 meters race then you have a very long way to go.

If you are already familiar with biofeedback practices and techniques then you can take advantage of other techniques more quickly. If not then you may be suffering from chronic pain for a long time before finding relief.

I am now recommending this treatment because researchers at Stanford University recently worked an experimental technique in which patients rewired their brains to stop the activation of the pain signal. In effect, they were using an opioid without the opioid and without the possibility of addiction. The researches placed the patients in an MRI scan, and were able to observe and verify that this indeed worked. Chiropractic I suppose that there is actually a third thing that Americans turn to, and that would be seeing a chiropractor.

The 2007 NHIS found that 8% (or more than 18 million) of adults and even 3% (or more than 2 million) children have visited a chiropractor. According to a study published about two years ago, chiropractic treatments are better than pain medications for neck pain. My educated guess is that this holds true if there is a physical cause of the pain. Regardless, you may want to try this. Like acupuncture, it is something that millions of Americans have turned to and is a simple, quick and inexpensive treatment for not only neck pain but a host of other conditions as well.

Pain pacemakers

When all else fails, this can be the one to turn to. It is extremely effective but it is also permanent (so if there is a good chance that your pain will go away after three years, then this may not be appropriate) and it is very invasive. It involves implanting a pacemaker-like device in your body. It delivers low-level electrical signals to the spinal cord or specific nerves. The wearer can turn it off or on, and adjust the intensity of the signals. It can be especially appropriate for those who have had failed back surgeries, and for cancer patients whose cancer has affected a nerve root.

Pain relief creams

These creams often contain capsaicin, which is found in the skin patch called Qutenza, and which is especially helpful and preferred by people suffering from knee osteoarthritis (and especially by the elderly). Capsaicin works by minimizing the sending of the neuropeptide “substance P” (a pain-relaying chemical) to the brain.

Creams that contain the following also are very effective:

1) Salicylate, which decreases inflammation and relieves pain, and is found in the brand names Aspercreme and Bengay and

2) Counter-irritants like camphor, eucalyptus oil and menthol which cause coolness or heat at the site of pain.

Relaxation techniques

Over the past 30 years, there have been numerous studies confirming that relaxation techniques are effective and beneficial for numerous ailments and conditions, including: anxiety (including panic attacks); asthma; depression; heart disease; high blood pressure, hot flashes; insomnia; irritable bowel syndrome; nausea; nightmares; overactive bladder; smoking cessation; temporomandibular disorder (pain and loss of movement in the jaws); tinnitus (ringing in the ears); and–most pertinently to this article–fibromyalgia, headache and pain.

As I wrote in another article about pain, perhaps the best–and certainly the simplest–are breathing exercises. One very easy exercise is to find a comfortable position; focus on breathing, and in doing it slowly and steadily; feel your tension escape as you breathe out; and do this for 10-15 minutes.

Skin patches

For many years, there have been nicotine patches and now, there are skin patches for chronic pain relief. These patches contain lidocaine, a common local anesthetic which is sometimes used in dentistry, and are FDA-approved to fight the chronic nerve pain from shingles (also known as postherpetic neuralgia).

It is not to be used if you have a second or third degree heart blockage (without a pacemaker); severe sinoatrial block (without a pacemaker); current usage of Class I antiarrhythmic agents; hypersensitivity to corn and corn-related products; and a few other conditions and ailments.

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Martin Nance
Hello, I am Martin Nance. I have recently retired after a lifetime of working as a pharmacist. I now live with my wife in Texas. In my 37 years of helping people manage medications and health, I know the meaningful impact a trusted pharmacist can bring to people's lives. I still love helping people and hope to provide information that can protect and help people in need.