Medically reviewed by Stacy Sampson, DO
Written by James Roland – Updated on May 18, 2017
What is intractable pain?
Intractable pain refers to a type of pain that can’t be controlled with standard medical care. Intractable essentially means difficult to treat or manage.
This type of pain isn’t curable, so the focus of treatment is to reduce your discomfort.
The condition is also known as intractable pain disease, or IP. If you have intractable pain, it’s constant and severe enough that you may need to be bedridden or hospitalized for care.
Types of pain
Pain tends to be categorized as acute or chronic.
Acute pain is the type of sudden pain you feel when you cut yourself or you break a bone. The pain comes on quickly but usually fades over a relatively short period of time or with treatment. Sometimes acute pain can develop into chronic pain.
Chronic pain is generally classified as pain that lasts at least three months and can’t be completely alleviated. If you have arthritis in your knees, for instance, physical therapy and over-the-counter pain relievers may reduce the chronic pain you feel in your knees. Simply resting your knees may ease the pain considerably.
Intractable pain is typically considered to be a severe form of chronic pain. But unlike chronic pain from arthritic knees or similar cause, intractable pain isn’t easily treated or relieved. Just getting mild relief may require nontraditional treatments, such as medical marijuana or electrical stimulation of specific points in your brain.
Some health experts believe that one way intractable pain differs from other types of pain is that the brain processes intractable pain signals differently than other kinds of pain signals. This may be why intractable pain is so resistant to treatment.
What causes intractable pain?
Intractable pain can develop from several types of health problems. It can be felt in your joints, bones, muscles, and even your head.
Conditions that can cause intractable pain include:
• migraine headaches and tension headaches
• rheumatoid arthritis
• degenerative disc disease
• central pain syndrome
Intractable pain doesn’t always have an obvious cause, which makes it even harder to diagnose and treat. What causes unyielding pain in one person may cause manageable pain in another.
But don’t assume that the pain is all in your head. Intractable pain is considered to be a real health problem, and it’s one that should be investigated.
How intractable pain is diagnosed
If you experience chronic pain and traditional pain-relief treatments aren’t effective, you should seek out a doctor’s evaluation. It’s important to describe your symptoms accurately and with detail.
Diagnosing the cause of your intractable pain can be challenging. If you experience daily chronic headaches, for example, you may be experiencing migraine or tension-type headaches. The symptoms of migraine-induced intractable pain, however, are like those of other types of headaches. This makes diagnosis difficult and treatment similarly problematic. You may end up being treated improperly for a condition that appears to be the cause of your pain.
Usually, intractable pain is formally diagnosed when, over the course of time, a variety of treatments fail to ease your pain. For example, after failing different non-injectable measures, you get a corticosteroid injection and it doesn’t ease your pain. Or your pain doesn’t ease even after taking several different types of medications, such as:
• nonsteroidal anti-inflammatory drugs
• muscle relaxants
• mild opioids
• anti-seizure medication
If these or other treatments, such as surgery, exercise and physical therapy, don’t work, your doctor may officially diagnose you with intractable pain.
Complications of intractable pain
Unlike chronic pain associated with arthritis, intractable pain can affect hormones, such as cortisol, because intractable pain also raises levels of stress and inflammation in your body. The can contribute to problems, such as high blood pressure and a high pulse rate. Intractable pain can also result in sexual dysfunction.
Intractable pain often interferes with sleep, making you more likely to feel fatigued. Insufficient sleep and constant pain can also combine to make it difficult to concentrate and make decisions. Along with interfering with your thinking skills, intractable pain can also affect your physical performance.
How intractable pain is treated
Because standard medical treatment doesn’t help with intractable pain, doctors have to try more aggressive methods. Several states have laws defining intractable pain and when it’s permissible for physicians to prescribe opioids or medical marijuana to relieve pain. These treatments must be supervised carefully by your doctor.
Often a multidisciplinary treatment plan is required to reduce pain. Talk with your doctor about working with a team of healthcare providers to get the best result possible. A multidisciplinary treatment plan could involve any or all of the following:
• physical rehabilitation
• physical therapy
• nerve blocks
Innovative new treatments are also providing some hope to people with intractable pain. Neurostimulation, for example, uses electricity to change the way your brain perceives pain. Spinal cord stimulator devices electrically stimulate the dorsal column and dorsal root ganglion areas of your spinal cord, which contain a lot of sensory nerve tissue, in hope of helping beneficially change how your brain perceives incoming pain signals.
Outlook for intractable pain
Dealing with intractable pain often means trying a variety of treatments to find relief. If one approach doesn’t help, you’ll need to work with your primary care doctor or find a doctor with expertise in chronic pain management who may have a better solution.