Chronic Pain Medication Overview

READ THIS - before choosing your chronic pain medication.

Currently, most types of pain are treated with aspirin (acetylsalicylic acid), acetaminophen (Tylenol), or other non-steroidal anti-inflammatory medications such as ibuprofen (Advil or Motrin), naproxen (Aleve or Naprosyn), and ketoprofen (Actron and Orudis). These over-the-counter (OTC) medications are usually inexpensive and readily available at most grocery stores, pharmacies, and convenience stores. In most cases, the generic brands are just as effective as the pricier name brands.

These medications are often prescribed for minor aches, pains, and fevers. They rank the lowest on most pain relief charts, but carry a lower risk of serious side effects. These drugs work by adhering to an enzyme called cylooxygenase-2 that is released from damaged cells. This interferes with pain signals so that they do not reach the brain. As a result, less pain is experienced.

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All of these drugs do have some risks associated with them, so it is important to follow directions. Aspirin is not recommended for children or young adults due to the possibility of contracting Reye’s syndrome, a potentially fatal complication that has been linked to aspirin use. Acetaminophen over use and overdose is the number one cause of liver failure in the US. And, as with most medications, there is always a risk of allergic reaction.

In some cases, doctors are beginning to prescribe tricyclic and tetracyclic antidepressants, such as amitriptyline, desipramine (Norpramin), doxepin hydrochloride (Sinequan), imipramine hydrochloride (Tofranil) and nortriptyline (Pamelor). Tricyclic antidepressants work by increasing the amount of norepinephrine and serotonin (chemical substances in the brain), thereby increasing the availability of these neurotransmitters and affecting the way in which the brain perceives pain. Tetracyclic antidepressants work by preventing neurotransmitters from binding with nerve cell receptors called alpha-2 receptors and as a result, indirectly increase the levels of norepinephrine and serotonin in the brain.

Tricyclic and tetracyclic antidepressants are available by prescription only and tend to be a bit pricey. Norpramin, for example, can cost upwards of $1.20 a tablet. These types of medication must be taken at regular intervals and can take 2 to 3 weeks before offering relief. They are most often prescribed for pain associated with neuropathies. Some side effects of these medications include, bladder problems, blurred vision, constipation, dizziness, dry mouth, drowsiness, sexual impairment, and increased heart rate.

In cases of acute pain, your doctor may prescribe a stronger pain medication from the opioid family. The list of these medications is quite extensive, as it includes natural opioids, semi-synthetic opioids, fully synthetic opioids, and medications that are not actually opioids, but work by acting on opioid receptors. Use of this class of medication is carefully controlled due to tendencies to produce addiction as well as many adverse side effects.

Our bodies contain several types of opioid receptors. These are located throughout our central nervous system, our gastrointestinal system, as well as other bodily tissues. The opioid chemicals bind with these receptors resulting in a reduction in our perception of pain. This results in a higher pain tolerance and a decreased reaction to painful stimuli.

Natural opiates (that come from the opium poppy) include such drugs as morphine, codeine, and thebaine. Some of the semi-synthetic opioids are hydromorphone,  hydrocodone, oxycodone, and diacetylmorphine (heroin). The fully synthetic forms of opioids include fentanyl, pethidine, methadone, and dextropropoxyphene. 

As mentioned above, there are some medications that bind with opioid receptors but are not chemically classified as opioids. These drugs carry a lower risk of abuse due to a weak opioid effect and are not usually associated with tolerance, physical dependence or psychological addiction. An added benefit of these drugs is their affect on neurotransmitters resulting in antidepressant properties, a great advantage for the patient who is suffering with chronic forms of pain. Some of these drugs include Tramadol, Faxeladol, and Tapentadol.

Occasionally, central nervous system (CNS) depressants are used to treat certain types of pain. CNS depressants are barbiturates and work by slowing brain activity. They are generally used as sedatives, but because these drugs cause the patient to relax, pain associated with tension (such as migraines) can sometimes be relieved. However, these drugs carry a high risk of withdrawal and other severe side effects and should never be combined with other CNS depressants (like alcohol).

Fioricet and Esgic are examples of CNS depressant preparations. These medications contain butalbital (the barbiturate part of the drug), acetaminophen, and caffeine. There are variations of this type of drug which include Phrenili (caffeine free), Fiorinal (containing aspirin rather than acetaminophen), and Fiorinal with Codeine and Fioricet with Codeine. While these drugs have not been approved for use as analgesics, they are often prescribed for pain associated with muscle tension.

In addition to pharmaceutical pain treatments, patients have many other options available to them. Each case is unique and requires the coordinated efforts by the sufferer and the physician. Whether the patient prefers a medical solution or a more holistic approach to pain relief, there is sure to be some solution that can bring relief.

Topical creams. Another option for chronic pain relief is the use of topical creams. Some of these topical creams can be extremely effective and natural topical creams such as Myo-Med Cream have all natural ingredients therefore can be used as much as needed and offer no side effects whatsoever.

A better understanding of the transmittal of pain through the sensory system will lead to new and improved treatments for the various types of pain that plague the American public. Whether you are suffering from back pain, headaches, or pain associated with a chronic disorder, there is likely to be a treatment option that can help you gain some form of relief.