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Medication Management
MEDICATIONS
A variety of medications are now in the quiver of the pain
specialist. The pain physician can now target specific receptors
in the nervous system, and either stimulate or inhibit those
receptors as is necessary to control the patient’s symptoms.
Medications can be used alone or in combination to either
diagnose or treat a variety of conditions. These drugs are
usually used in a continuum which starts with the weakest
medication with the lowest number of side effects. Depending
on the effect, the physician advances to stronger medications
with potentially more side effects or problems. The categories
of medications which can be used are listed below with some
examples from each group. This list is not intended to be
totally inclusive.
1. OPIOID ANALGESICS- This
group of medications can be very useful in some types of
pain and not so helpful in others. The weaker opioids include
codeine, propoxyphene, and the stronger ones include morphine,
oxycontin, and fentanyl. These medications can be given
via a variety of routes and dosages.
2. NON-OPIOID ANALGESICS-
This group of medications include salicylates like aspirin,
the non-steroidal anti-inflammatories or NSAIDS, acetaminophen
or Tylenol, and newer medications like tramadol or Ultram.
These can be used in combination or alone.
3. ANTI-DEPRESSANTS- Depression
is indeed a problem with chronic pain. However, these medications
help increase certain natural chemicals in the nervous system
such as serotonin and norepinephrine. These chemicals have
been shown to decrease pain signals that start at the spinal
cord level. This added affect make this group of medications
very valuable in the fight against chronic pain. Examples
include: Elavil, Serzone, Paxil, Prozac, Zoloft, Effexor,
Remeron, Norpramin, and many others.
4. ANTI-SEIZURE- The same
drugs that decrease firing potentials in the central nervous
system, have the same effects in the peripheral nervous
system. Injured nerves can exhibit firing activity which
is abnormal, but can be controlled or decreased by this
group of medications. Examples include: gabapentin or Neurontin,
Tegretol, Dilantin, or Depakote.
5. MUSCLE RELAXERS- These
can work centrally or peripherally to relax muscles, which
many times spasm due to direct injury, or as a reaction
to nerve tissue irritability. They can be very effective
in some cases, but can cause sleepiness or sedation. Examples
include: Robaxin, Parafon Forte, Flexeril, Soma, or Baclofen.
6. ANTI-ANXIETY- In many
cases anxiety can worsen pain and make the patient more
miserable than is necessary. A medication which helps the
patient relax can improve sleep, muscle spasm, and decrease
the perception of painful stimuli. Examples include: Valium,
Xanax, Ativan, and Buspar.
7. BLOOD PRESSURE/HEART MEDS-
This group of medications which are normally used to control
hypertension, can also be used to control abnormalities
of the autonomic nervous system. The sympathetic nerves
can malfunction in some pain syndromes and worsen some types
of pain. Examples include: clonidine, Vasotec, propranolol,
and many others.
8. LOCAL ANESTHETICS- This
group can be injected into tissue at specific locations
for diagnosis or treatment. A short-acting local anesthetic,
such as lidocaine, can be injected intravenously, as a test
of certain pain receptors. An oral medication, mexilitene,
can be given orally if the intravenous dose is effective.
Longer acting local anesthetics are being developed for
the future, so that a single injection might give months
of relief. Examples include: Xylocaine, bupivicaine, Tetracaine.
9. STEROIDS- This group
of very potent anti-inflammatories can decrease tissue swelling,
and decrease firing of damaged nerve tissue. These medications
can be injected directly into tissues such as into the epidural
space, joints, trigger points, and other inflamed tissues.
In addition, a short burst of oral steroids can be given
to attempt to relieve painful symptoms. This group of medications
can cause significant problems, or side effects if used
excessively or inappropriately. Examples include: prednisone,
methylprednisolone, triamcinolone, and dexamethosone.
10. SLEEP MEDICATIONS-
Pain is always worse when a patient is sleepless,
and thus, exhausted. The anti-depressants can also be used
to induce sleep, if dosed properly. In some patients the
use of a mild sleep aid can be helpful if used for short
periods of time. Examples: Halcion, Ambien, Dalmane, and
Restoril. Our pain specialists are trained to use all of
the medications available for diagnosis, treatment, or control
of the patient’s pain. The patient should expect a thorough
discussion of each medication prescribed, the effect expected,
side effects, and possible problems or adverse reactions.
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