The treatment for chronic pain depends on its cause, if one can be identified. However, chronic pain is often complex, involving physical, mental, and social factors, so managing it usually requires more than one approach. Your health care provider will recommend a treatment plan based on your specific condition, as well as your age, overall health, and medical history.

Access to some pain treatments, however, may be complicated by legal regulations and stigma. For example, opioid prescriptions are increasingly restricted in many U.S. states. Additionally, medical marijuana is illegal in about half of U.S. states and in many other countries. People seeking chronic pain treatment often encounter suspicion or judgment from health care providers.

Treatments for chronic pain generally fall into four main categories: medications, surgical procedures and devices, nerve block injections, and complementary therapies. If you’re living with chronic pain, you may be wondering: How do I deal with severe chronic pain? What’s the best treatment for chronic pain? In this article, we’ll review some of the top chronic pain treatment options and their possible risks and benefits.

1. Medications

Some medications for chronic pain work by reducing inflammation or acting on the body’s pain receptors. Other nonopioid pain medications block pain signals sent by nerves or inhibit the body’s ability to perceive pain. If you’re wondering which painkiller is best for long-term use, this section outlines some of the pharmacological options for managing chronic pain.

Nonsteroidal Anti-Inflammatory Drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first treatment many people try for chronic pain. Some NSAIDs are available over the counter, such as:

• Aspirin
• Ibuprofen (Advil, Motrin)
• Naproxen (sold as brand names such as Aleve)

Other NSAIDs require a prescription, including celecoxib (Celebrex), diclofenac (such as Cambia), and another form of naproxen (Naprosyn).

NSAIDs are believed to work by blocking the production of chemicals that cause pain sensation and inflammation in the body. However, when taken regularly in high doses, some NSAIDs can increase the risk of gastrointestinal issues, such as stomach ulcers, and lead to abnormal bleeding.

Opioids

For pain that’s not controlled with other treatments, opioids such as these may be prescribed:

• Fentanyl
• Hydrocodone/acetaminophen
• Hydromorphone (Dilaudid)
• Morphine
• Oxycodone/acetaminophen (such as Percocet)
• Tramadol

Opioids are thought to work on the brain by altering the body’s ability to perceive pain. The National Institute on Drug Abuse reports that regular use of opioids — even when prescribed by a doctor — can lead to dependence. Misusing opioids increases the risk of overdose and death.

Evidence-based sources recommend that opioids should be prescribed for chronic pain only when other treatments haven’t worked. When opioids are necessary, they should be given at the lowest effective dose and combined with nonopioid therapies. Extended-release or long-acting opioids should be reserved for people who require continuous pain management, while immediate-release formulations at the lowest dose are preferred for short-term use.

Anticonvulsants

Drugs used to prevent seizures in people with epilepsy can help reduce chronic pain in some people. Known as anticonvulsants, these drugs include:

• Gabapentin (Gralise, Neurontin)
• Pregabalin (Lyrica)
• Topiramate (Topamax)

Anticonvulsants work by blocking pain signals from damaged nerves. Common side effects include drowsiness and loss of appetite. In some people, anticonvulsants can cause suicidal thoughts or behavior.

Note: If you or someone you know needs help, you can contact the 988 Suicide & Crisis Lifeline by calling or texting 988 or chatting online.

Corticosteroids

For types of chronic pain related to inflammation, doctors may prescribe a short course of corticosteroids such as:

• Hydrocortisone
• Methylprednisolone
• Prednisolone
• Prednisone

Steroids may be taken orally, given intravenously, or injected directly into inflamed joints. These medications may cause serious side effects including unwanted weight gain, mood changes, and high blood glucose when taken long term.

Antidepressants

Depression and anxiety are common symptoms in people with chronic pain. In addition to treating mood disorders, certain antidepressants have been shown to help manage neuropathic (nerve-related) pain. These medications include:

• Amitriptyline
• Duloxetine (Cymbalta)
• Escitalopram (Lexapro)
• Milnacipran (Savella)
• Nortriptyline (Pamelor)
• Venlafaxine

Topical Analgesics

Some pain medications may be applied locally, such as:

• Capsaicin — A cream used to treat muscle, joint, and nerve pain
• Diclofenac (Voltaren) gel— A topical formulation used to treat osteoarthritis
• Lidocaine (Lidoderm) — A transdermal patch or cream used to treat postherpetic neuralgia
• Lidocaine/prilocaine (EMLA) — A cream used to numb the skin before surgery

2. Surgical Procedures and Devices

In cases of chronic pain, most surgeries and injections focus on reducing inflammation or blocking the nerves that send pain signals to the brain.

Transcutaneous electrical nerve stimulation (TENS) devices are approved by the U.S. Food and Drug Administration (FDA) for managing chronic pain relief. TENS works by sending mild electrical pulses through the skin to block pain signals. This noninvasive, drug-free treatment option causes minimal side effects and is suitable for home use.

Radiofrequency ablation (RFA) is a technique that uses heat generated by radio waves to disrupt nerve function, providing long-term relief for certain types of chronic pain. It’s typically performed in clinical settings, such as a hospital or doctor’s office. RFA is commonly used to treat back pain, from the neck to the pelvis, including in the cervical, lumbar, and sacroiliac areas. It also targets the intervertebral discs, dorsal root ganglion (nerve cell cluster), and sympathetic ganglia.

Chemical sympathectomy is a surgical technique that may provide long-term relief for some types of neuropathic chronic pain, such as complex regional pain syndrome. During this procedure, chemicals like alcohol or phenol are used to destroy sympathetic nerves. However, chemical sympathectomy is less commonly used today due to the risk of complications. Less invasive options are often preferred.

Intrathecal implants are pumps surgically placed in the body to deliver small doses of analgesics (painkillers) directly into the spinal fluid. Doctors may recommend intrathecal implants when more conservative techniques, such as oral or injected medications, aren’t effective. Intrathecal implants may be considered for various types of chronic pain, including pain from failed low back surgery syndrome.

Surgical decompression may be performed to relieve chronic pain associated with back problems such as spinal stenosis or herniated discs. It involves removing bone or tissue that is pressing on nerves or the spinal cord.

3. Injections

Many types of injections can be used to provide pain relief. For example, medication can be injected directly into a joint to relieve inflammation. In a nerve block injection, a doctor injects medication into a cluster of nerves responsible for transmitting pain signals. Most injections for chronic pain are performed as outpatient (same-day) procedures. The effects of nerve block injections are usually temporary.

Types of injections for chronic pain include:

• Epidural steroid injection — Used to relieve chronic pain in the neck, arms, back, and legs. It may help in cases of chronic pain caused by conditions such as sciatica, spinal stenosis, spondylolysis, or disc degeneration or herniation.
• Facet joint injection — Targets the facet joints of the spine, which allow bending and twisting. It may help relieve chronic pain in the lower back, arms, neck, or legs due to spinal stenosis, sciatica, spondylosis, a herniated disc, arthritis, or postsurgical pain.
• Lumbar sympathetic block — Can be used to treat complex regional pain syndrome, Raynaud’s disease, painful blood vessel spasms, or some types of chronic stomach pain
• Botulinum toxin injection (Botox) — May help manage muscle-related pain, such as postsurgical pain, migraine headaches, piriformis syndrome, facial pain, myofascial pain, tennis elbow, chronic anal fissures, temporomandibular joint syndrome, low back pain, and chronic prostatic pain
• Stellate ganglion block — Used to treat chronic pain in the head, neck, upper arms, and upper chest, often related to complex regional pain syndrome, postherpetic neuralgia, or phantom limb pain
• Celiac plexus block — Can temporarily relieve some types of chronic abdominal pain

The effectiveness and duration of pain relief vary depending on the individual and the type of injection. Relief can range from partial to complete and may last anywhere from days to years.

4. Nonpharmacologic and Complementary Therapies

Cognitive behavioral therapy (CBT) is a type of psychotherapy designed to help people identify and manage stress or other negative emotions. CBT is goal-oriented, focusing on specific problems and ways to improve them. It helps people recognize negative or faulty thinking, understand problematic situations and relationships, and develop better strategies for managing these challenges.

Physical therapy can improve strength, balance, and joint stability, helping to reduce many types of chronic pain. It’s also useful for rehabilitating the body after surgery or injury.

Chiropractic focuses on issues related to the muscles, nerves, and skeletal system. It’s commonly used to relieve pain and stiffness, particularly in the neck and back, and may be helpful for conditions including sciatica, fibromyalgia, herniated or degenerated discs, and spondylosis.

Complementary and alternative therapies are popular among many people who have chronic pain. Natural or alternative treatments include:

• Acupuncture
• Yoga
• Massage
• Low-level laser therapy
• Herbal supplements
• Meditation
• Ayurvedic therapy (a traditional medicine system from India)

Medical marijuana is widely used as a complementary therapy to treat chronic pain.

It’s important to note that most complementary or natural treatments for chronic pain haven’t been shown to be safe or effective in clinical trials. Before trying an alternative treatment, it’s essential to consult with your doctor to learn about potential interactions or side effects.

Connect With Others Who Understand

MyChronicPainTeam is the social network for people with chronic pain and their loved ones. On MyChronicPainTeam, more than 72,000 members come together to ask questions, give advice, and share their stories with others who understand life with chronic pain.

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