Pain Management: Drugs

What medications are subscribed for neuropathic pain?

Typical medications that are prescribed for neuropathic pain are either in the class of anti-seizure medications or antidepressant medications. The reason these medications are used to treat neuropathic pain is because they work. They don't work for everyone, and we often have to try a lot of different medications to find the right one for that particular person. In prescribing them for neuropathic pain, they are in off-label use and they are not being used for the purpose they were manufactured for. As a result we don't have as delineated a treatment plan.

What are "nonsteroidal anti inflammatory drugs"?

The nonsteroidal anti-inflammatories are things like Aspirin and Ibuprofen, and they're used to reduce prostaglandins in the body, which are pain mediators and inflammatory mediators. They block this action, and they will reduce pain, inflammation, and oedema.

Are nonsteroidal anti inflammatory drugs recommended as treatment for chronic pain?

The positive side of using nonsteroidal anti-inflammatory drugs for chronic pain is that if a person has a low level of inflammation, and they take an anti inflammatory every day, they may be more functional, they may be in less pain, and they may be happier; all the obvious things that you would get from medication. However, on the other hand, we've already had studies out regarding using nonsteroidal anti-inflammatory drugs for chronic pain which show that there is actually more joint destruction from using them. We're also finding now that nonsteroidal anti-inflammatory use for chronic pain actually blocks the bio-synthesis of cartilage. I think also that there's another reason for more joint destruction if you're using nonsteroidal anti-inflammatory drugs: if you have less pain and you have a damaged joint, you may have osteoarthritis for example, you're going to use that joint more when the pain is really there as a signal to help you slow down; to look at it and see whether you really should be doing that with yourself.

What are "narcotics"?

Narcotics are medications that hit server receptors in the brain that create endorphins, which make us feel very good. There are people that sometimes come out of surgery and they'll have a morphine injection, and they'll know there's pain there, but it actually feels good. It's an amazing type of drug. It's very akin to what heroin is for drug addicts.

Are narcotics safe and effective for managing chronic pain?

Narcotics are excellent to get the patient over that hard spot when they've had a new injury and they're in a lot of pain. I don't like seeing people take narcotics for chronic pain, because they're not going to heal them; they're going to move into more of a depressive state, they're going to be more sedated, they're going to get addicted, and they're going to get constipated. We have so many side-effects from narcotics that are negative, and narcotics just don't really do the job of getting a person better.

What are the drawbacks to using short acting medications like Percocet Vicodin and morphine for chronic pain?

There are many forms of short-acting medications for chronic pain. The good news is they're short-acting, so they're out of your system fairly quickly. But the bad news is their onset is so quick that you get a little bit of a rush or euphoria from them. And the shorter acting a medication is like that, the more addictive potential it has. So if someone is taking Zanax for panic attacks, for pain or for relaxation, there's a high probability, if they're taking it regularly, that they're going to be addicted very quickly to that medication. Methadone on the other hand, may have some addictive potential but it has an extremely long half-life to it, and a person doesn't usually get the euphoric feeling when they first take it. Again if a person is injected or has an IV of something like morphine, they're not going to feel any pain, and they're going to have an addictive potential that is extremely high.

Are long-acting opioids like Methadone Oxycodone and Fentanyl effective treatments for chronic pain?

There's quite a bit of disparity among doctors as to whether or not to use very long-acting analgesic medications; pain medications. The reason for that is that some doctors are afraid of the addiction potential, whereas other doctors feel that you have to get hold of the pain and grab it before it really rises up its ugly head and then forces a person to take these more short-acting types of medications. When patients take these short-acting medications, they'll have an immediate decrease in pain and then when it wears off quickly, they're going to have a spike and then they're going to reach for more short acting pain medications (analgesics) that will force them into an addictive cycle of using these medications.

Is there a danger of addiction when using narcotic medicine for pain?

As with any type of narcotic medication that a person gets pain relief from, the more addictive ones are the ones that have a quick onset, the ones that they get the rush from and get the pain relief from immediately. They're going to want to reach immediately for that when they're experiencing chronic pain, and if it's not there, they're going to have a withdrawal immediately. And one of the other problems with using long-term narcotics is a person becomes what we call tachy-phylactic, or tolerant to the medication, meaning that they need more and more to get the same relief they were getting from the orginial, smaller doses.

Why do I sometimes need to increase the dose of pain medication to get the same effect?

The question always arises, why do you need to take more and more of the same medication that used to work before? Now you are taking five times as much. But the answer is very simple. We have receptors in the body and in the brain that accept these chemicals, and as we take more and more of it, these receptor sites will shut down. Then we have to use more and more of the medication to fill up those receptor sites and stimulate them to have the effects that are needed.