In diagnosing the cause of pain, the physician will review the patient’s medical history and should perform a physical examination. Patients will be asked to describe their pain in detail – location, duration, aggravating or relieving factors. Patients may also be asked to fill out a pain assessment questionnaire that helps the physician to determine how pain is affecting their life.

Diagnosis may be a lengthy process for some disorders, such as fibromyalgia. A wide range of diagnostic tests may be used, such as blood tests, urine tests, x-rays, radionuclide imaging or CAT scan (computed axial tomography).

Many treatments are available to alleviate pain. In many cases, they will be combined as part of a treatment plan to treat the underlying condition and the pain that results.

Over-the-counter and prescription medications are used to manage pain. These include:

• Analgesics. Painkillers that do not decrease inflammation include two main categories:
  
  
• • Non-narcotic. Drugs such as acetaminophen relieve minor headaches and mild to moderate pain.
    
    
  • Opioids. These morphine-like drugs treat severe acute pain and some forms of severe chronic pain, such as cancer pain.
    
    
• Anti-inflammatory drugs. Reducing pain and inflammation, these drugs come in two main categories:
  
  
• • Nonsteroidal anti-inflammatory drugs (NSAIDs). These include aspirin, ibuprofen, naproxen and prescription-only COX-2 inhibitors.
    
    
  • Corticosteroids. These treat serious inflammation, such as that from chronic arthritis.
    
    
• Disease-modifying antirheumatic drugs (DMARDs). This class of medication reduces joint damage caused by conditions such as rheumatoid arthritis and systemic lupus erythematosus. 
  
  
• Headache medications, such as triptans.
  
  
• Antidepressants. These drugs are primarily used to treat depression, but some of them have also been shown to relieve the pain associated with certain disorders, such as diabetic neuropathy. The U.S. Food and Drug Administration (FDA) has advised that antidepressants may increase the risk of suicidal thinking in some patients, and all people being treated with them should be monitored closely for unusual changes in behavior.

• Anticonvulsants. These drugs help treat shooting pain by decreasing abnormal painful sensations caused by damaged nerves.

Injection therapy may be an option. Local anesthetics and/or corticosteroids can be injected around nerve roots or into muscles and joints. Such injections can reduce swelling, irritation, muscle spasms and abnormal nerve activity. For example, local anesthetics and corticosteroids can be injected in epidural space (the area between the protective covering of the spinal cord and vertebrae) for back pain. With nerve blocks, local anesthetics and/or corticosteroids can be injected to block a group of nerves (known as a plexus or ganglion) from causing pain in a specific organ or body region. For instance, a nerve block may be injected around the sciatic nerves for sciatica pain. 

Several health professions contribute to pain management, including:

• Physical therapy (PT). A program including exercise, stretching and training in posture and ergonomics can reduce pain, resolve gait disturbances and increase a patient’s mobility and function.
  
  
• Occupational therapy (OT). This treatment helps individuals who have difficulty carrying out self-care, work or leisure activities. The difficulties may be due to pain, injury or illness, developmental or learning disabilities, psychosocial dysfunctions or age.
  
  
• Exercise therapy. Exercise can strengthen muscles and increase range of motion. It also causes the body to release chemicals such as endorphins and enkephalins, which block pain signals from reaching the brain. Exercise therapy is offered by professionals such as exercise physiologists and certified trainers. It is also a common part of PT and OT.
  
  
• Manipulation therapy. A variety of treatments use human touch or mechanical devices to improve body movement. Manipulation therapy is used to treat a variety of injuries, conditions and diseases such as back pain, neck pain, headaches and fibromyalgia. Types include:
  
  
• • Chiropractic
  • Massage therapy
  • Osteopathy
    
    
• Cognitive behavioral therapy. These methods help patients to use body and mind to deal with pain, and include deep breathing, imagery and mediation.
  
  
• Psychological support. Patients who experience pain often suffer associated mental anguish. Feelings such as anger, sadness and hopelessness can overwhelm patients who are suffering from pain. They can even lead to feelings of suicide, especially in depressed patients. These feelings can change the patient’s mood and personality and interfere with relationships and work and sleep patterns. Counselors and support groups can help patients to better cope with their condition.

Many modalities (physical therapeutic agents) are used in pain management. Some, such as heating pads or cold packs, can be used at home. Others, such as ultrasound therapy, require the expertise of a professional such as a physical therapist or occupational therapist. Classes of modalities include:

• Thermotherapy. Heat improves circulation, relaxes muscles and decreases stiffness. Types include ultrasound therapy, which can break down scar tissue.
  
  
• Cryotherapy. Therapeutic use of cold reduces inflammation and swelling.
  
  
• Hydrotherapy. Treatment using water is often incorporated into exercise therapy, thermotherapy and cryotherapy.
  
  
• Electrical therapy. These techniques use mild electrical currents to stimulate nerves and muscles. Examples include transcutaneous electrical nerve stimulation (TENS), microcurrent electrical therapy (MET) and interferential electrical stimulation (IFC).

Some patients find relief from complementary and alternative techniques such as acupuncture, acupressure, biofeedback or hypnotherapy. Patients are advised to consult their physician before trying alternative methods, including nutritional supplements.

Surgery is usually a last resort for patients who do not respond to other therapies. Examples include:

• Arthroscopy. Arthroscopic surgery, involving small incisions, is less invasive than traditional operations.
  
  
• Arthroplasty. Joint replacement, especially of the knees, is a common treatment for severe osteoarthritis. A fracture caused by osteoporosis may require a hip replacement.

• Spine surgery. Types include fusion, discectomy, laminectomy and vertebroplasty and kyphoplasty.
  
  
• Carpal tunnel release. Wrist surgery is sometimes recommended for carpal tunnel syndrome.