Treating Chronic Neck, Shoulder, and Back Pain

Question: I’m confused and need a definitive answer. I live with chronic neck, shoulder, and back pain that started five years ago after an automobile accident. My orthopedist originally told me to medicate the symptoms, so I have taken medication only when the pain gets worse. Recently, I’ve been referred to a pain specialist who is saying that I should not wait until the pain becomes severe to take the newly prescribed medication. What should I do: take the drug when I can’t tolerate the pain or take it regularly as prescribed?

Answer: According to Jason Sobel, M.D., an internist holding board certification in hospital and palliative medicine who works with Capital Care in northern Virginia, the orthopedist most likely anticipated that your pain would last a week or two at most. That’s why the pain meds were recommended on an “as-needed” basis. In hindsight, your injury was worse than originally appreciated, and it likely has changed over time.

Dr. Sobel said, “To make matters worse, the protracted nature of your pain has reprogrammed your nervous system so that your pain has become an altogether different beast. This is more challenging to treat.” Pain medicines are prescribed on a schedule to minimize your discomfort, which you may or may not need indefinitely. Dr. Sobel said, “It is critical that you and your physicians explore what culprits are contributing to the chronicity of your pain. There may be some spinal stenosis or other problems causing referred pains to other areas of your body. There are additional interventions to oral medication, such as injections and physical therapy, that can further help to alleviate the pain. As you move through multistep decisions to evaluate the therapeutic process, you will need to take your pain meds on a scheduled basis, at least until the structural problems can be resolved.”

Our expert: Jackson Rainer is a board-certified clinical psychologist who practices with the Care and Counseling Center in Decatur, Georgia, helping people living with chronic illnesses. He consults with a variety of experts to answer a selection of readers’ questions in each issue of Pain-Free Living.

Have questions about living with and managing chronic pain? Email questions to [email protected]. Please put “PFL Q&A” in the subject line.

 

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