Pain medicine is a multi-disciplinary approach that incorporates modalities from various specialties to ensure a comprehensive evaluation and treatment of the pain patient. Pain can be very challenging to treat. Our Pain Management Specialists at Virginia Spine Institute have sophisticated new treatments to provide pain relief. Advances continue to emerge as researchers and clinicians gain a greater understanding about the origin, mechanism, and perception of pain.
This general pain reliever and fever reducer is a common medication found in a variety of over-the-counter (OTC) medications for a variety of illnesses. For pain relief, it works by elevating the body’s overall pain threshold so you feel less pain. This is a safe and effective medication when taken as directed. This medicine is typically taken 2-3 times per day as needed for pain. The maximum daily dose is 3000mg/day. If you exceed this daily dose, you are at risk for developing liver problems. Be sure to read all of your medication labels, as acetaminophen can be found in multiple OTC medications.
NSAIDs, or non-steroidal anti-inflammatory drugs, are a class of medication that works on the inflammatory pain pathways. There are many OTC and prescription NSAIDs including ibuprofen, aspirin, naproxen, meloxicam, diclofenac, celecoxib, and ketorolac. Dosing is dependent on which medication you are taking and these drugs are taken once to three times daily. You should not mix multiple different kinds of NSAIDs due to the risks of increased side effects. NSAIDs can cause increased stomach acid and heartburn, stomach ulcers and GI bleeding, elevated blood pressure, and kidney problems. These need to be monitored closely by your physician and potentially avoided if you have these underlying conditions.
Corticosteroids are chemicals produced naturally in your body. They are powerful anti-inflammatories that can help reduce pain and swelling. The mechanism of action is at the cellular level. It appears that steroids bind to certain proteins that regulate certain cellular functions, including inhibiting certain pro-inflammatory molecules. In addition to inflammation, steroids affect a wide variety of body functions, which is where most of the side effects come from. Steroids can suppress the immune system, making it harder to fight infections. They raise blood sugar, interfere with bone metabolism and bone density, and thin skin. Steroid can alter your adrenal access and interact with other hormones. They can make you feel very energetic, hungry, and keep you from sleeping. Many of these side effects can be temporary but must be considered before starting this medication.
These medications are designed to help reduce muscle tension and spasms. The most commonly used prescriptions are cyclobenzaprine, methocarbamol, tizanidine, metaxalone, and baclofen. Each of these medications work slightly differently from each other, but all dampen the excitability of the central nervous system, allowing the muscles to relax. These medications are best used in the acute pain setting. Several side effects are possible with the use of skeletal muscle relaxants, including but not limited to drowsiness, dizziness or lightheadedness, headache, fatigue, and gait disturbances. In patients who have liver, kidney, and/or heart problems, these drugs must be used with caution.
There are many different classes of nerve medications. Gabapentin and pregabalin are the two most common nerve pain medicines used. These work by stabilizing nerve membranes to make them less excitable and painful. The most common side effects are drowsiness, dizziness, and fatigue. Other nerve pain medications include medicines from the antidepressant class like duloxetine, amitriptyline, and topiramate. These medications act on the neurotransmitters that are used in nerve communication. By upregulating or down regulating certain neurochemicals, pain fibers can be modulated and pain is reduced.
Opioid analgesics are important medications in the treatment of severe pain. They originally came from the poppy plant but now are also produced synthetically in labs. Commonly prescribed opiates are Vicodin, Percocet, OxyContin, Oxycodone, Methadone, Morphine, Opana, Dilaudud, and Fentanyl among others. These medications work by binding to pain receptors in the body to block the transmission of pain signals. While opiates are highly effective medicines, they can also be dangerous if used incorrectly or used for too long. They are highly addictive substances, even when monitored and prescribed by your physicians. Commonly, patients will build tolerances to the medications, leading to increasing doses to achieve the same level of pain relief. Common side effects of opiate use include constipation, dry mouth, sedation, dizziness, nausea, and vomiting. Less common side effects include dramatically worsening pain (opiate-induced hyperalgesia), depressed immune system and hormonal dysfunction, muscle rigidity, and myoclonus. If too much opiate medication is consumed, overdose and death can occur. Signs of overdose include difficulty breathing, faint pulses, pale and clammy skin, blue lips, fingers, or toes, or becoming very sedated or unresponsive. Side effects and overdose risks increase if mixed with other substances like alcohol or benzodiazepines. Often your doctor will co-prescribe the rescue medication naloxone to reverse the effects of the opiates should overdose occur. For these reasons, opiates should only be prescribed in very specific circumstances and be closely monitored.
Medications are usually the first line of treatment for both acute and chronic pain. All pain is not equal. There are different types of pain; some examples include somatic or neuropathic pain and central or peripheral pain. These types of pain can respond to different medications. Finding the most effective medications for your specific pain may be a trial and error process due to individual sensitivities and life exposures. There is no one best drug for everyone. Different drugs and drug combinations will be tried until you achieve effective pain relief with minimal side effects.
Dr. Niteesh Bharara
Orthopedic Specialist - Non-Surgical Sports Medicine
Director of Regenerative Medicine
Reviewed by: Dr. Christopher Good, MD, FACS.