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Medication for Pain Series

April 14th, 2014 · No Comments

This is a series about medications for pain. For each medication class, we’ll cover:

  • what are your choices?
  • how do various medications work?
  • what are the pros and cons of different types of medication?
  • how about side effects?

I hope this information will be helpful to you, both to better understand the current medications you’re on, as well as learning about options to consider with your pain management physician. As always when I discuss medication or any treatment, discuss these ideas with your doctor. Don’t make any changes to your treatment by yourself. These articles are intended as information only, and not as medical advice (see my disclaimer).

These are the medications and topics we’ll cover during this series:

  1. NSAIDS (Non-steroidal anti-inflammatory drugs)
  2. Anticonvulsants
  3. Antidepressants
  4. Anesthetics
  5. NMDA receptor antagonists (e.g. Ketamine)
  6. Muscle relaxants
  7. Blood Pressure Medication
  8. Anti-Psychotics
  9. Opiates (Narcotics)
  10. Medication Advances Coming Soon
  11. Research Advances

Some general points about medication:

1. Medication is part of comprehensive treatment

When I work with patients with pain, I talk about the many aspects of pain treatment. These include:

  • treating the underlying medical problem
  • decreasing pain sensations
  • coping with remaining pain
  • living life despite pain

Medication can treat the underlying medical problem, decrease pain sensations, or both.

2. A comprehensive treatment plan may include:

  • other medical treatments like injections, infusions, and spinal cord stimulators
  • psychological treatment including relaxation, guided imagery, and visualization
  • physical therapy, including treatments, TENS, and pacing of activities
  • family support
  • evaluation and treatment of psychiatric problems that pain may cause, for example, depression or anxiety
  • work to increase functioning, in whatever ways are meaningful and possible

Most often to get a good result, you have to focus on all parts of comprehensive treatment, not just hope medication does it all.

3. What is your goal?

For many people, medication isn’t curative, nor does it reduce pain to zero. But that doesn’t mean it’s not helpful. The goal of pain treatment is to reduce pain as much as possible AND to function as fully as possible. Don’t lose sight of the second because of only focusing on getting rid of pain. And don’t wait for pain to get to zero before figuring out how to live life despite pain.

4. Medication treatment is an art as well as a science

We know some things about medications, but there’s a lot we don’t know! For many of the medications we use, or use in combination with others, we don’t know enough about what types of pain they’re best for, what combinations work best for what types of pain, etc. FDA approval of a medication for a certain disease is the best level of assurance that a medication might work well for you. Unfortunately, many of the medications we use aren’t FDA approved – we’re just not there yet in our research. That doesn’t mean they’re not good – we just don’t know for sure.

The second best level is when there’s some research and a lot of clinical experience, but just not FDA approval. After that comes medication that a physician has some experience with, but a lot is still unknown. Obviously the farther you get away from FDA approval, the more you have to weigh the possible risks with benefits.

Combination treatment – using multiple medications at one time – also has varying degrees of research backing it up. Unfortunately again, it’s mostly on the “little research” end. But that’s beginning to change – there are more and more studies looking at combination treatment. So we’re getting somewhere!

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