Management options for Chronic pain

Chronic pain management can be divided into two main categories, non-invasive pain management and invasive procedures.

Non-invasive pain management is defined as therapeutic activity that does not require use of needles or the insertion of catheters or devices. These include,

  1. Non-pharmacological management
  2. Exercise, physiotherapy, Cognitive and behavioural therapy

  3. Pharmacological management
  4. Analgesics: paracetamol, Non-steroidal anti-inflammatory drugs (NSAID), opioids Adjuncts

    • - Anticonvulsants: gabapentin, pregabalin, carbamazepine
    • - Antidepressants: amitriptyline, nortriptyline
    • - Local anaesthetics: lidocaine
    • - Miscellaneous: baclofen, benzodiazepines

Invasive procedures include nerve blocks, injections, ablative procedures, implants, and neuromodulation.

Nerve blocks: procedures designed to temporarily interrupt nervous system activity, usually with local anaesthetics. It can be,

Injections: needle techniques intended to reduce pain in muscle, tendons, and joints or to reduce inflammation around nerves or neuraxis e.g. trigger point injections, joint injections, acupuncture, epidural steroids.

Ablative procedures: invasive procedures that permanently interrupt nervous system activity.

  • i) Chemical: alcohol, phenol
  • ii) Physical: radiofrequency denervation, cryoneurolysis

Implantations:

  • - continuous catheter techniques, peripheral nerve stimulators
  • - neuromodulations e.g. intrathecal drug delivery, spinal cord stimulators