RE: Treating Pain With Medications

[Guest guest]

Treating Pain With Medications

Harvard Medical Review

In the past 20 years, a host of new pain medications have become available.

These new formulations give people with chronic pain more options than ever.

But all drugs can have side effects that limit how they\'re used.

Two strategies can guide your use of pain medications:

First, if you\'re taking pain medications, you\'ll want to find the lowest

dose that controls your pain. The lower the dose, the fewer and less severe

the side effects.

And second, it\'s often better to \ " stay ahead\ " of chronic pain by taking

your medication at regular intervals, rather than waiting until the pain

becomes intolerable. If the pain is predictable, as migraine pain can be,

taking your medication before the pain begins may be the best approach.

The following are among the most common drugs used for chronic pain:

Acetaminophen

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Capsaicin

Corticosteroids

Muscle Relaxants

Antidepressants

Anticonvulsants

Narcotics (Opioids)

Tramadol

Anesthetic Nerve Blocks

Acetaminophen

Example: Tylenol

Description: Acetaminophen is a safe and mild pain reliever when used in

moderation.

Side effects: If you drink alcohol regularly, high doses of acetaminophen

can cause liver damage, so be sure to tell your physician if you drink.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Examples: Aspirin, ibuprofen and naproxen

Description: NSAIDs reduce inflammation. They also relieve pain, even if

there\'s no inflammation.

Side effects: Minor side effects associated with NSAIDs are common and

include rash, nausea and heartburn; however, ulcer disease is the most

common of the serious side effects. The risk of ulcers appears to be lower

with newer NSAIDs, including celecoxib and rofecoxib.

Capsaicin

Trade name: Zostrix

Description: Capsaicin is a cream that is applied to the skin. Usually

applied sparingly three or four times each day, capsaicin is used to reduce

pain in the treated area. It is mostly used for nerve pain (neuropathy) or

arthritis (in the fingers).

Side effects: Capsaicin can cause burning sensation on the skin. Contact

with the eyes should be avoided, as it is quite irritating.

Corticosteroids

Examples: Prednisone, methylprednisolone and dexamethasone

Description: Corticosteroids are anti-inflammatory drugs. They may be taken

orally or injected directly into the site of nerve irritation or

inflammation. In some cases of chronic back or leg pain caused by spinal

stenosis, degenerative joint disease or disk disease, injecting

corticosteroids into the spine (often along with an anesthetic) can reduce

or eliminate the pain for weeks or months. Usually, no more than three

injections per year are recommended because of the risk of side effects.

Side effects: Regardless of how you take corticosteroids, the higher the

dose and the longer the therapy, the greater your risk of side effects,

including weight gain, diabetes, hypertension, facial puffiness,

osteoporosis and infection. If corticosteroids are injected, side effects

include discomfort, infection and thinning or discoloration of the skin at

the injection site, but these problems are quite rare when injections are

not frequent.

Muscle Relaxants

Examples: Cyclobenzaprine, methocarbamol and carisoprodol

Description: Muscle relaxants are particularly good for treating muscle

spasm, which contributes to many cases of back pain. These drugs may reduce

pain by acting directly on certain chemical messengers in the brain rather

than by directly relaxing muscles.

Side effects: Because muscle relaxants may act on chemical messengers in the

brain, this may explain why they also cause drowsiness.

Antidepressants

Examples: Amitriptyline, nortriptyline, desipramine and doxepin (tricyclic

antidepressants); fluoxetine (Prozac)

Description: Antidepressants likely act on chemical messengers in the brain.

By doing so, they can dull pain perception. In some cases, antidepressants

work by treating accompanying depression that is making chronic pain more

difficult to tolerate. These drugs sometimes work well even in doses too low

to treat depression.

Side effects: Side effects include dry mouth, sedation (drowsiness) and

heart rhythm disturbances.

Anticonvulsants

Examples: Carbamazepine, phenytoin and gabapentin

Description: Anticonvulsants (antiseizure medications) may be particularly

helpful for pain caused by neuropathy (nerve damage). Unlike antidepressant

drugs, which affect certain chemical messengers in the brain,

anticonvulsants also act directly on nerve tissue.

Side effects: Sedation, liver damage and blood cell changes are the most

common side effects that limit the use of anticonvulsants.

Narcotics (Opioids)

Examples: Codeine, hydrocodone, morphine and meperidine

Description: Narcotics are often used to treat severe, unrelenting pain,

such as cancer pain. They are the most powerful pain relievers available and

are generally used when other treatments have failed. Narcotics can be given

by mouth, can be injected or can be administered by a patch, which delivers

the drugs through the skin. In some cases, patients can wear a small device

that feeds a trickle of narcotics into the spinal fluid through an implanted

tube, or the painkiller can be delivered by a pump implanted directly into

the abdomen. In general, narcotics are not used alone for chronic pain. They

are often part of an approach that includes nondrug options (such as

counseling and physical therapy), as well as other nonnarcotic drugs.

Research shows that many people who do not have adequate pain relief with

narcotic analgesics are either receiving prescriptions that undertreat their

pain or are not following the recommendations for those prescriptions

because they fear side effects. For example, a recent study from the

University of California at San Francisco interviewed cancer patients in

their homes and found that fear of side effects was a major cause of

inadequate drug use. In addition, fewer than a third of patients had been

prescribed both as-needed and around-the-clock pain drugs as recommended by

current guidelines.

Side effects: Unfortunately, narcotics can cause constipation, sedation and

nausea. In susceptible persons (especially people with lung disease), these

drugs may dangerously slow breathing. They can also be addictive and may

require steadily increasing doses to remain effective; in the past, however,

the risk of addiction for people with chronic pain may have been

overestimated. Although side effects and the risk of addiction have caused

some patients and their health-care providers to shy away from using

narcotics, even when they may be the best way to treat severe pain, this

anxiety about narcotics is gradually changing. More health-care providers

are willing to prescribe these drugs when needed.

Tramadol

Trade name: Ultram

Description: Tramadol is a fairly new nonnarcotic pain reliever that acts in

a similar way on the brain as narcotics do; it also affects levels of the

chemical messenger serotonin in the brain.

Side effects: Stomach upset, an increased risk of seizures (in susceptible

persons) and harmful interactions with other drugs are the most common side

effects.

Anesthetic Nerve Blocks

Examples: Lidocaine and bupivacaine

Description: Similar to novocaine, anesthetic nerve blocks may be injected

into specific nerve bundles to interrupt pain signals before they are sent

to the brain. The relief is usually temporary but may provide information

that can lead to better treatment; if the nerve block works, for example, a

second injection in the same area with a chemical that damages the involved

nerve can block the signals and provide longer relief.

Side effects: Side effects may include nerve damage and infection.

Judy/Atlanta

The Ehlers Danlos National Foundation

<a href='http://www.ednf.org'>www.ednf.org</a>