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.
Information from The Johns
Hopkins Medical Guide to Health After 50
Additional Information and
webpage by Paul Susic MA Licensed
Psychologist Ph.D. Candidate
