als for this technique, people definitely feel better when you numb the
pain nerves."
4. Microdiscectomy
If patients have pain from a herniated disc, and that disc is impinging
on the nerve and causing it to fire, surgery to resect that small portion
of the herniated disc can relieve the pain.
"Surgery definitely works compared to not having surgery," says Dr.
Cohen. "But it's usually done in people who have failed to respond to
non-surgical treatments."
The risks are the same as for other surgical procedures — bleeding,
infection and worsening back or leg pain, says Dr. Cohen. Post-surgi-
cal visits are needed, but there is no long-term follow-up required.
"It can provide fast relief of leg pain from nerve impingement, but is
not a very effective treatment for back pain," he says.
5. Non-opioid treatments
Non-opioid treatments for pain are different depending on the type of
pain patients have. For neuropathic pain, for example, the treatments
tend to be anti-epileptic drugs or anticonvulsants, because these drugs
stop injured nerves from firing.
"The first-line treatments for these are anticonvulsants like Lyrica
(pregabalin) and also drugs that enhance your own ability to inhibit
pain signals," says Dr. Cohen. "The latter are usually antidepressant
drugs — tricyclic antidepressants — like Pamelor (nortriptyline) or
Elavil (amitriptyline) or a newer drug, like Cymbalta (duloxetine)."
All these drugs, says Dr. Cohen, are approved for depression, but
they're also used for pain. They're dosed differently and can relieve
pain even in people who aren't depressed.
"The doses tend to be higher for depression. And they work differ-
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