Medication Management

Medications and Chronic Pain

Many people with chronic pain are able to manage adequately without medications and can function at a near-normal level. Others find that their overall quality of life, in terms of comfort and function, is improved with medications.

When it comes to treating chronic pain, medications can play a crucial role. There are numerous medications available to help you manage pain. However, every pain patient is different and responds to medications differently. Pain medications can be helpful for some patients in chronic pain, but they are not universally effective. Some people may need to take prescription-strength non-steroidal anti-inflammatory drugs (NSAIDs) daily, while others may need something more potent, such as an opioid. In some individuals, pain medications may actually worsen their symptoms over time or cause unwanted or dangerous side effects.

Even the strongest medications used for pain do not always completely eliminate pain but rather may reduce the severity of pain. As such, medications may not be adequate treatments by themselves but should be considered as part of a comprehensive approach to pain management.

Although there are many types and brands of medications, what medication your doctor prescribes depends on you — your pain level, treatment goals, and overall health. We treat each person with chronic pain as an individual, and will work with you to weigh the benefits compared to other alternatives, cost, potential side effects, and your other medical diagnoses.

Typical Medications and Side Effects

There are many categories of medications that are used for the treatment of chronic pain. In general, your primary physician, pain specialist, or pharmacist can answer any specific questions about the dosage and side effects from these medications. The most commonly used medications can be divided into the following broad categories:

1. Nonsteroidal Anti-inflammatory Drugs and Acetaminophen

There are many different types of nonsteroidal anti-inflammatory medications (NSAIDs). Some of them (such as ibuprofen) may be obtained over-the-counter. NSAIDs can be very effective for acute muscular and bone pain as well as some types of chronic pain syndromes. When taken for an extended period of time or in large quantities, they may have negative effects on the kidneys, blood clotting, and the gastrointestinal system. Bleeding ulcers is a risk of these medications. Long-term use may be associated with an increase in cardiovascular (heart) risks. Acetaminophen is easily obtained over-the-counter. However, care should be taken not to take more than 4000 mg in 24 hours; otherwise, severe liver failure may occur. There are some opioid medications that contain acetaminophen. You should be aware that many over-the-counter medications also have acetaminophen as one of their ingredients and when taken in combination with prescribed medication, this may result in an overdose of acetaminophen.

2. Antidepresssants

Some categories of antidepressants may be very helpful in controlling pain; specifically the tricyclic and SNRI (serotonin-norepinephrine reuptake inhibitors) antidepressants. The pain relieving properties of these medications are such that they can relieve pain in doses that are lower than the doses needed to treat depression. These medications are not meant to be taken on an “as needed” basis but must be taken every day whether or not you have pain. Your physician may attempt to lessen some of the side effects, particularly sedation, by having you take these medications at night. There are some other side effects like dry mouth that can be treated with drinking water or fluids. These medications may not be given to patients with certain types of glaucoma. In addition, these medications should never be taken in larger doses than are prescribed.

3. Anticonvulsants (Anti-seizure) Medications

These medications can be very helpful for some kinds of nerve type pain (such as burning, shooting pain). These medications also are not meant to be taken on an “as needed” basis. They should be taken every day whether or not you feel pain. Some of them may have the side effect of drowsiness which often improves with time. Some have the side effect of weight gain. The newer anticonvulsants do not need liver monitoring but required caution if given to patients with kidney disease.

4. Muscle Relaxants

These medications are most often used in the setting of muscle spasm. These medications may be taken on an as-needed basis. The most common side effect seen with these medications is drowsiness.

5. Opioids

When used appropriately, opioids may be very effective in treating or helping to treat chronic pain. They tend to be less effective or require higher doses in neuropathic (or nerve type) pain. For unremitting pain, a long acting opioid a may be indicated. One of the most frequent side effects is constipation, which may be managed through dietary means, and over-the-counter and prescription medications. Drowsiness is another side effect which often gets better over time. Excessive drowsiness should be discussed with your physician. Nausea is another side effect which may be difficult to treat and may require switching to another better tolerated opioid. Opioid therapy should only be used at the lowest effective dose and should be tapered off and discontinued as the condition and pain improve. For some people, this can be a cost effective and safe therapy but there is variability in how much relief it can provide for chronic pain and does not work well for everyone. One of the main reasons opioid therapy does not work well long term is tolerance; which is a term for when opioids work well for a while and then lose their effectiveness. This is usually considered to be a failure for that particular opioid which should be rotated to an equivalent dose of another opioid, or weaned off and another type of therapy tried. More regarding tolerance and withdrawal can be learned here.

6. Corticosteroids

These medications may be given orally or injected directly to counteract inflammation-induced pain. Some of the potential side effects of steroids include elevated blood sugars, weight gain, stomach ulcers, and temporary decrease in immune system function.

At PrairieShore™ Pain Center, our goal is to relieve your pain and improve your quality of life. If your primary physician has advised you to see a specialist for your pain, turn to us for help. To schedule your appointment, please contact us here or give us a call at (847) 883-0077.