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A variety of medications are now available for the treatment of pain. The pain physician can now target specific receptors in the nervous system – either stimulate or inhibit those receptors, as necessary, to control the patient’s symptoms. Medications can be used alone or in combination with other drugs to either diagnose or treat a variety of conditions. These drugs are usually used in a continuum which starts with the lowest dose of a medication associated with the lowest number of side effects. Depending on the effect, the physician advances to stronger medications with potentially more side effects or problems.
The categories of medications which can be used are listed below with some examples from each group. This list is not intended to be totally inclusive. Ask your physician if these medications are appropriate for you.
This group of medications can be very useful in some types of pain and not so helpful in others. The weaker opioids include codeine, propoxyphene; and the stronger ones include morphine, oxycontin, and fentanyl. These medications can be given via a variety of routes and dosages.
This group of medications include salicylates like aspirin, the non-steroidal anti-inflammatories or NSAIDS, acetaminophen or Tylenol, and newer medications like tramadol or Ultram. These can be used in combination or alone.
Depression is indeed a problem with chronic pain. However, these medications have also been reported to help increase certain natural chemicals in the nervous system such as serotonin and norepinephrine. These chemicals have been shown to decrease pain signals that start at the spinal cord level. This added effect makes this group of medications very valuable in the fight against chronic pain. Examples include: Elavil, Serzone, Paxil, Prozac, Zoloft, Effexor, Remeron, Norpramin, and many others.
The same drugs that decrease firing potentials in the central nervous system, have the same effects in the peripheral nervous system. Injured nerves can exhibit firing activity which is abnormal, but can be controlled or decreased by this group of medications. Examples include: gabapentin or Neurontin, Tegretol, Dilantin, or Depakote.
These can work centrally or peripherally to relax muscles, which many times spasm due to direct injury, or as a reaction to nerve tissue irritability. They can be very effective in some cases, but can cause sleepiness or sedation. Examples include: Robaxin, Parafon Forte, Flexeril, Soma, or Baclofen.
In many cases, anxiety can worsen pain and make the patient more miserable. These medications help the patient relax, improve sleep, relieve muscle spasm, and decrease the perception of painful stimuli. Examples include: Valium, Xanax, Ativan, and Buspar.
BLOOD PRESSURE/HEART MEDS
This group of medications which are normally used to control hypertension, can also be used to control abnormalities of the autonomic nervous system. The sympathetic nerves can malfunction in some pain syndromes and worsen some types of pain. Examples include: clonidine, Vasotec, propranolol, and many others.
This group can be injected into tissue at specific locations for diagnosis or treatment. A short-acting local anesthetic, such as lidocaine, can be injected intravenously, as a test of certain pain receptors. An oral medication, mexilitene, can be given orally if the intravenous dose is effective. Longer acting local anesthetics are being developed for the future, so that a single injection might give months of relief. The use of topical anesthetics for localized pain are also available. Examples include: Xylocaine, bupivicaine, Tetracaine, Lidoderm or Flector patch.
This group of very potent anti-inflammatories can decrease tissue swelling, and decrease firing of damaged nerve tissue. These medications can be injected directly into tissues such as into the epidural space, joints, trigger points, and other inflamed tissues. In addition, a short burst of oral steroids can be given to attempt to relieve painful symptoms. This group of medications can cause significant problems, or side effects if used excessively or inappropriately. Examples include: prednisone, methylprednisolone, triamcinolone, and dexamethosone.
Pain is always worse when a patient is sleepless, and thus, exhausted. The anti-depressants can also be used to induce sleep, if dosed properly. In some patients the use of a mild sleep aid can be helpful if used for short periods of time. Examples: Halcion, Ambien, Dalmane, and Restoril. Our pain specialists are trained to use all of the medications available for diagnosis, treatment, or control of the patient’s pain. The patient should expect a thorough discussion of each medication prescribed, the effect expected, side effects, and possible problems or adverse reactions.