This article is one in a series on Medications for Pain… what are your choices? how do various medications work? what are the pros and cons? how about side effects? (Discuss these ideas with your doctor. Don’t make any changes to your treatment by yourself.)
This class of medication is called NSAIDS, Non-Steroidal Anti-Inflammatory Drugs. The 3 types of medication in this class are:
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Aspirin
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“Non-selective” cox inhibitors, e.g. Motrin (Ibuprophen). (The “cox” simply relates to an enzyme in our bodies involved in inflammation.)
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“Selective” cox-2 inhibitors, e.g. Celebrex
Effect of NSAIDS: NSAIDS block inflammation from occurring, and thus stop the pain that’s caused by inflammation.
Uses of NSAIDS: Because NSAIDS block inflammation, they’re helpful in disorders that have inflammation, such as arthritis and some types of back pain. They don’t help in pain disorders that don’t have inflammation, such as fibromyalgia.
Side Effects:
- Bleeding
- Stomach upset
- Asthma (in 10% of people)
- Kidney problems
- Cox-2 medications increase clotting, which can cause heart attacks and stroke. This is why some of these medications have been taken off the market.
- Liver toxicity above recommended doses
While these medications can be helpful, don’t eat them like candy. They’re not benign! Many people don’t recognize this, as they’re sold over the counter, and so are assumed to be perfectly safe.
Interesting fact: In studies, there are no differences in effectiveness between 1 medication in a class and another. Therefore generic aspirin is just as good as Bayer.
Next Monday, we’ll review Anticonvulsants. Other articles in this series:
- Medication 101: What Are My Options For Pain Treatment?
- Anticonvulsants
- Antidepressants
- Anesthetics
- Ketamine
- Muscle Relaxants
- Blood Pressure Medication
- Anti-Psychotics
- Narcotics (Opiates)
- Medication Advances Coming Soon
- Research Advances
Thanks to Canardo at Flickr for the photo.
2 responses so far ↓
Maryanne // Aug 18, 2008 at 7:28 pm
Hi, I am 78 years old, have had 4 back surgeries,two of them spinal fusions and I have arthritis. I now take neurontin,percocet,valium ( at night only) and celebrex. My doctor prescribed nortriptyline recently . I started at 10mg , then increased to 20mg.When I increased, I had many problems, but my pain was much relieved. I felt out of body, no ambition,lazy,etc. Last night I went back to 10mg and I will probably go off it. I have tried just about all the anti-depressents and they make me dizzy, etc. Am I taking too many medications to add these drugs ? My age might be a factor. Please reply. Thanks, Maryanne
How to Cope with Pain // Aug 19, 2008 at 11:51 am
Maryanne, thanks for your questions. As you know, I can’t give individual people medical advice, but I can make some general comments about your situation.
Tricyclic antidepressants (TCA’s) like nortriptyline often have more side effects than newer antidepressants like Prozac. However, TCA’s are more effective for most types of pain. However, the good news if that many people get benefit from TCA’s as low doses such as those you’re using, so can sometimes use low doses and get benefit before getting too many side effects.
Older people and those on other medications in addition to the TCA often get more side effects.
Some suggestions to discuss with your doctor:
1. You might see if a slower increase in dose lets your body get adjusted to the medication, and if side effects subside with time.
2. If you find that you can only tolerate 10 mg, you might find that even at this dose you get at least some benefits. Sometime even a little does something for you.
3. Sometimes slowly or slightly decreasing other medication when you add a TCA overall gives you a better balance between benefit and side effects. (Again, make sure to discuss with your physician before doing this.)
4. While nortriptyline is a TCA usually with fewer side effects, it might be worthwhile to try other low-dose TCA’s to see if you can tolerate another one better. Or, trying a newer medication formulated like the TCA’s but with often less side effects might be another option.
Good luck, and certainly give your doctor feedback about this experience, so she/he can discuss other options with you.
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