Treatment of pain includes both drugs and nondrug methods. Treatment depends on the type and duration of pain, and is best decided by a physician.
Medications for pain
- Acetaminophen: Acetaminophen is often used to treat pain. It does not have anti-inflammatory effects. Some cases of chronic pain, have no inflammation at the site of the pain, and thus acetaminophen may be an appropriate treatment choice. It is a safe drug when used appropriately, but can have serious adverse effects when used excessively.
- Non-Steroidal Anti-Inflammatory Medications (NSAIDs): The NSAIDs (such as ibuprofen, naproxen, diclofenac, and aspirin) are very effective in cases of acute pain, and in some cases of flare-ups in patients with chronic pain. NSAIDs are effective in treatment of inflammatory conditions such as tendonitis, bursitis, and arthritis. Prolonged use of NSAIDs should be avoided as these drugs can cause digestive upset, ulcers, and gastrointestinal bleeding. In some patients they can make asthma worse, increase blood pressure and interfere with clotting of blood. The new COX-2 inhibitors, such as Celecoxib are as effective as other NSAIDs in decreasing pain and inflammation and are less likely to cause digestive upset, nausea, bloating, heartburn, bleeding, and peptic ulcers. They are less likely to interfere with clotting as compared to other NSAIDs.
- Corticosteroids: Corticosteroids have good anti-inflammatory effect and are most effective for treatment of acute pain or for flare-ups of a chronic inflammatory problem. These drugs can be prescribed as an oral medication (Prednisone), or injected into the soft tissues or joints (cortisone injections). Long term use of corticosteroids is avoided as they are associated with several side effects some of which can be severe.
- Narcotics: Narcotic analgesics (such as morphine, codeine, Oxycodone, Meperidine, Hydromorphone, Pentazocine) for pain relief should be considered if pain cannot be otherwise controlled. These medications are very effective but are associated with several side effects and can cause dependence as well. Short acting narcotics are useful for acute pain, but can lead to overuse and the development of tolerance. Long-acting options have fewer side effects, and more effectively control chronic pain.
Adjuvant analgesics are drugs that are not primarily meant for use in pain relief but may relieve pain in some circumstances. They are usually used in combination with other analgesics or nondrug pain treatments. The adjuvant analgesics most commonly used for treatment of pain are antidepressants (such as amitriptyline, bupropion, desipramine, fluoxetine, and venlafaxine), anticonvulsants (such as gabapentin and pregabalin) and oral and topical local anesthetics.
- Antidepressants: Antidepressants are often beneficial in treatment of chronic pain. Tricyclic antidepressants (such as amitriptyline and nortriptyline) are probably more effective for relieving pain than other antidepressants. Newer antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and selective serotonin and norepinephrine reuptake inhibitors (SSNRIs, such as duloxetine) are also well tolerated. The antidepressants may help you sleep, which can make you feel healthier.
- Anticonvulsants: Antiepileptic drugs (such as gabapentin, carbamazepine, pregabalin) are often beneficial in relieving nerve pain. Pregabalin is specifically used for the treatment of pain in fibromyalgia. These drugs can slow or prevent uncontrolled pain signals. Gabapentin and pregabalin is used most often, but others, anti-convulsants such as carbamazepine, clonazepam, divalproex, lamotrigine, oxcarbazepine,...
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