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Drugs Commonly Used in Chronic Pain Treatment

Drugs and Medicines can often help control Chronic Pain. Many different drugs, both prescription and non prescription, are used to treat chronic pain treatment.

All these medicines can cause side effects and as such I introduce them slowly and cautiously and monitor them all carefully by telephone consultation periodically over a few weeks. Everyone reacts differently to these agents and I try to tailor the therapy to the patient's response.

It may take several weeks before medicines work to reduce pain. The first step is to check that the patient is able to tolerate the drug without experiencing too many side effects. Older adults are more likely to experience adverse side effects, so medicines may be started at even lower doses and increased more slowly.

Medicines used to treat chronic pain include the following:

 Mild to Moderate Pain

  1. Paracetamol - this may be purchased across the counter. It is generally well tolerated but is important to stick to the recommended dosages.

  2. Non Steroidal Anti-inflammatory
    These are drugs that reduce inflammation and relieve pain. Inflammation is the body's response to irritation or injury.

    NSAIDs are used in my pain clinic to treat a variety of conditions that cause inflammation, including arthritis and tendinitis.

    NSAIDs are also used to treat pain from injury or other causes of long-term pain.

    Some NSAIDS that can be purchased over-the-counter include:
    Ibuprofen, Naproxen, Aspirin, Ketoprofen and Diclofenac

    Others must be prescribed:
    Indomethicin, Piroxicam, Meloxicam, Celebrex*

    (*The Cox-2 inhibitor Celebrex is a newer form of NSAID that also relieves inflammation. It is less likely to result in unwanted side effects that can occur with older types of NSAIDs, especially stomach bleeding. While Celebrex is generally safer in this regard, there is still some risk to the stomach)

  3. Compound Analgesics
    This refers to tablets containing paracetamol combined with another analgesic tablet. Some of them may be bought across the counter and others need prescribing.

    Paracetamol may also be combined with other painkillers in medicines such as:

    Tramacet - (paracetamol and tramadol)
    Co-codamol (codeine phosphate/ paracetamol)
    Co-dydramol (dihydrocodeine tartrate/ paracetamol)

 Moderate to Severe Pain

This is usually treated with a;
  1. A Combination of a NSAID and a Compound Analgesic

  2. Tramadol - a weak opiate

 Severe Pain

This usually requires the use of opiates in addition to one or more of the medications listed above or alone.

The main opiates I use in my pain clinic are;

Morphine Sulphate, Oxycontin, Fentanyl Patches, Buprenrophine Patches.

Often when these agents are used over a prolonged period, they become ineffective and as such it may be necessary to change them to a different one. This is called opiate rotation.

 Drugs Used to treat Neuropathic Pain

In chronic pain treatment we often encounter patients who suffer with what is called neuropathic pain. This simply means that the nerves transmitting pain to the spinal cord and the brain are behaving in an abnormal pain.

It is often characterised by burning sensations, pins and needles and electric and shooting skins. The affected area may be very sensitive to ordinary touch and mildly painful stimulation can be excruciating.

Some of the drugs used in the treatment of Neuropathic pain are listed below;
  1. Anti convulsants - as their name suggests these drugs were originally used to treat patients with fits and epilepsy. They have found a useful role in treating neuropathic pain.

    Commonly used agents include- Gabapentin, Pregabalin,
    Less commonly used agents are Carbamazepine, Lamotrogine

  2. Anti depressants - as their name suggests, these drugs were originally used and to some extent still are used to treat depression. Many patients living with Chronic Pain do suffer with depression but in certain instances, these drugs have the specific properties of reducing neuropathic type pain.

    Commonly used agents include - Amitriptyline, Nortriptyline, Duloxetine

  3. Anti arrhythmic - these agents are used in the treatment of arrhythmias but occasionally they are use in the treatment of difficult pain conditions.

    Mexiletine is the most common anti arrhythmic used.

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