Understanding Your Chronic Pain Medication Options
Chronic pain is any pain that lasts for longer than a few short months. Typically, when considering pain, doctors will mark pain as being chronic if it has lasted more than 3 to six months however some doctors will consider it as chronic only when it has been bothering the person for 12 months of time.
It can be very confusing when trying to analyze whether or not pain is chronic when even the doctors don’t seem to agree on whether pain is chronic or simply, acute. At any given time, anywhere from 10 to 50 percent of people are suffering from some type of pain.
Pain can be very challenging to treat and often the exact treatment will be dependent upon where it has originated from in the body. To help alleviate pain, many patients are referred to a pain management clinic or specialist where a team of doctors (pain management team) will work together alongside the patient to help reduce or alleviate their pain.
To complicate matters further, patients who are suffering from chronic pain often struggle with depression, anxiety and sleep disorders. It’s not exactly clear whether or not this is due to the pain itself or if it is an underlying condition that may even be contributing to the pain.
For this reason, many doctors find that they must treat all of the conditions and try to unravel if one is creating the other condition. It’s not always easy to tell even for the most experienced doctor.
Additionally, those struggling with chronic pain also may also struggle with weight issues such as increased or decreased weight. Thus, it’s important to treat all of the conditions alongside of the pain to help manage the pain.
If a patient needs to gain weight doctors will put them on a weight gaining diet, if the patient needs to lose weight the doctor will have them work closely with a nutritionist or dietitian to help them improve their eating habits. By maintaining the proper weight many patients find a great reduction in their pain symptoms.
Each member of a pain management team will have his or her own role in the pain relief for the patient. There may be counselors to help counsel the patient in dealing with the pain, nutritionists to help the patient gain or reduce their weight as well as the doctor that will oversee the entire treatment protocol.
This team will work closely with the patient to help develop the ideal protocol for treating and managing their pain condition. As circumstances change the team may also change and incorporate members that can add additional expertise to the pain situation for the patient.
Medications that are given must be compatible with one another so if a medication is being used to treat the pain, often a medication may also be used for the depression, insomnia and the weight issues.
All of the medications will work together to help reduce the patients pain. Doctors and pharmacists will keep close tabs on all of the medications that a patient is taking in order to ensure that nothing will interact adversely or create further issues for the patient.
There are actually four basic categories for pain. Doctors will try to pigeon hole where a patient’s pain fits in when they do an evaluation. To help the doctor determine where the patients pain levels fit in the doctor will ask a myriad of questions to the patient.
These questions will help the doctor to determine exactly what is going on and help the patient to receive the right kind of treatment for their pain.
The four basic types of pain are characterized as follows:
Acute pain is considered any pain that is recent or transient. It is usually from a known cause and will typically go away after a period of time. These can be from a minor injury or a minor medical condition.
Chronic pain is persistent and recurrent. It will last much longer than the acute pain and will adversely affect how the person is able to function. It can be from an unknown cause or it may be from a brain injury or a nerve injury. Pain is often considered chronic if it has lasted anywhere from three to six months’ time.
Central pain is from a neurological condition. It will affect the central nervous system and may include the brain, spinal cord and even the brain stem. Some conditions that may cause this sort of pain are strokes, multiple sclerosis, Chronic regional pain syndrome or reflex sympathetic dystrophy, Parkinson’s disease, tumors, amputated limbs, spinal or brain injuries, headaches, fibromyalgia and the like.
This category of pain is often present for the better part of the day. Doctors will prescribe medication for round the clock care. Patients will have to take their medication every so many hours throughout the day in order to even function.
Flare ups aren’t actually a type of pain, but rather a condition of pain. Many conditions will have ‘flare up’ pain. This pain will break through at will and can be related to activity or weather as well as changes in the medical condition causing the pain. Even stress and anxiety can cause a flare up.
Those suffering from a flare up may have been more or less active than usual and can sometimes help to regulate the pain by their level of activity. Pain may be well controlled but suddenly one day a patient is in more pain than usual in spite of taking their pain medication. This is what is known as a ‘flare up’.
Options On Pain Management
Depending upon the type of pain a patient is suffering from, doctors will prescribe a variety of medications. From over the counter medications, alternative care methods and prescription medications doctors will help the patient to evaluate the best course of action for the patient to take.
There are 7 main categories that pain medications fall into. Doctors try to start with the most basic and over the counter remedies before proceeding to something stronger. Many patients will do fine with something as simple as acetaminophen while others will require a stronger pain medication.
Depending upon the medical condition that is causing the pain doctors may prescribe more than one form of pain medication. Patients will take the prescription medication as required and supplement this with over the counter medications if needed.
Medication will help to control pain. Some medications will take effect immediately while others may require up to several weeks before the patient notices any changes in their pain. Often other treatments are incorporated into the treatment regimen. Patients may undergo physical therapy as well as counseling to help them deal with their pain.
Occasionally, after some medications have been used for a long period of time, they begin to lose their ability to work. The body develops a tolerance and the patient will either have to change medications or take more of the medication in order for it to prevent the pain from breaking through. A doctor will advise the patient of how to proceed if this does happen.
Pain Medication List
When treating pain, doctors prefer to start patients out on basic over the counter remedies. This helps the doctor determine the level of pain and what will and won’t work for the patient. It also helps to give the patient fewer side effects. As required the doctor will step the patient up to something stronger.
To begin with the doctors will start patients out on the basic over the counter remedies. Pain medications in this category such as the following:
Over The Counter
Acetaminophen: These come in generics as well as the name brand of Tylenol. There are a variety of formulas and strengths available from 200 mg all the way up to 1000 mg. Doctors will always try the patient out on the lowest possible dose before advancing a patient to a higher dose.
NSAID or Nonsteroidal anti-inflammatory drugs: These will include any type of aspirin or ibuprofen as well as naproxen. Again, there are a variety of dosages and strengths available on the market today. Doctors will try to keep patients to a minimum dose whenever possible but if need be they will up the dosage level accordingly.
Tricyclic antidepressants: Amitriptyline is a good example of this medication. Can also be utilized to help the patient get some sleep if they are struggling with insomnia.
SNRI or Serotonin and norepinephrine reuptake inhibitors: This category includes such medications as duloxetine or Cymbalta.
Anticonvulsants: Neurontin or gabapentin as well as pregabalin or Lyrica.
Opiates: This category is perhaps the most well-known and includes such medications as hydrocodone or Vicodin. Because these are so addictive doctors often choose them as a last resort when other medications aren’t working or touching the pain. Oxycontin or oxycodone are also in this category. Tramadol is a synthetic opiate that many doctors will prescribe as well.
Some medications are topical and will be rubbed or sprayed on the skin. This may also include patches which are applied to the skin as well. These will include such things as a lidocaine patch, EMLA creams, and lidoderm. A few of these also contain chili peppers known as capsaicin. This occurs naturally in chili peppers and can help to relieve or reduce pain.
Sprays will be in an aerosol and are often a great way to reduce pain as well. There is biofreeze and some other types that can help to reduce pain, swelling and irritation. These work by ‘freezing’ the nerve endings and helping to ease the pain.
There are also some creams that can be rubbed on the skin in areas that are sore. These often have a menthol base and may also contain some capsaicin. The advantage is that they can be rubbed directly where it hurts.
However, many people object to the menthol smell and will shy away from these creams due to the odor. Additionally, the cream may stay on the fingers or hand that applied it and if rubbed in the eye or a sensitive area it may burn and sting.
The creams and ointment can often be applied several times per day and will give relief for a number of hours. This allows patients to get the rest that they need or be able to take short walks and the like if they are having issues with a sore muscle.
Another form of pain medication is injections. There are several different types of injections that doctors can use to help alleviate pain. Many of these injections only have to be done a few times per year and the patient can enjoy a pain free life.
These injections include an epidural steroid injection into the spine. They will help to relieve low back pain, neck pain and ease the pain of a pinched nerve or disc issues in the back. Sadly they won’t work for everyone but, for those who they do work for they are a Godsend to ease the pain.
Joint block injections are injected directly into the painful area or joint. This is a corticosteroid and will help to ease the pain quickly. Often only a few treatments are required to ease pain.
Nerve blocks are another form of pain injections. These work as an anesthetic is injected directly into the nerve that is affected. They relieve the pain and may last for several days. Unfortunately they must be repeated when the pain returns.
While they may not cure the pain, they will allow for enough ease in the symptoms that the patient can begin a physical therapy session and ideally improve their range of motion so that normal healing may begin.
Trigger Point Injections are given by injecting the medication (an anesthetic) into the trigger point where the pain originates. This is usually a tender area of the body. These are often used in treating fibromyalgia. They do not work for everyone but many doctors will give them a try to help ease the pain. If they work the patient may be scheduled for injections on a regular basis.
Additional treatments may include such things as massage therapy where the patient will go in for treatments once or twice per week. The area will be massaged by a licensed massage therapist and the patient may find a bit of relief from the pain.
Other forms of treatment involve counseling that may help the patient to understand their condition and deal with the pain in an alternative method such as mind over matter. Patients will learn alternate ways to deal with their pain including the medications that they are on.
Pain is a mysterious condition that often will come and go as it pleases. Many patients work closely with doctors to try and deal with their pain. Not all conditions are easy to treat and many patients will go through a time of trial and error when it comes to dealing with their pain.
Doctors will always try to identify the source of the pain before proceeding but if the source isn’t easily identifiable doctors can still treat the condition safely with medications and other therapies.
Every one experiences pain to some degree or another at some point in their life. For most, a simple over the counter remedy is all that is required, but for those who struggle with chronic pain, there are some great medications on the market today that work very well in controlling the pain.
New technology and medications are always being introduced and many that have great promise are undergoing testing at present. As doctors discover newer ways to treat pain they often change a patient over to the newer medications in hopes of helping them to lead a longer, healthier and more pain free lifestyle.
Patients and doctors must work closely together to help alleviate pain. Many patients will become hooked on their pain medications and many doctors will have to help taper the patient off of their pain medications. This can be a very challenging time for both the patient and the doctor.
For this reason patients should always take the least amount of medication possible to control their pain and they should consult their doctor if they are having a flare up.
The more a patient lets the doctor know how things are working the less likely they are to become dependent upon pain medications and the less likely the patient is to become hooked on their medication.
Understanding what a pain medication should do to help ease their pain is important and helps keep the patient in control of their pain. Always call the doctor if the medication doesn’t seem to be working and there is more pain than usual.
Many medications should be taken at specific intervals for best results. By sticking to the regimen most patients can lead a relatively pain free life and enjoy their normal activities.
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