Experts say that injections of steroids or other medications, nerve blocks that interrupt pain signals, physical therapy, and psychological interventions such as cognitive behavioral therapy, biofeedback, and guided imagery, as well as other relaxation techniques can all be beneficial. Acupuncture is another option. It's thought to ease pain by raising the level of endorphins—the body's natural pain relievers—in the body, Christo says. "They are released when the body experiences pain, when you sprain your ankle, cut your finger—in response to injury." The therapy may work for some but isn't a cure-all; a review of 13 studies published in January in the British Medical Journal found that acupuncture offered only a small level of relief for people with low-back pain, migraines, knee osteoarthritis, and postoperative pain.
And while it may sound counterintuitive, people with chronic pain should try to get exercise, both for the same health reasons as everyone else and, specifically, to avoid muscle atrophy. A 2005 study published in the Annals of Internal Medicine found that a supervised, individually tailored exercise program may help both ease pain and improve function. A physical therapist or personal trainer can help.
If you are using prescription opioids, be aware of the different states that your body may experience. Tolerance occurs when the body adjusts to one dosage and needs increasingly more medication over time to achieve the same result. (This also applies to side effects, so if opioids make you itch, for instance, that feeling may go away as your body adjusts.) People should not be overly concerned about developing tolerance to pain medications, because it's a part of taking the drugs, experts say. Users can also experience physical dependence, causing withdrawal symptoms such as diarrhea, perspiration, and abdominal cramping when they abruptly stop taking the medication. It can occur after as few as two days of continuous use; to reduce symptoms, physicians can help you taper off the dosage, says Christo.
Addiction is far more serious. It involves compulsive use of the drug, continued use despite harm to a person or loved ones, and cravings for the substance. Not everyone who takes the medicine will get hooked, even with years of use, and there's no sure way to predict who will. Wonder if you have a problem? The hallmarks of addiction are an inability to keep up with work, school, or family matters as a result of drug abuse, and an inability (or refusal) to stop despite those consequences, says Scott Fishman, professor and chief of pain medicine at the University of California-Davis School of Medicine.
If you suspect that you or a family member might have developed an addiction to prescription opioids, contact a doctor (a personal physician or a local addiction medicine specialist). Some physicians prescribe the medication buprenorphine—a narcotic sold under the brand name Suboxone that makes it easier to withdraw from prescription opioids—for outpatient use. This is not a do-it-yourself project; this medication can also be abused and needs to be used under a doctor's supervision. And be sure there's a plan for ending its use. For more severe cases, people may be referred to addiction treatment centers, which offer detox and treatment.
Patients admitted to the Betty Ford Center in Rancho Mirage, Calif., are first put on buprenorphine, then weaned off the drug quickly. "The drug is only a step to facilitate recovery," says Garrett O'Connor, president of the Betty Ford Institute, the nonprofit arm of the treatment center. Traditional 12-step programs are also necessary, he says, because a "major part of recovery is doing work on character defects and lifestyle problems [such as] grandiosity, antisocial activity, cheating, lying, being unaccountable and irresponsible. They're the things that have to be examined and then put into reverse," says O'Connor.