PAIN MEDICATION
A number of different types of medications may be used to reduce pain in various parts of the body. Any of the medications described below may be helpful in relieving pain, depending on the medical condition of the patient and the severity of the pain being experienced.
Over-the-Counter Medications
Over-the-counter medications are frequently helpful in relieving symptomatic pain that is mild to moderate. Such medications may include analgesics such as acetaminophen and non-steroidal anti-inflammatory drugs, or NSAIDS, such as ibuprofen and naproxen. It is important for patients to consult with their physicians regarding appropriate dosages and to avoid possible interactions with prescribed medications or over-the-counter preparations they may be already taking.
Topicals
There are many topical medications that can be helpful in reducing pain in skin and superficial structures that can be reached when the medication is applied to the overlying skin. Such medications include menthol rubs, lidocaine, diclofenac (NSAID) and capsaicin. Most can be obtained over the counter and by prescription at slightly higher concentrations. Specially formulated creams can also be prescribed but often are not paid by prescription drug plans but can be purchased by patients themselves.
Muscle Relaxants
Muscle relaxants can also help to relieve symptoms of pain, particularly when such symptoms are associated with muscle spasms. Examples of commonly used muscle relaxants are cyclobenzaprine (Flexeril), carisoprodol (Soma) and diazepam (Valium).
Gabapentinoids
Gabapentin and pregabalin are medications initially developed as anti-seizure medications but which can also modify painful impulses along the many routes that pain can be generated. The medications serve as nerve traffic cops and help to reduce excessive nerve traffic which can be contributory to pain generation. As all prescribed medication, it is best to take as prescribed because proper use will achieve the correct blood level of the active medication that can positively modify pain impulses. They can have side effects such as sleepiness, constipation and dry mouth.
Tricyclic Anti-Depressants
This class of medications was initially developed for treatment of depression but a lower doses have been found to be useful for some chronic pain conditions. These medications also serve as nerve traffic cops to slow conduction of painful impulses which can improve quality of life and function. Side effects can include sleepiness, constipation, dry mouth and rapid heart-beats.
Serotonin Reuptake Inhibitors and Serotonin – Norepinephrine Reuptake Inhibitors
Opioids
For severe or post-operative pain, opioids, sometimes known as narcotics, may be necessary. These may include codeine, hydrocodone (Vicodin) and oxycodone (Percocet, Oxycontin). While these drugs can be extremely effective against pain, they tend to be addictive. Ultram (Tramadol), a prescribed medication called an opioid analgesic, is somewhere between an over-the-counter medication and a narcotic and may be habit-forming.
Our treatment of pain with opioids is considered only while developing a more definitive plan to address pain and performing it; our plan is to stop these medications after addressing pain with a more sustainable course of treatment. Sometimes patients who have intractable cases of pain for which all other options have failed or are unavailable can be managed with chronic opioid therapies. These medications have to be carefully managed to be safe. Our policies of management are meant to provide a safety profile that is in the patient’s, families’, and society’s best long-term interest. Patients that are taking anti-anxiety medications from the benzodiazepine class, illegal drugs or other drugs that could cause adverse interactions are not candidates for these medications. We attempt to keep the dose as low as possible so that the many potential side effects can be managed.
These medications can be used to treat many types of psychiatric disease with the primary one being depression but also have been found to modulate or decrease many types of chronic pain. These medications are nerve traffic cops and the side effects are similar to others mentioned above.
Additional Resources