What are the treatment options for pain management?

From the Guidelines

To treat heel pain, a comprehensive approach including rest, ice, and over-the-counter pain medications like ibuprofen or acetaminophen, along with physical and occupational therapy, is recommended. This approach is based on the principles outlined in the 2017 HIVMA of IDSA clinical practice guideline for the management of chronic pain in patients living with HIV 1, which emphasizes the importance of a multidisciplinary approach to pain management.

The treatment plan should include:

• Rest and ice to reduce inflammation
• Over-the-counter pain medications like ibuprofen (400-800mg every 6-8 hours with food) or acetaminophen (500-1000mg every 6 hours) to manage pain
• Physical and occupational therapy to improve mobility and strength, as recommended by the 2017 HIVMA of IDSA clinical practice guideline 1
• Stretching exercises for the calf muscles and plantar fascia, especially before getting out of bed
• Wearing supportive shoes with good arch support and cushioning, and considering adding heel pads or custom orthotics
• Rolling the foot over a frozen water bottle or tennis ball for 5 minutes several times daily for immediate relief
• Using night splints to keep the foot flexed during sleep if the pain is from plantar fasciitis

These treatments work by reducing inflammation, stretching tight tissues, and providing proper support to distribute pressure evenly across the foot. If pain persists beyond 2-3 weeks despite these measures, or if it's severe, consulting a healthcare provider is necessary as physical therapy, corticosteroid injections, or other interventions may be required 1. A patient-centered framework within a biopsychosocial perspective, as emphasized by the EULAR recommendations for the health professional's approach to pain management in inflammatory arthritis and osteoarthritis 1, should guide the treatment approach. Additionally, the NCCN Adult Cancer Pain Guidelines Panel advises a multimodal and comprehensive approach to pain management, which can be applied to heel pain management as well 1.

From the FDA Drug Label

The efficacy of the maximum recommended dose of pregabalin for the management of neuropathic pain associated with diabetic peripheral neuropathy was established in three double-blind, placebo-controlled, multicenter studies with three times a day dosing, two of which studied the maximum recommended dose Treatment with pregabalin 100 and 200 mg three times a day statistically significantly improved the endpoint mean pain score and increased the proportion of patients with at least a 50% reduction in pain score from baseline Study DPN 1: This 5-week study compared pregabalin 25,100, or 200 mg three times a day with placebo Treatment with pregabalin 100 mg three times a day statistically significantly improved the endpoint mean pain score and increased the proportion of patients with at least a 50% reduction in pain score from baseline

Pregabalin is effective in treating neuropathic pain associated with diabetic peripheral neuropathy and postherpetic neuralgia.

• The studies showed that treatment with pregabalin statistically significantly improved the endpoint mean pain score and increased the proportion of patients with at least a 50% reduction in pain score from baseline.
• Some patients experienced a decrease in pain as early as Week 1, which persisted throughout the study.
• The recommended dose of pregabalin for the management of neuropathic pain is 100-200 mg three times a day 2.

From the Research

Treatment Options for Pain

• Various conservative treatments are being used to control chronic pain, including pharmacological therapy, procedures, and exercise 3
• Medications such as anticonvulsants, nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and antidepressants are commonly used to manage chronic pain 3
• Procedures like injection of steroids and local anesthetics, pulsed radiofrequency (PRF), repetitive transcranial magnetic stimulation (rTMS), and prolotherapy are also used to treat chronic pain 3

Neuropathic Pain Treatment

• Pregabalin is a US FDA-approved drug for neuropathic pain in spinal cord injured patients, with efficacy noted within the first several days of administration 4
• Gabapentin and pregabalin have been shown to suppress tactile allodynia and potentiate spinal cord stimulation in a model of neuropathy 5
• Both gabapentin and pregabalin appear to be efficacious for neuropathic pain in spinal cord injury, although pregabalin may be more efficacious in some variables 6

Conservative Treatment for Neck Pain

• Conservative treatment strategies for neck pain include medications, physical therapy, and exercise 7
• Basic pharmacology for neck pain treatment includes opioids, nonsteroidal anti-inflammatory drugs, adjuvants, and topical analgesics 7
• Therapeutic exercise, manual therapy, and modalities are also used to treat neck pain, with treatment considerations discussed for each category of medication and physical therapy 7