Tension-type headaches can be either episodic or chronic. They are rarely disabling or associated with any significant autonomic phenomena, thus patients do not usually seek medical care and usually successfully self-treat. Unlike migraine, there is no significant nausea, no vomiting, and a lack of aggravation by routine physical activity.
In this podcast Mark Green, Professor of Neurology, Anesthesiology and Rehabilitation Medicine, Director of Headache and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, gives a clinical overview of the condition.
Researchers in Germany published a study in the journal Pain in December showing that open-label placebos can help relieve chronic lower-back pain, replicating a 2016 study. A similar study by University of Colorado, Boulder researchers found that placebo saline injections reduce chronic lower-back pain.
Two other recent studies showed placebos openly given to cancer patients helped relieve cancer-related fatigue. And a forthcoming study by German researchers found openly giving placebo to elderly patients helped improve knee pain.
More researchers are looking at the idea of placebos—substances that have no actual pharmaceutical effect—as an alternative to traditional pain medications, which can be ineffective and carry significant side effects. Placebos might have particular potential for difficult-to-treat conditions like chronic back pain, cancer-related fatigue and symptoms of irritable bowel syndrome, researchers hope.
As many as 30% to 50% of chronic pain patients will respond to placebos, research suggests. And new studies are helping to identify genetic and brain differences that make certain people more likely to respond.
Geriatricians like Dr. Brandon Verdoorn see the wide range of effects of chronic pain on older patients. Minor, short-lived pain can be managed at home with ice, heat or over-the-counter medication.
If you have severe pain, persistent pain or pain that affects function, you should see your health care provider to determine the underlying cause and develop a pain management plan. That might mean physical therapy, exercise, massage or acupuncture.
Medication strategies often are used, too — typically starting with lower-risk approaches like acetaminophen and topical medications, and reserving higher-risk medications for more difficult cases.
Sleep problems may decrease the likelihood of recovery from chronic low back pain (LBP) over the long term and those who have musculoskeletal pain on top of insomnia have an even lower possibility of recovery, a study has found.
“The probability of recovery [from LBP] is especially low among persons who often/always experience sleeplessness and who also suffer from co-occurring musculoskeletal pain,” the researchers write.
The study took place over more than 10 years and also found the likelihood of recovery from chronic LBP decreased further among people with muscle and joint pains, in addition to sleeplessness.
The researchers conducted a prospective cohort study that included 3712 women and 2488 men aged at least 20 years who participated in the HUNT study, one of the largest, longest running health studies in Norway. HUNT began in 1984 and has data on over 120,000 participants.
“Another behavior change is physical exercise,” Pillemer said. “A paradox of pain is that exercise helps reduce it, but it’s difficult for people in pain to think about exercising. So they don’t exercise, they get more sedentary and the pain increases; it’s a vicious circle. So how do you get people to actually change their behavior?”
More than 100 million Americans suffer from chronic pain – outnumbering those affected by heart disease, diabetes and cancer combined.
To develop innovative approaches to pain management, a team of behavioral and social science researchers on Cornell’s Ithaca campus, clinical researchers at Weill Cornell Medicine and computer scientists at Cornell Tech has received a five-year, $3 million grant from the National Institute on Aging, part of the National Institutes of Health (NIH).
Chronic Pain: Observations as Patient and Provider About What Works (…And What Doesn’t)
Dr. Grace Dammann, medical director of the Pain Clinic at Laguna Honda Hospital, and seven of her colleagues talk about what does and does not work in the treatment of chronic pain. She talks as both a patient and a provider. There is also a discussion of various non-pharmacologic and complementary medicine modalities to treat pain.