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Home | Pain Overview | Types of Pain | Treatment Methods | Chiropractors | Anesthesiologists | Biofeedback | Get Answers To All Of Your Pain Questions Massage | Pain Management Drugs | Glossary of Pain Drugs | Top Pain Programs | Pain Associations | Pain Doctors | Pain Terminology | Insurance | Site Map
These may involve opioid drugs (analgesics) or other medications such as sumitriptan or DHE-45 (for migraines), tricyclic antidepressants, anticonvulsants, antihistamines, or phenothiazines. Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to treat mild to moderate pain. Many patients are being taken off drugs altogether, however. Pain clinics often begin by detoxifying patients and then starting a program of graded exercise. Available Pain Therapeutics Drugs... Anti-seizure medications Some of the more effective and commonly used medications for chronic pain are drugs that were developed to control other conditions. Anti-seizure (anticonvulsant) medications were developed primarily to reduce or control epileptic seizures, but they also help control stabbing or shooting pain from nerve damage. These drugs seem to work by quieting damaged nerves to slow or prevent uncontrolled pain signals. Anti-seizure medications used for chronic pain include:
These medications can cause dizziness, drowsiness, nausea and lack of balance and coordination. But most people are bothered only minimally. More severe but less common side effects include blood and liver disorders. To reduce your risk of side effects, your doctor will likely start you off on a small amount of the drug and gradually increase the dose while monitoring you. Cox-2 inhibitors COX-2 inhibitors are a type of nonsteroidal anti-inflammatory drug (NSAID) that specifically inhibits an enzyme known as cyclooxygenase-2 (COX-2). These drugs are used to treat pain and may be less likely to cause gastrointestinal bleeding than other NSAIDs. COX-2 inhibitors include:
Cyclooxygenase comes in two forms: COX-1 and COX-2. Unlike other NSAIDs, COX-2 inhibitors suppress only one form of cyclooxygenase, COX-2. Researchers believe part of the role of COX-1 is to protect your stomach lining. Because the other NSAIDs suppress its function, side effects such as stomach and bleeding problems can result. COX-2 inhibitors affect only that form of the enzyme (COX-2) involved in inflammation. Because they don't affect COX-1, COX-2 inhibitors may cause fewer side effects in your digestive system. However, this result, along with the long-term effects of COX-2 inhibitors, needs to be verified with further research. In addition, COX-2 inhibitors don't thin your blood like aspirin and other NSAIDs. If your doctor has prescribed aspirin for a heart condition, don't use COX-2 inhibitors instead. Opioids Opioids are prescription medications and are regulated as controlled substances by the Drug Enforcement Administration. A doctor must have a special license in order to prescribe these drugs. Opioids are often used to relieve pain from cancer, terminal illness, severe injury or surgery. They come in several forms. Some are natural compounds derived from the opium poppy. These are called opiates. There are also synthetic opioids that work in similar ways. Opioids include both these natural and synthetic forms and is the preferred term. Frequently prescribed opioids include the following:
Tricyclic Antidepressants Some of the more effective and commonly used medications for chronic pain are drugs that were developed to control other conditions. Among these are tricyclic antidepressants. In addition to relieving symptoms of depression, these drugs interfere with certain chemical processes in the brain that cause feelings of pain. The tricyclic antidepressants most commonly used for pain management are amitriptyline (Amitril, Elavil) and nortriptyline (Aventyl, Pamelor). Others used on occasion for treating chronic pain include:
Newer Antidepressants New data show Cymbalta, an investigational serotonin and norepinephrine reuptake inhibitor (SNRI) being studied for the treatment of depression by Eli Lilly, significantly reduced pain associated with diabetic neuropathy after one week of treatment and throughout the remainder of the study. The data, presented this past spring at a major psychiatric meeting, complement previous studies in which patients treated with Cymbalta experienced significant improvement in both the emotional and painful physical symptoms of depression versus patients treated with placebo. In addition to their role in depression, serotonin and norepinephrine are believed to mediate pain perception in the brain and spinal cord pathways. Lilli hypothesizes that an imbalance of these neurotransmitters may explain why painful physical symptoms affect up to 70 percent of patients with depression. NSAIDS NSAIDs are most effective for mild to moderate pain accompanied by swelling and inflammation. These drugs relieve pain by inhibiting an enzyme in your body called cyclooxygenase. This enzyme makes hormone-like substances called prostaglandins, which are involved in the development of pain and inflammation. NSAIDs are especially helpful for arthritis and pain resulting from muscle sprains, strains, back and neck injuries or cramps. Over-the-counter NSAIDs include:
NSAIDs available only by prescription include:
When taken as directed, NSAIDs are generally safe. But if more than the recommended dosage is taken — and sometimes even the recommended dosage — NSAIDs may cause nausea, stomach pain, stomach bleeding or ulcers. Large doses of NSAIDs can lead to kidney problems and fluid retention. Risk increases with age. If you regularly take NSAIDs, talk to your doctor so that he or she can monitor you for side effects. NSAIDs have a so-called ceiling effect, or limit to how much pain they can control. This means that beyond a certain dosage, they don't provide additional benefit. If someone has moderate to severe pain, exceeding the dosage limit may not help relieve the pain. Many NSAIDs require a prescription, but some lower-dose NSAIDs, such as aspirin and ibuprofen, are available over-the-counter. These nonprescription NSAIDs are generally divided into two groups: · Aspirin. Aspirin relieves pain, fever and inflammation. It also affects your blood platelets and interferes with your blood's ability to clot. This may reduce your risk of heart attack and stroke but can increase your risk of bleeding. · Others. This group includes ibuprofen (Advil, Motrin, others), naproxen (Aleve, Anaprox, others) and ketoprofen (Orudis KT, Oruvail). These medications are often used to treat inflammation and pain associated with arthritis, tendinitis, bursitis, menstrual cramps and back problems. They also help treat headache and fever. Injections Instead of prescribing pills to control your pain, your doctor might inject medication. Injections typically don't cure pain, but they may help you through an initial period of intense pain or a flare-up of severe pain. Injections are most effective for joint, muscle or nerve pain that's confined to a specific location. Injected medications may be an anesthetic to control the pain, a steroid to reduce inflammation or a combination of the two. In addition, a substance that improves joint mobility is also sometimes injected. One benefit of injections is that the medication works primarily in a limited part of your body. By targeting a specific area, injections may reduce the amount of medication needed and the number and intensity of side effects. Injections can also help in diagnosing the cause of your pain. Suppose, for example, that a small amount of anesthetic injected at a specific location relieves your pain. This may indicate that the pain is coming primarily from that joint, muscle or nerve. One of the things a patient must consider is that every shot requires a visit to the doctor's office. In addition, the site of the injection and the type of medication used can limit how often an injection is received. For instance, injected steroids may cause adverse side effects that become worse with frequent use. Injections are seldom used by themselves to treat chronic pain. Rather, they're usually used in conjunction with a program that includes physical therapy. Injections can make such therapy more comfortable. Injections can be divided into three broad categories: joint injections, soft tissue injections and nerve block injections. Joint Injections When joints become inflamed and painful, a physician may inject medications into them to ease discomfort. Two types of medications are used for joint injections. They are corticosteroids and hyaluronic acid. Corticosteroids. If arthritis has caused joints to become inflamed, swollen and painful, a physician may suggest injecting the affected joint with a corticosteroid. Corticosteroids mimic the effects of the hormones cortisone and hydrocortisone, which are made by the outer layer (cortex) of the adrenal glands. When prescribed in doses that exceed natural-occurring levels, corticosteroids suppress inflammation. They are injected into one or several affected areas of the body, such as the shoulder, elbow, hip or knee. Some joint injections, such as facet or sacroliliac injections, are given in the spine. In the short term, corticosteroids can make patients feel dramatically better. But when used for many months or years, they may become less effective and cause serious side effects. Side effects can include weakened cartilage and ligaments, easy bruising, thinning of bones, cataracts, weight gain, a round face, diabetes and high blood pressure. Corticosteroid injections may offer some pain relief for 4 to 6 months. Hyaluronic acid. Hyaluronate (Hyalgan) and hylan G-F 20 (Synvisc) are injectable drugs that are used to treat osteoarthritis of the knee. Hyaluronic acid is a substance found in normal joint fluid. Joint fluid acts as a lubricant. Hyaluronate and hylan G-F 20 help relieve pain by supplementing hyaluronic acid in the joint. These drugs may be offered if someone can't get relief from exercise, physical therapy or other pain medication. Because they're injected directly into the knee, hyaluronate and hylan G-F 20 don't cause the side effects of oral pain medications. Hyaluronate is administered in a series of five injections — one per week — into the knee joint. A local anesthetic is injected first to ease discomfort from the hyaluronate, which is thick and must be administered with a large-gauge needle. Relief may last up to 12 months. Hylan G-F 20 is given in three injections. Relief may last 6 months or longer. Both drugs usually bring pain relief more slowly than do corticosteroids. Don't take Hylan G-F 20 if you're allergic to eggs. The effectiveness of hyaluronate injections for treating chronic knee pain associated with osteoarthritis is still being studied.
Source: Marketdata Enterprises, Inc., Chronic Pain Management Programs: A Market Analysis
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