More than 1.5 billion people around the world suffer from chronic aches and pains. Often these discomforts are felt daily, and their effects can be debilitating.

Unlike the agony associated with a specific injury or illness, chronic pain often persists regardless of any evident damage to the body. The underlying cause can be mysterious—and treatment is therefore challenging. Fortunately several approaches to chronic pain management may bring some relief.

1. Yoga
The mental and physical discipline of contorting the body into geometric shapes not only limbers ligaments, it may also alleviate painful conditions. Scientists speculate that yoga may physiologically alter the experience of pain—although the mechanism is unknown—and decrease nervous system activity and heart rate.

The Evidence:
In a controlled study in 2010 of 53 female fibromyalgia patients James Carson, a clinical health psychologist at Oregon Health & Science University, and his collaborators found that those who were randomly assigned to eight weeks of a tailored yoga program ended up with less intense fibromyalgia symptoms than patients who did not practice yoga. They experienced improvements in pain, fatigue and mood and developed positive coping strategies. Other studies have shown that yoga reduces biological markers of inflammation and stress. Carson cautions, however, that not enough research exists to confirm yoga’s benefits in relieving pain.

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2. Cognitive-Behavior Therapy
Scientists have recently recognized cognitive behavioral therapy (CBT)a form of psychotherapy that encourages patients to examine relations among their thoughts, feelings and behaviors—as a pain management tool. “In the last 10 years or so everyone’s been talking about [CBT],” says Karen Davis, a neuroscientist at the Toronto Western Research Institute. Guided therapeutic techniques may cultivate a patient’s sense of control over his or her pain.

The Evidence:
Psychologist Julia Anna Glombiewski of Philipps University Marburg in Germany and her colleagues performed a meta-analysis of 23 studies of CBT treatments with a total of about 1,400 people in 2010. Glombiewski found CBT to be more effective at reducing fibromyalgia pain than other psychological treatments. “Research has shown that there are very real and strong brain effects that can be achieved using CBT,” says Davis, although she cautions that its effectiveness varies from person to person.

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3. Antidepressants
Antidepressant medications typically are used to treat mood disorders such as depression but research suggests that they may also alleviate nerve pain, headaches, lower back pain and fibromyalgia. In general, most antidepressants affect how chemical messengers, or neurotransmitters, perform in the brain.

The Evidence:
Not all antidepressants have the same effect on pain. Studies suggest that a class of medications called tricyclic antidepressants may be particularly effective at easing neuropathic pain, which is caused by nerve injuries. In a 2010 review of about 60 randomized controlled trials using 31 types of antidepressants to treat this form of pain oncologist Tiina Saarto of Helsinki University Central Hospital and her collaborator found that both tricyclic antidepressants and venlafaxine, a member of the class of antidepressants called serotonin and norepinephrine reuptake inhibitors (SNRIs), provided at least moderate pain relief in one out of three patients.

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4. Deep-Brain Stimulation
For decades surgeons treated various types of pain by intentionally damaging tissues in specific parts of the brain. In the 1990s a less injurious technique emerged in the form of deep-brain stimulation (DBS). In this approach electrodes are surgically inserted into pain-modulating areas near the middle of the brain. A wire under the skin connects the electrodes to a pacemaker implanted in the chest. The pacemaker sends electrical pulses to the electrodes, which change the way neurons fire in that area.

The Evidence:
Neuroscientist Sandra Boccard of John Radcliffe Hospital in Oxford, England, and her colleagues found in 2013 that DBS calms a range of pain conditions, including poststroke pain, headache and phantom limb pain. Of 59 patients who had DBS, 66 percent improved, according to quality-of-life surveys and pain questionnaires. The treatment seemed to work best in relieving phantom limb pain. Researchers are currently investigating this technique but the U.S. Food and Drug Administration has not yet approved DBS as a chronic pain treatment.

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5. Sympathectomy
The sympathetic nerve chain is a lanky string of nerves that straddle the spine from the base of the skull to the tailbone. When this electrical highway is damaged, it can transmit surges of pain to the rest of the body. A surgeon can interrupt this process surgically or chemically. For example, the doctor can snip clusters of nerve cells to halt their painful transmissions. Sympathectomy was most popular in the 1980s and 1990s, although it is still practiced today.

The Evidence:
Scientists agree that malfunctioning sympathetic nerves contribute to chronic pain but sympathectomy remains controversial. Few scientifically strong studies of the procedure exist and it can have serious complications. Nevertheless, some researchers believe in the intervention’s potential. In one of the stronger studies to date, published in 2008, anesthesiologist Prashanth Manjunath, now at Bingham Memorial Hospital in Idaho and his colleagues found that those who received a sympathectomy by either injecting an anesthetic into the nerve area or heating tissue with radio waves had a 50 to 75 percent reduction in pain that lasted more than four months.

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