Medication Management
There are a number of different types of treatments involving medications. Depending on your type of pain, the cause of your pain, your individual needs and other factors, your physician can determine if managing your pain with medications is the right choice for you.
OTC (Over-the Counter) Medications
These are sometimes overlooked, but can be helpful for pain such as from headaches or arthritis.
Example: Tylenol
Non-Steroidal Anti-Inflammatory Drugs
+ Advantages: Little chance of sedation, dizziness etc.
- Disadvantages: Risk of ulcers; May be some increased stroke and heart attack risk in people with high blood pressure, heart disease, etc.
Example: Naproxen
Opioid Analgesics
Although these medications are often called “narcotics”, the term opioids more properly encompasses all powerful pain killer medications acting on a certain pain-modulating neurotransmitter receptor in the body.
These medications can be very effective for some types of chronic pain; however, they are not appropriate for everybody. Your body may become dependent on the medication and withdrawal symptoms may be experienced if the medication is stopped too suddenly. People with a personal or family history of addiction are at higher risk to experience compulsive use of the medication for purposes other than pain control. Taking the medication in doses other than prescribed, or by another route, can be fatal.
So, this type of drug is not appropriate for everybody with chronic pain, and certain precautions need to be taken when they are being considered. Other options should usually be tried before committing to this type of treatment.
ADDITIONAL INFORMATION | Our Pain Medication Office Policy
ADDITIONAL INFORMATION | Clinical Guidelines for the Use of Chronic Opioid Therapy
ADDITIONAL INFORMATION | Florida's Department of Health "Standards for the Use of Controlled Substances for the Treatment of Pain" Opioid Guidelines
Tramadol
This medication is in a class by itself. It has many of the painkilling properties of opioids but also seems to act on other pain-modulating systems such as norepinephrine.
It has some possible side effects that are similar to those of opioids but also should be avoided if there is a history of seizures.
Medications for neuropathic pain
A number of pain medications are not painkillers per se, but act to reduce pain by acting on various areas of the nervous system. They can be very helpful for neuropathic pain (which is due to injury or damage to the nerves or spinal cord).
Examples: Neurontin (gabapentin - also used to prevent seizures), Lyrica, and Cymbalta (used for nerve pain, fibromyalgia, as well as depression)
Topical medications (patches, creams)
Some of these can be helpful when the pain is localized to a small area. One advantage is a lower risk of side effects than when pills are administered to the whole body.
Migraine medications
Some newer, very effective medications are available to treat migraines. They specifically act on the migraine mechanism and usually don't have the drawbacks associated with painkillers. However, in some patients with very frequent headaches, medication may actually be part of the problem.
The regular use of medication to relieve the pain of headache can result in “rebound headache” with increasing frequency of headache episodes. In such cases, the answer may lie in modification of lifestyle and dietary habits as well as other preventative measures. These measures may be daily medication to modify the migraine propensity, acupuncture, or Botox®.
Vitamins, supplements, and herbal medications
Some of these have a beneficial effect on migraines and a few other pain conditions. In most cases, the effect is not very strong.
Some nutritional deficiencies can result in neurological or neuropathy conditions. Large doses of some supplements can have side effects.
Some vitamins and herbal medications can interact with prescription medications, so always inform your doctor if you are taking any of these.
