Pain Medication Management

29 Nov Pain Medication Management

There are many options for the treatment of chronic pain. Under the general categories of medicines, there are both topical and oral therapies. Topical medications, whether by patch, cream, or ointment, are medications that may be applied to the skin. Some of the patches work by being place over the painful body region where lidocaine is released. Others, such as fentanyl patches, work by being absorbed into the bloodstream through the skin. Oral medications are taken by mouth, and they can be used in conjunction with topical agents.

Acetaminophen

Acetaminophen (Tylenol) is easily obtained, and is the treatment of choice for mild pain. However, you should not take more than 4,000 mg in a 24-hour period. This drug can be toxic to the liver, so you should not take it long-term either. Many medications contain acetaminophen, so check with your pharmacist or doctor before you take the over-the-counter drug along with prescribed medicines.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Common NSAIDs include ibuprofen, ketoprofen, and naproxen. These are anti-inflammatory agents that work well for pain related to inflammation. Because these drugs are associated with increased bleeding, renal toxicity, and gastrointestinal discomfort, you should avoid taking large doses of NSAIDs long-term. NSAIDs work through a complex process. The body receives pain signals from nerve receptors. The signals occur due to complex responses between chemicals and cells in the body.

Tricyclic Antidepressants

Tricyclic antidepressants work well for neuropathic pain, and these drugs are used for chronic problems. The pain relieving properties associated with tricyclic antidepressants are associated with brain chemicals. Commonly prescribed antidepressants for chronic pain are amitriptyline and nortriptyline.

Anticonvulsants

For shooting and burning nerve pain, anticonvulsants are commonly prescribed. These drugs are taken daily to block certain chemicals associated with pain. Experts believe these drugs block the flow of pain signals from the nervous system. Examples include carbamazepine (Tegretol), gabapentin (Neurontin), oxcarbazepine (Trileptal), and pregabalin (Lyrica). According to a recent study, 7 out of 0 people with nerve pain who took carbamazepine reported some relief. In addition, pregabalin was found to help 5 out of 10 people with nerve pain.

Muscle Relaxants

Skeletal muscle relaxants are used for many musculoskeletal conditions, and include carisoprodol, dantrolene, baclofen, chlorzoxazone, and tizanidine. These drugs work by decreasing muscle contraction activity. Cyclobenzaprine is the best studied muscle relaxant, being proven superior to placebo for fibromyalgia pain relief.

Opioids

Most opioids are µ-opioid receptor agonists, which means that have specific affinity for certain opioid receptors. These drugs are only used for severe, chronic pain that is not relieved with other medicines. In a review of numerous studies, opioid analgesics were found to be more effective than placebo for functional and pain outcomes.

Topical Analgesics

Topical analgesics bypass the gastrointestinal tract and bypass systemic side effects. These include:

• Lidoderm patch – This 5% lidocaine patch works well for nerve pain.
• Capsaicin – An alkaloid derived from chili peppers, this drug depletes substance P from afferent neurons to block pain. In a recent study, 57% of people reported relief of pain using capsaicin.
• Salicylate – Proven superior to placebo for treating pain. A recent study found that topical ibuprofen was useful for treating pain associated with knee osteoarthritis.

Resources

American Society of Regional Anesthesia and Pain Medicine (2016). Retrieved from: https://www.asra.com/page/46/treatment-options-for-chronic-pain

Park HJ & Moon DE (2010). Pharmacologic Management of Chronic Pain. Korean Journal of Pain, 23(2), 99-108.