Start with your primary care doctor who can initiate an evaluation with blood work, imaging, and a trial of some medications and refer you to the right specialist. Let your physician know if you have a history of addiction, as you may be at higher risk for addiction to painkillers. If your pain is due to the aftereffects of cancer treatments, talk to your oncologist. Pain specialists and oncologists have the most experience dealing with the many complex issues surrounding the treatment of pain. The first step in the medical management of pain is to determine the cause of the pain. The pain may be from disorders such as arthritis, fibromyalgia, cancer, and more.  It might take additional studies, evaluation, and time to find the source.  Once the underlying cause is determined, then treatment can be discussed. You may need to see a number of different doctors, including a rheumatologist, orthopedic, neurologist, and/or physical medicine and rehabilitation specialist. After you determine the cause of your pain, you and your doctor can discuss the use of medication. In general, acetaminophen (Tylenol) or NSAIDs (Aleve, Advil, aspirin) are used first. The idea is to start first with medications with the fewest side effects. For all these pain medications, it is very important to follow the instructions exactly as written. If the instructions are not clear, make sure you ask your doctor, nurse, or pharmacist to explain them until you are very clear on when and how to take the medication. Report any side effects or problems with the medications right away.  Under some circumstances, tricyclic antidepressants such as amitriptyline may be used to control pain. A third class of drugs that may be used are the Serotonin and norepinephrine reuptake inhibitors (SNRIs) such as duloxetine (Cymbalta). Corticosteroids are primarily used for inflammatory rheumatology and autoimmune disorders. Sometimes a short course is ordered to treat acute pain as well. Anticonvulsants such as gabapentin (Neurontin) or pregabalin (Lyrica) have been shown to be useful for some types of nerve pain, including fibromyalgia and neuropathies. Opiates are generally reserved for pain that doesn’t respond to other pain medications. They should be used only for a short period of time and/or after you and your doctor develop a careful treatment plan, as opiates are highly addictive. It is very important to be aware of and stick to the dosage recommended by your physician to minimize the chances of developing a problematic tolerance to the pain medication. Tolerance is defined as “a phenomenon or adaptation of the body over a period of time in which one or more effects of a drug become less with repeated use at the same dose.”  This is often referred to as becoming “immune” to the action of the drug. It is important to understand that tolerance is not an addiction. Tolerance is the body’s adaptation to the drug. The problem with tolerance is that more and more drugs are needed to achieve the same effect, and increasing doses also means there is an increased risk of dangerous or unacceptable side effects and the chance of an accidental overdose. Following the dosage schedule can slow down the tolerance process. More and more pain management programs are interdisciplinary and utilize many different professionals with a wide diversity of skill sets that can help you deal with chronic pain in the healthiest way possible, improving your quality of life as much as possible.  This team first includes you. The pain management team can also include a physician and nurses, in addition to physical, massage, occupational, recreational, and psychological therapists. There may also be social workers, nutritionists and other support staff. The important thing for you to remember is to access the team and make use of the services they have to offer you. You should consider including a physical therapist as part of your pain management team. A physical therapist can help you manage pain by giving you bodily treatments catered towards relieving your pain. These exercises include strengthening exercises, flexibility exercises, manual therapy, posture help, and body mechanics instruction.
Talk to your doctor. Determine the cause of the pain. Decide on a medication. Follow medical dosage instructions. Work with your pain management team. Get physical therapy.