Level One Pain Therapies

The first step in the chronic pain treatment continuum begins with conservative treatment and progresses to more aggressive approaches.

• Exercise Programs. One of the first treatments for chronic pain may be light exercise, such as walking. Exercise stimulates the release of the body's natural pain relievers called endorphins. It promotes flexibility, strength, and endurance, and it helps reduce stress. Exercise can also strengthen unused or weak muscles to help take over the work of a muscle that is overworked and causing pain.
  
  
• Over-the-Counter Pain Medications. Another early treatment for pain is an over-the-counter analgesic (such as aspirin or acetaminophen) or an anti-inflammatory agent (such as ibuprofen), combined with bed rest.
  
  
• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs). When over-the-counter medications do not provide adequate relief, your physician may prescribe an NSAID. NSAIDs may provide pain relief within the first 24 to 48 hours of treatment, but it may take up to three weeks to get the full benefit from these medications, which includes relief from pain, swelling, and inflammation.
  
  
• Rehabilitative Therapy. Rehabilitative therapy includes a variety of techniques—physical therapy, occupational therapy, massage therapy, chiropractic therapy, and retraining of physical activities—to reduce pain and increase function. Therapists may use stretching exercises, heat or cold therapies, water therapy, muscle relaxation techniques, biofeedback, traction, or weight training and conditioning. Rehabilitative therapy is an important part of early pain treatment and is often combined with other treatments, such as oral medications.
  
  
• Transcutaneous Electrical Stimulation (TENS). In TENS therapy, electrical impulses are applied to nerve endings through electrodes placed on the skin over the painful area. Researchers theorize that these impulses temporarily interrupt the transmission of pain signals from small sensory nerves at the site of the pain. TENS may also stimulate the release of endorphins, which produce analgesia and feelings of well-being.
  
  
• Cognitive and Behavioral Modification. Chronic pain is a tremendous psychological burden, and the way a person responds to and tolerates pain depends on factors such as their personality, culture, and past pain experiences. Cognitive and behavioral therapies take these factors into account in an effort to help a patient learn new skills and strategies for dealing with chronic pain. These skills and strategies can include relaxation techniques, visualization exercises, and one-on-one counseling sessions with the patient and family to build coping skills.

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