Medicines

Because of the complexity of chronic pain you may have tried many different types of medicine. Medication is just one tool which is used to help people to deal with persistent pain, and for some people it suits them not to use medication at all. It is important to understand that with the intended benefits of medicines come potential side-effects which may occur immediately or over a period of time. It is always advised that you take the advice of your general practitioner, pharmacist, or specialist regarding your medicines if you are considering any changes.

There are three main types of medication.

1. Analgesics

These tend to work fairly quickly and can be used as required, or taken regularly. There are four main types-

a. Paracetamol

Paracetamol can be effective for body pains, but not for nerve pains. More than 4g per day (8 x 500mg tablets) can harm the liver.

b. NSAIDs (Non-Steroidal Anti Inflammatory Drugs) e.g. ibuprofen, diclofenac, naproxen.

NSAIDs are often NOT helpful in persistent pain because usually there is little inflammation present. NSAIDS don’t help nerve pains. NSAIDS can cause harmful stomach, kidney and heart problems when taken in higher doses – especially if used long term.

c. Opioids (morphine-based drugs) e.g. codeine, buprenorphine, fentanyl, morphine.

Opioids like codeine and morphine are much more effective in short term pain problems than in persistent pain. All have similar side effects such as constipation and drowsiness. If you take them regularly, you can become physically dependent on them leading to withdrawal symptoms when you stop them.

The body often becomes tolerant of opioids i.e. ‘gets used to them’ so that you need higher and higher doses to have the same effect. Taken in higher doses for more than a few weeks, opioids can actually make pain worse, as well as weaken the immune system and interfere with sex hormones. There is a limit to the doses which are considered safe to prescribe. They are really best used when you are starting a rehabilitation programme, to enable you to move around more easily, but should generally be reduced and stopped when possible.

d. Drugs with part opioid and part other action (tramadol, tapententadol)

Tramadol and tapentadol are drugs with some opioid (morphine) type effect combined with some of the pain treating effect of antidepressants (see below). Like opioids, they work better in short term pain than persistent pains. They can interact with other drugs and must be prescribed carefully.

2. Anti-epileptics

Anti-epilepsy medication, or anticonvulsants (e.g. pregabalin (LYRICA®) / gabapentin) tend to work slowly, and need to be taken regularly every day to be effective. They work by reducing the speed and intensity of the messages travelling along the pain nerves in the body. They are used to treat nerve pains and/or to reduce widespread pain oversensitivity.

They need to be started at a low dose which can be increased gradually, until you reach an effective dose at which any side effects are tolerable (e.g. dizziness, sedation). If effective, the medication should be continued for 6 to 12 months before slowly weaning off it.

3. Antidepressants

Antidepressants tend to work slowly, and need to be taken regularly every day to be effective. They can be effective in nerve pain, and they can help reduce widespread pain oversensitivity. They act on pain centres in the brain. If someone is injured when they are very focused on something else (e.g. a footballer in the middle of an important game, or a soldier in the middle of a battle) the brain has the ability to block the pain messages until the person has finished what they are doing, and then they notice that they are in pain.

This demonstrates that the brain has an important role in controlling the level of pain we feel, and when a pain becomes persistent, it is often due to over activity within the pain centres in the brain.

Antidepressants can help to settle the dysfunction and reduce the level of pain you feel.

Summary

These three types of drugs (painkillers, anti-epileptics and antidepressants) can sometimes be taken together but possible interactions between the drugs should be thought about and explained to you. They are started one at a time in case you experience any side effects, so that you can work out the effect of each drug.

Other medications that might be given to you at InHealth Pain Management Solutions

Introduction

If you have an injection at Inhealth Pain Management Solutions you will have at least one of the medications below injected into your skin or deeper tissues in order to reduce the intensity of your pain for a short period of time. This is done so that you are more able to work with our staff to improve your self-management.

Local Anaesthetic Agents

Local anaesthetic agents include drugs such as Lignocaine and Levobupivacaine.

Lignocaine is used to numb your skin prior to carrying out an injection deeper within the body so that it doesn’t hurt (e.g. epidural injection)

Lignocaine and Levobupivacaine might be used to alleviate pain symptoms in deeper tissue (e.g. muscle tissue, nerves, joints).

Corticosteroid drugs

Methylprednisolone or Triamcinolone are pain relieving corticosteroid drugs used in many types of injections at Pain Management Solutions. Sometimes after an injection your pain might feel worse initially but this should not last for more than a few days.

Onubotulinumtoxin A (Botox)

On some occasions (such as certain types of chronic headache) the doctor at InHealth Pain Management Solutions may inject Botox into certain sites. The doctor will have discussed this with you in advance.

Advise to you and your GP

When you attend InHealth Pain Management Solutions we might advise you about medications prescribed by your GP. However, we will not actually prescribe or dispense any medicines ourselves. We will contact your GP to ask for the necessary changes to be made by them.