Medications for Pain Relief
Medications that relieve pain are called analgesics. Analgesics are often used in pain management. Using specific medications for the correct indications is the key in the selection of analgesics for pain management.
Aspirin was discovered and used more than a century ago, and it remains one of the most widely used pain relievers in the world.
It relieves minor to moderate pain, fever, headaches, and swelling. It is inexpensive, and no prescription is needed.
It can cause stomach upset or bleeding in the stomach, kidney damage is possible if taken in excessive amounts, and some people with asthma have adverse reactions to aspirin.
Nonsteroidal Anti-Inflammatory Drugs:
Similar to aspirin, these medications, which are either of a prescriptive nature or can be over-the-counter, are among the most common class of medication used for pain symptoms.
Again, similar to aspirin, it provides mild to moderate pain relief, reduces fever, is often used for headaches, and also is important to decrease swelling.
It can cause stomach problems and occasionally bleeding ulcers. Kidney or liver damage at high doses can be an issue. Again, patients with asthma may have issues with these drugs. Lastly, it can increase the risk of a heart attack and a stroke secondary to increased blood pressure.
Opioids (such as morphine, oxycodone, and others) are strong pain medications for severe pain. They can be formulated to either be delivered in a time released fashion or through the skin in a transdermal patch.
The benefits of opioids are that they are useful for stronger types of pain but have a “ceiling” effect on their usage.
Small amounts of opioids (such as hydrocodone, oxycodone, morphine, Dilaudid, and fentanyl) are useful long-term if used in low doses. One issue that people see with opioid analgesics is that tolerance often occurs, and a larger amount of medication is used to obtain the same results. This “chasing your tail” phenomenon can best be mitigated with limiting the amount of opioid that one uses and never going above that.
One relatively new phenomenon has been described and now being well documented clinically is the relatively new diagnosis of opioid induced hyperalgesia. In this state, individuals who have taken large amounts of opioids now have become not only immune to their benefit but actually have increased pain. One of the hallmarks of this phenomenon is that not only is their typical location of pain worse even with high doses of pain killers, but other areas in their body now have become more susceptible to pain or increased out of proportion to what they were previously.
Decreasing the opioids is one of the only ways to accomplish an elimination of this paradoxic pain problem.
Antiepileptic Drugs (AEDs):
Seizure medicines have been used for decades for primarily neuropathic pain. Neuropathic pain typically involves nerves or nerve like pain in any area of the body. This can be electrical sensations, burning sensations, or hypersensitivity.
Older AEDs had some issues with long-term usage, and blood monitoring was required. Newer AEDs have a much higher safety profile and two of the most common AEDs—Lyrica (pregabalin) and Neurontin (gabapentin)—have shown to have no end-organ toxicity. That means that continued long term use of these drugs had no impact on the liver, kidney, stomach, or other vital organs.
Topamax, Depakote, Lamictal, and Keppra are other examples of AEDs that are used in pain management, particularly for neuropathic pain.
Many non-drug treatments are also used for pain management. Combining treatments may reduce the level of pain, improve your ability to cope, and overall enhance your quality of life.
Antidepressants have long been used in the treatment of chronic pain. The reason for this is not because of mood disorders that often accompany patients who have chronic pain, but because of the chemistry that occurs in patients with chronic pain disorders.
Serotonin is a critical chemical that is in our brain, and it is used for many things, including multitasking, emotional stability, pain regulation, and other cognitive functions. When someone has chronic pain, serotonin levels drop precipitously. Without replacing serotonin in one’s system, the ability to fight one’s own pain is severely hampered. By using antidepressants, we increase the level of serotonin and, hence, allow the body to fight pain in its own natural way. Often, patients feel that doctors prescribe antidepressants in chronic pain because they feel that the pain is “in their head.” It is in their head but not because of a mood disorder, but because of the chemistry that it changes in chronic pain patients.
Other medications that are typically not considered pain medications are often used in the management of a chronic pain patient. Occasionally, medications that were originally designed for schizophrenic patients are used in people with pain who have high anxiety. Again, we are not treating any psychiatric disorder, such as schizophrenia, but the calming effect of some of these medications can be very helpful in the treatment of chronic pain patients. Other types of medications (which have been used in other modalities) are often used in pain management as well, and these may be brought up by your pain physician as a possible adjunct to your treatment.
Many non-drug treatments are also used for pain management. Combining treatments may reduce the level of pain, improve your ability to cope and overall enhance you quality of life.