Medication and Chronic Pain: The Good, The Bad & The Ugly
In my opinion chronic pain medication is one of the most complicated strands within the painweb. Chronic pain medications will also connect and influence every other strand within the painweb.
Medication is often an important and necessary component in managing your chronic pain. Unfortunately that same medication can also complicate your painweb. It is important to understand this correlation.
Note: mypainweb represents my opinions regarding chronic pain medications. Medications have been used in the management of my chronic pain for almost 24 years.
Types of Chronic pain medication:
The pain process is complex, and is further complicated because different people respond differently to medications. These medications provide relief by acting through a variety of physiological mechanisms:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) act on substances in the body that cause inflammation, pain, and fever.
- Corticosteroids are often administered at the site of musculoskeletal injuries. They exert powerful anti-inflammatory effects.
- Acetaminophen increases the body’s pain threshold, but it has little effect on inflammation.
- Opioids, also known as narcotic analgesics, modify pain messages in the brain as a way to provide pain relief.
- Muscle relaxants reduce pain from tense muscle groups, most likely through sedative action in the central nervous system.
- Anti-anxiety drugs work on pain in three ways: they reduce anxiety, they relax muscles, and they help patients cope with discomfort.
- Some antidepressants, particularly the tricyclics, may reduce pain transmission through the spinal cord.
- Some anticonvulsant drugs also relieve the pain of neuropathies, possibly by stabilizing nerve cells.
Some specific chronic pain medications:
1 Dilaudid (hydromorphone) is used to relieve moderate to severe pain from a variety of causes. Hydromorphone is a narcotic pain reliever (opiate-type). It works in the brain to change how your body feels and responds to pain.
2 Lortab is a combination of a narcotic (hydrocodone) and a non-narcotic (acetaminophen) used to relieve moderate to severe pain.
3 Ativan Oral is used to treat anxiety. Lorazepam belongs to a class of drugs known as benzodiazepines which act on the brain and nerves (central nervous system) to produce a calming effect. This drug works by enhancing the effects of a certain natural chemical in the body (GABA).
4 Ambien Oral( Zolpidem) is used to treat sleep problems (insomnia) in adults. If you have trouble falling asleep, it helps you fall asleep faster, so you can get a better night’s rest. Zolpidem belongs to a class of drugs called sedative-hypnotics. It acts on your brain to produce a calming effect.
5 Celebrex Oral is a nonsteroidal anti-inflammatory drug (NSAID), specifically a COX-2 inhibitor, which relieves pain and swelling (inflammation). It is used to treat arthritis, acute pain, and menstrual pain and discomfort. The pain and swelling relief provided by this medication helps you perform more of your normal daily activities. Celecoxib is also used to decrease growths found in the intestines (colon polyps) of persons with a family history of this condition.
6 Celexa Oral Citalopram is an antidepressant (selective serotonin reuptake inhibitor-SSRI) used to treat depression. It works by restoring the balance of certain natural substances (neurotransmitters such as serotonin) in the brain. Citalopram may improve your feelings of well-being and energy level.
7 Cymbalta Oral (Duloxetine) is used to treat major depression and anxiety. In addition, duloxetine is used to relieve nerve pain (peripheral neuropathy) in people with diabetes. It is also used to treat pain caused by a condition called fibromyalgia that affects the muscles, tendons, ligaments, and supporting tissues.
8 Fioricet Oral (Butalbital) is used to treat tension headaches. Acetaminophen helps to decrease the pain from the headache. Caffeine helps increase the effects of acetaminophen. Butalbital is a sedative that helps to decrease anxiety and cause sleepiness and relaxation.
9 Flexeril Oral relaxes muscles. It is used along with rest and physical therapy to decrease muscle pain and spasms associated with strains, sprains or other muscle injuries.
10 Keppra Oral (Levetiracetam) is used in combination with other medications to treat seizure disorders (epilepsy). Levetiracetam has been shown to decrease the number of seizures in adults and children with a certain type of seizure (partial onset). It is not known how it works to prevent seizures.
11 Lexapro Oral (Escitalopram) is an antidepressant (selective serotonin reuptake inhibitor-SSRI) used to treat depression and anxiety. It works by restoring the balance of certain natural substances (neurotransmitters such as serotonin) in the brain. Escitalopram may improve your feelings of well-being and energy level and decrease nervousness.
12 Lortab Oral is used to relieve moderate to severe pain. It contains a narcotic pain reliever (hydrocodone) and a non-narcotic pain reliever (acetaminophen). Hydrocodone works in the brain to change how your body feels and responds to pain. Acetaminophen can also reduce a fever.
13 Lyrica is used to treat pain caused by nerve damage due to diabetes and shingles (herpes zoster) infection. It is also used with other medications to treat certain types of seizures, and is the first medication to be FDA-approved for the treatment of fibromyalgia.
14 Mobic Oral (Meloxicam) is used to treat arthritis. It reduces pain, swelling, and stiffness of the joints. Meloxicam is known as a nonsteroidal anti-inflammatory drug (NSAID).
15 MS Contin Oral is an opioid which contains morphine sulfate and is used for severe pain.
16 Neurontin Oral (Gabapentin) is used with other medications to help control seizures in adults and children (3 years of age and older). It is also used to relieve nerve pain associated with shingles (herpes zoster) infection in adults.
17 OxyContin Oral (Oxycodone) is used to help relieve moderate to severe ongoing pain (such as due to cancer). Oxycodone belongs to a class of drugs known as narcotic (opiate) analgesics. It works in the brain to change how your body feels and responds to pain.
18 Paxil CR Oral (Paroxetine) is a selective serotonin reuptake inhibitor (SSRI) used to treat depression, panic attacks, obsessive-compulsive disorder (OCD), anxiety disorders, post-traumatic stress disorder, and a severe form of premenstrual syndrome (premenstrual dysphoric disorder).
19 Percocet Oral is used to help relieve moderate to severe pain. It contains a narcotic pain reliever (oxycodone) and a non-narcotic pain reliever (acetaminophen). Oxycodone works in the brain to change how your body feels and responds to pain. Acetaminophen can also reduce a fever.
20 Prozac Oral (Fluoxetine) is a selective serotonin reuptake inhibitor (SSRI) used to treat depression, anxiety disorders (panic attacks), obsessive-compulsive disorder (OCD), a certain eating disorder (bulimia), and a severe form of premenstrual syndrome (premenstrual dysphoric disorder).
21 Robaxin Oral relaxes muscles. It is used along with rest and physical therapy to decrease muscle pain and spasms associated with strains, sprains or other muscle injuries.
22 Seroquel Oral (Quetiapine) is used with or without other medications to treat certain mental/mood conditions (such as bipolar disorder, schizophrenia). Quetiapine is known as an anti-psychotic drug (atypical type). It works by helping to restore the balance of certain natural chemicals (neurotransmitters) in the brain.
23 Soma Oral is used short-term to treat pain and discomfort from muscle injuries such as strains, sprains, and spasms. It is usually used along with rest, physical therapy, and other treatments (e.g., anti-inflammatory medication).
24 Tegretol Oral (Carbamazepine) is used to prevent and control seizures. This medication is known as an anticonvulsant or anti-epileptic drug. It is also used to relieve one type of nerve pain (trigeminal neuralgia). This medication works by reducing excessive nerve signals in the brain and restoring the normal balance of nerve activity.
25 Ultracet Oral is used to treat moderate to moderately severe pain. It contains 2 medications: tramadol and acetaminophen. Tramadol is similar to narcotic analgesics. It works in the brain to change how your body feels and responds to pain. Acetaminophen is used to relieve pain, and it can also reduce a fever.
26 Ultram Oral is used to relieve moderate pain. It is similar to narcotic pain medications. It works on certain nerves in the brain that control how you experience pain.
27 Valium Oral (Diazepam) is used to treat anxiety, acute alcohol withdrawal, and seizures. It is also used to relieve muscle spasms and to provide sedation before medical procedures. This medication belongs to a class of drugs called benzodiazepines which act on the brain and nerves (central nervous system) to produce a calming effect. It works by enhancing the effects of a certain natural chemical in the body (GABA).
28 Vicodin Oral is used to relieve moderate to severe pain. It contains a narcotic pain reliever (hydrocodone) and a non-narcotic pain reliever (acetaminophen). Hydrocodone works in the brain to change how your body feels and responds to pain. Acetaminophen can also reduce a fever.
29 Wellbutrin Oral (Bupropion) is used to treat depression. It can improve your mood and feelings of well-being. It may work by helping to restore the balance of certain natural chemicals (neurotransmitters) in your brain.
30 Xanax XR Oral (Alprazolam) is used to treat the panic and anxiety symptoms associated with panic disorder. Alprazolam belongs to a class of medications called benzodiazepines which act on the brain and nerves (central nervous system) to produce a calming effect. It works by enhancing the effects of a certain natural chemical in the body (GABA).
31 Zanaflex Oral (Tizanidine) is used to treat muscle tightness and cramping (spasm) caused by conditions such as multiple sclerosis or spinal injury. Decreasing spasms can reduce pain and improve your ability to move around. Tizanidine is a short-acting muscle relaxant that works by blocking certain nerve signals from the spine to the brain (alpha adrenergic agonist).
32 Zoloft Oral (Sertraline) is used to treat depression, panic attacks, obsessive compulsive disorder, post-traumatic stress disorder, social anxiety disorder (social phobia), and a severe form of premenstrual syndrome (premenstrual dysphoric disorder).|
33 Amrix Oral relaxes muscles. It is used along with rest and physical therapy to decrease muscle pain and spasms associated with strains, sprains, or other muscle injuries.
34 Savella Oral (Milnacipran) is used to treat pain caused by a condition called Fibromyalgia that affects the muscles, tendons, ligaments, and supporting tissues.
35 Nucynta Oral (Tapentadol) is used to treat moderate to severe short-term pain (such as pain due to injury or following surgery). Tapentadol is a narcotic pain reliever (opiate-type). It acts on certain centers in the brain to give you pain relief. It also acts on a natural substance in the brain (norepinephrine) involved with pain.
36 Embeda Oral contains a combination of morphine and naltrexone. Naltrexone is a special narcotic drug that blocks the effects of other narcotic medicines and alcohol. Embeda is used to treat moderate to severe pain when around-the-clock pain relief is needed for a long time period.
37 Onsolis contains fentanyl, an opioid pain reliever, in a small film (about the size of a dime or nickel) that sticks to the inside of your cheek (buccal delivery) and eventually dissolves within 15 to 30 minutes after it is applied. Onsolis is used to manage breakthrough pain (flare-up of pain occurring in patients with otherwise stable, constant pain) in patients with cancer, 18 years of age and older, who are already using another opioid pain medicine around-the-clock and whose body is used to the medicine (opioid-tolerant).
38 Ryzolt Oral is used to relieve ongoing, moderate pain in people who need all-day pain relief (“around the clock” dosing). It is similar to narcotic pain medications. It works on certain nerves in the brain that control how you experience pain.
39 Zamicet Oral is used to relieve moderate to severe pain. It contains a narcotic pain reliever (hydrocodone) and a non-narcotic pain reliever (acetaminophen). Hydrocodone works in the brain to change how your body feels and responds to pain. Acetaminophen can also reduce a fever.
Here are a few more chronic pain medications other than the more common “oral” delivery route:
- Pain relievers that are applied directly to the skin (topical analgesics), such as EMLA cream or a lidocaine patch (Lidoderm).
- Capsaicin, a naturally occurring substance that is found in chili peppers and is used to make certain topical analgesic creams.
- Cooling spray. This involves using a cooling spray (such as Biofreeze) directly on the skin. This may be repeated several times.
- Creams or gels containing medicines or combinations of medicines. The cream or gel is rubbed directly on the painful area. Some of these creams or gels can be made at the pharmacy according to your doctor’s directions.
- Narcotics such as Actiq and Fentora are absorbed in the mouth (transmucosal and buccal)
- Narcotics can also be delivered through the skin via a patch (transdermal) like Duragesic.
Here are a few invasive chronic pain medication therapies:
- Nerve block injections. An anesthetic is injected into the affected nerve to relieve pain. The anesthetic may relieve pain for several days, but the pain often returns. Although nerve blocks do not normally cure chronic pain, they may allow you to begin physical therapy and improve your range of motion.
- Epidural corticosteroids injections (injecting corticosteroids into the epidural space of the spine). Although these injections have been used for many years and may provide relief for low back or neck pain caused by disc disease or pinched nerves, they may not work for everyone.
- Trigger point injections. These may relieve pain by injecting a local anesthetic into trigger points (or specific tender areas) linked to chronic fascial pain or fibromyalgia. These injections do not relieve chronic pain in everyone.
Chronic pain medication is complicated and at times overwhelming. The medication arsenal is extensive.
The Pain Scale
During the 1990’s this type of Pain Scale was located in just about every hospital room in America. Pain was was considered to be the “5th Vital Sign”. The 4 Vital Signs being body temperature, pulse rate, respiration rate, and blood pressure.
Pain was considered to be inhumane. The hospital staff would ask the patient to point to the face that represents their pain. More pain would allow the hospital staff to give more medications (more powerful medications) to the patient to reduce the patient’s pain and suffering.
Recently, the American Medical Association has removed Pain as the 5th Vital Sign as it’s believed that philosophy was part of the reason for over-prescribing opioids.
Read this informative Doctor’s conversation on this important topic:
Here are a few simple things to remember:
The Good:
Chronic pain medication:
- will reduce some pain
- will provide some relaxation to promote sleep
The Bad:
Chronic pain medication:
- will NOT fix anything.
- is NOT a healthy longterm solution
- is NOT a substitute for other “Conservative” therapies
The Ugly:
Chronic pain medication:
- will complicate your painweb as a result of medication side effects. It is important to read and understand all side effects (physical, psychological, and physiological) associated with your medication(s). You will find them listed on your prescription medication(s) packaging as well as further information available online. Be sure to talk to your Doctor and/or pharmacist about any questions, or concerns.
- requires you to be sure your Doctor and pharmacist are aware of any sensitivities, or allergic reactions you may have to medications.
- may need to be stopped, changed, or used in combination with other chronic pain medications as prescribed by your Doctor.
Chronic pain medication Bottom Line:
Use the least amount of chronic pain medication possible in combination with other “Conservative” therapies.
Never deviate from your doctor’s prescription orders. Take what is prescribed in the dose it’s described when it’s prescribed to be taken.
Tell your doctor how you feel. Be honest. If it’s not reducing your pain tell your doctor. If you don’t feel right due to side effects tell your doctor.
Chronic pain medication can only be effective and safe if you openly and honestly communicate with your doctor.
Want to know more about dangerous drugs in general? Visit DrugWatch.com to obtain the latest news on medical research, recalls and FDA warnings.
Everyone’s pain is unique, and how people respond to pain is unique, and how people respond to pain medication is unique, so the the chronic pain medication plan must be customized to your painweb.
This requires some basic understanding of your chronic pain medication(s) along with communicating with your doctor how you are responding to the pain medication’s side effects along with your level of pain relief. Realize there may be some trialling of medications to find what works best for you.
While most pharmacies check for drug interactions when multiple medications are being prescribed, it’s an important step you can do for yourself. Visit mypainweb “Drug Interaction” to see how you can protect yourself against adverse reactions while taking multiple prescription medications. It’a another effective way to control your painweb.
mypainweb “Forms” provides you with an easy-to use chronic pain medication log to track your medication use. It’s an easy yet effective way to update your Doctor(s) on your chronic pain medication history.
Hopefully the use of non-prescription chronic pain medications will prove effective in managing your chronic pain.
In the event you find prescription chronic pain medications necessary, please take some time to review mypainweb “Opioid Truths”.
mypainweb “Links” is also an excellent resource to learn more about chronic pain medication.
