Drug Treatment For Chronic Pain

Medication is the most common choice of treatment for chronic pain in the United States. Drugs treat the symptoms rather than the cause of pain, and therefore offer a short-term solution. Side effects, drug interactions and overdose are potential concerns when using medication for pain management.

OPIATES: Opiates (also called narcotics) are drugs derived from the opium poppy and have been used since the days of ancient Rome. Opiates such as morphine effectively reduce pain by mimicking the body’s endorphins — natural painkillers produced in the brain. Controversy surrounds the use of opiates in treating chronic pain for many reasons, one of which is the potential for misuse and addiction, strict federal regulations, and potentially dangerous side effects.

Recent data disputes tightly held beliefs about the addictive nature of narcotics in the general population. In his research David Jorenson, MSSW, Director of the Pain and Policy Studies Group at the University of Wisconsin Medical School in Madison, found the rate of narcotic abuse was unchanged despite a significant increase in the amount of opioids prescribed by doctors in the United States from 1990-1996.

Although beliefs about using opioids for pain management are changing, many pain experts feel that these drugs are underused and patients are suffering unnecessarily. As Russell Portenoy, M.D., points out, “There are a tremendous number of barriers to physicians prescribing and patients using narcotics such as fear of federal regulation and chemical dependency.”

B. Eliot Cole, M.D., M.P.A., says, “The biggest trend in medical management of chronic pain is the movement toward earlier introduction and use of opioid medications. There is new evidence that says opioids are not as dangerous as we thought.” Mike Royal, M.D., Medical Director of the Pain Evaluation and Treatment Center in Tulsa agrees and adds, “If people take medications for the treatment of pain, not for psychological reasons, the likelihood of addiction is very, very small. People should not be afraid of getting addicted if they are taking the appropriate drug.”

NON-STEROIDAL ANTI-INFLAMMATORY MEDICATIONS: NSAIDs like aspirin, ibuprofen and naproxen are used to treat a variety of conditions including muscle pain, tension headaches, and osteoarthritis. Injury causes a release of chemicals into the body (called prostaglandins) that make nerve fibers more irritable and can increase the experience of pain. NSAIDs interfere with the production of prostaglandins and reduce the feeling of pain. Side effects of long-term NSAID use include stomach, kidney and liver problems.

In 1999 the FDA approved two new NSAIDs that inhibit COX-2, an enzyme that plays an important role in pain and inflammation. Studies showed Celebrex and Vioxx are as effective as other NSAIDs in reducing pain, but do not cause gastrointestinal side effects like peptic ulcers.

STEROIDS: Steroids are hormones that reduce pain by blocking the synthesis of prostaglandins. Experts say they are the best anti-inflammatory medication, but many people cannot tolerate the associated side effects including decreased immune system function, osteoporosis and psychosis.

ANTIDEPRESSANTS: Antidepressants such as tricyclic antidepressants (TCA) and selective serotonin reuptake inhibitors (SSRIs) are effective in treating some types of chronic pain. These drugs increase the level of neurotransmitters (serotonin and norepinephrine) in the body, which cause the release of endorphins.10

ANTICONVULSANTS: Anticonvulsants such as Neurontin and Tegretol are used to control seizures and can help treat severe muscle pain. They work by stopping the abnormal electrical discharges in damaged nerves that causes neuralgia, peripheral neuropathy and phantom limb pain.

MUSCLE RELAXANTS: Muscle relaxants help to calm muscle spasms by sedating the central nervous system. These drugs are especially useful for the short-term treatment of back and neck pain.

TRIPTANS: The FDA recently approved a new family of drugs called triptans for the treatment of migraine headaches. These drugs have revolutionized the treatment of migraine headaches by significantly reducing the associated pain and nausea.

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