Category Archives: Pain Issues

Chronic Pain: What are the treatments of choice?







Chronic pain treatment overview: 

Chronic pain treatment comes in many forms.  If the pain is of an inflammatory or musculoskeletal origin, it can often be treated successfully with analgesics such as nonsteroidal anti-inflammatory drugs (NSAID’s), or opiates, possibly in combination with physical therapy or corrective surgery.  Some specific chronic pain treatment regimens have been developed to relieve the pain of rheumatoid arthritis for example, an autoimmune inflammatory disorder, and severe osteoarthritis, a musculoskeletal disorder, which also results in some inflammation.  Neuropathic pain usually requires its own unique chronic pain treatment regimen. The following medications are primarily used to treat neuropathic pain:
 



Tricyclic antidepressants such as desipramine (Norpramin) and nortriptyline (Pamelor) can relieve neuropathic pain such as that caused by trigeminal neuralgia and postherpetic neuralgia.  These antidepressants have been found to be effective even in the absence of any depression.  It is believed that the neurotransmitters norepinephrine and serotonin may have an important role in the control of pain pathways in that the antidepressants evidently relieve pain by boosting the levels of both serotonin and norepinephrine.  Also, contemporary research indicates that antidepressants can also enhance the pain relieving effects of opiates which then allows lower dosages to be used. 

Antiseizure drugs are believed to reduce the pain signals which are discharged from injured sensory nerves in patients with neuropathic pain. Gabapentin (Neurontin) and lamotrigine (Lamictal) have proven effective in alleviating the pain associated with diabetic neuropathy, postherpetic neuralgia and trigeminal neuralgia. 

Opioids such as oxycodone (OxyContin), fentanyl (Duragesic), or morphine (MS Contin) are also frequently used for neuropathic pain, often in combination with antidepressants or antiseizure drugs. Opioids have significant side effects and may cause drowsiness, respiratory depression, nausea and constipation. When they are given in combination with antidepressants or antiseizure drugs, their dosage can be lowered and the potential side effects may be minimized. 

Many people are very aware of the potential for the abuse of opioid medications.  Despite the potential for abuse, drug addiction is relatively rare among patients receiving chronic pain treatment. It is believed that the addiction rate is less than 1% in people without a previous history of addiction.  This addiction potential is probably relatively limited in such chronic pain treatment patients; because the opiates provide relief from pain in a form that supplies a steady release of medication throughout the day and does not really produce the euphoric effect that addicted individuals prefer.

Some information from The Johns Hopkins Medical Guide to Health After 50 

Additional Information and webpage by Paul Susic Ph.D. Licensed Psychologist