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Medication

Many Chronic Pain conditions respond well to medication. Combination therapy of two or more drugs may allow improved pain control at lower total doses. This often reduces the risk of associated side effects.

A small number of drugs used to treat Chronic Pain are prescribed 'off licence', that is the pharmaceutical company does not licence their use in such pain conditions. However, their use is widely supported in Pain Clinics in the UK, Europe and America.

Medication can be swallowed as a tablet, dissolved under the tongue or be administered transdermally as a patch, plaster or cream applied to the skin. The following classes of medication may be considered:

  • Opioid
  • Non -steroidal anti-inflammatory
  • Anti-depressant
  • Anti-epileptic
  • Benzodiazepine
  • Muscle relaxant
  • Topical medication


 

a) Opioids: are first line analgesia for many pain conditions. Sustained release preparations reduce the numbers of doses. Examples include codeine, morphine, buprenorphine, oxycodone and fentanyl.

Side effects can be controlled with appropriate dosage and attention to symptoms such as constipation. Patients on long term treatment should be reviewed regularly to reduce any potential adverse effects.

b) Non-Steroidal Anti-inflammatories( NSAID's): are used in combination with opioids and reduce the inflammatory component of Chronic Pain. Examples include ibuprofen, naproxen, diclofenac, meloxicam and celecoxib.

Patients with gastrointestinal, asthmatic and kidney complaints should be carefully assessed prior to considering such treatment.

c) Anti-depressants: Why prescribe anti-depressant medication for pain? Neuropathic (nerve) Pain is due to a complex dysfunction within the nerves. Nerve pain is poorly controlled by opioids and NSAID's. Fortunately, anti-depressants can reduce the abnormal nerve dysfunction.Examples include amitriptyline, imipramine, prothiaden, fluoxetine, duloxetine and venlafaxine.

Side effects can be controlled with appropriate dosage and attention to timing of medication. However, some patients may experience dry mouth and bowel changes.

d) Anti-epileptics: Why prescribe anti-epileptic medication for pain? Neuropathic (nerve) Pain is due to a complex dysfunction within the nerves. Anti-epileptics can reduce the abnormal hyper-excitable state within nerves that may cause neuropathic pain. Examples include carbamazepine, topiramide, gabapentin, pregabalin and lamotrigine.

Side effects can be controlled with appropriate dosage, or when used in combination. However, some patients may experience drowsiness and bowel changes.

e) Benzodiazepines, such as clonazepine, may be prescribed for nerve pain and muscle relaxation.

f) Topical medication: some neuropathic pains may respond to the application of medication directly to the skin. Examples include capsaicin ointment, lidocaine plasters and NSAID cream.

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