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Pharmacotherapy - Common Medications prescribed for your pain

Many different drugs, both prescribed and non prescribed are used to treat chronic pain. All these medicines can cause side effects and should be taken exactly as they are prescribed. In some cases, it may take several weeks before pain reduction can be felt. It is important to let your health professional know all the medicines you are taking (including herbal and other complementary medicines);to avoid dangerous drug interactions

Medication: Anti-inflammatory (NSAIDS)

NSAIDS such as Diclofenac or Naprosyn relieve swelling, aches and pain. They also relieve pain by effectively stopping tissue inflammation. Celecoxib and Etirocoxib are the latest generation of anti-inflammatory with better side effects profile.

What to watch out for:

• The most common side effects of NSAIDs are stomach upset, heartburn, ulcers, and skin rashes. Taking NSAIDs with food may help prevent some of these problems. Your chances of having these side effects are greater if you take large doses of NSAIDs or for a prolonged period. Celecoxib and Etirocoxib have marked reduced gastric irritation
• High blood pressure
• Swelling of legs

Drug interactions: before you start NSAIDS, be sure if your doctor knows if you are taking any of the following class of drugs:

• Blood thinners, such as warfarin, heparin, or aspirin
• Medicine to treat kidney impairment
• Medicine to decrease swelling
• Medicine for arthritis or diabetes

Medication: Antidepressants

Antidepressants such as Amitriptyline, Lexapro or Trazadone can be used to treat your pain, relax muscle and improve sleep. They are prescribed because they increase the level of serotonin in the brain and central nervous system. When utilized for such purposes, antidepressants are not used to treat depression. Besides, treatment of depression requires a much higher dosage.

Common side effects include:

• Constipation
• Dry mouth
• Blurred vision
• Drowsiness and or Fatigue
• Palpitation and or nervousness

Medication: Anticonvulsants

You may have been prescribed Anticonvulsants such as Carbamazepine, Gabapentin or Pregabalin. Indications for its use in pain include the reduction in pain signals (glutamate) transmission; stabilization of overly excited nerves and consequently reducing the amount of pain signals to the brain. The dosage used in treatment of pain is far lower than that required to treat fits or seizures.

What to watch out for:

• Common but temporary side effects may include dizziness, drowsiness, headache, skin rash, fatigue, nausea, vomiting and or loss of appetite. Inform your doctor if you experience any of them
• Do not abruptly stop taking an anticonvulsant. Your health professional will slowly reduce the dosage of this medicine so that you won't develop withdrawal symptoms such as anxiety, nausea, pain, sweating, and insomnia

Medication: Opioids

Opioids such as Oxycodone, Morphine or Fentanyl are used in chronic refractory pain by blocking the pain signals in the central nervous system. It is not reserved only for cancer pain but also for moderate to severe pain as well. The fear of addictions and dependence is unfounded when used under your pain specialist supervision; addiction or drug-dependencies are minimal or negligible.

Mode of delivery:

• Oral: The oral route is the most common, least invasive and the easiest route. All opioids given orally are absorbed via the stomach and intestines and then transported to the liver where they undergo "first-pass metabolism" before entering systemic circulation. Oxycontin is a long acting drug while Oxycodone is fast acting drug used for breakthrough pain
• Transdermal patch: Provides round-the-clock systemic delivery of Fentanyl analgesic for 72 hours. The patch should be applied on intact skin. Apply patch by pressing it firmly in place and held on for a minimum of 30 seconds to ensure adherence
• Intrathecal infusion: Provides round-the-clock delivery of analgesic in the spinal cord, thus allowing higher concentration of medication with minimum systemic side effects and consequently decreasing the total opioid daily dose significantly

What to watch out for:

Opioids may often cause side effects such as:

• Constipation
• Weakness
• Dry mouth
• Sedation
• Difficulty urinating

In some cases, more than one type of opioid medicine may be prescribed to relieve pain without increasing the individual dose. Many combinations of opioids with nonopioids have been effective, such as combining opioids with NSAIDS.

You may become physically dependent on opioids if you take them regularly. Physical dependence is not addiction, but rather a gradual change in your body in response to the opioids. If you stop taking opioids abruptly, you may develop nausea, sweating, chills, diarrhea, and tremors. The physical dependence and withdrawal symptoms are non life-threatening. You can avoid withdrawal symptoms if you gradually reduce opioids consumption over a set period of time, as prescribed by your pain specialist.

In the past, opioids were used only for short periods for short-term pain or for cancer pain. Many experts now use opioids for longer periods to treat chronic pain, resulting in increased functional capabilities, and better quality of life. If you are about to begin a long-term course of opioids, increase your dietary fiber and water consumption to prevent constipation. Discuss with your pain specialist should you require a stool softener or laxative.