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Most chronic pain sufferers are no strangers to medications. Unfortunately many do not understand their medications or realize what the potential is for positive or negative effects. Understanding your medications helps you become a more informed consumer. You will be better able to ask the appropriate questions of your doctor and recognize when medications are and are not working. In addition, you can avoid the problems of drug abuse and addiction.
The following is a summary of the different types of pain relievers:
Narcotics are powerful pain killers and their use is controversial. While narcotic medication reduces pain in the short-term, it can have adverse side-effects and long-term consequences. One of the major side-effects is addiction. You are addicted to a drug when you need more and more of it to get the same effect (referred to as tolerance) and have withdrawal symptoms when you cut down on or stop taking the drug.
As your tolerance to narcotics increases you need to take more and more. This creates the potential for side-effects. Side-effects from narcotics include: sedation, loss of sex drive, memory impairment, confusion and possible damage to certain organs of the body. Due to problems in thinking - such as confusion, loss of concentration and memory impairment - your ability to cope with the emotional aspects of pain may become impaired. In addition, people may no longer be able to function at work, in their family or socially on high dosages of narcotics.
The decision to use narcotic medication in chronic pain should be determined on a case-to-case basis. A full evaluation and physicians knowledgeable in using narcotics with chronic pain are important.
Common Narcotics are: Morphine, Codeine, Duragesic Patch, Propoxyphene (Darvon), Hydromorphone (Dilaudid), Levorphanol (Levodromoran), Meperidine (Demerol), Methadone (Dolophine), Hydrocodone (Vicodin, Lortab, Norco, Lorcet), Oxycodone (Percodan, Roxicet), Roxycodone (Percocet).
Non-Narcotic Analgesics are used to reduce pain and have much less potential for side-effects. They are not addictive and do not cause tolerance and withdrawal. The most common side-effect with these class of drugs is stomach irritation.
Non narcotic medications fall into two categories, Acetaminophen and Non-steroidal Inflammatory Drugs (NSAIDs). The acetaminophen class of drugs, like Tylenol, are mild analgesics and are good at reducing fevers and mild pain. They have no anti-inflammatory action and are not useful in conditions like arthritis. NSAIDs are aspirin-like drugs which reduce fever and are very useful in conditions like arthritis because they reduce inflamation. The problem with NSAIDs is that they often upset the stomach, can cause ulcers and in rare cases interfere with the ability of the blood to clot, causing a tendency to bleed.
Common Non-narcotic Analgesics include: Acetaminophen (Tylenol, Panadol etc.) and Ultram. Nonsteroidal Anti-inflammatory Drugs (NSAIDs) include: Aspirin, Sulindac (Bufferin, Ascriptin etc.), Sulindac (Clinoril, Diflunisal Dolobid), Piroxicam (Feldene), Indomethacin (Indocin), Ibuprofen (Motrin, Rufen, Advil, Nuprin), Fenoprofen (Nalfon), Naproxen (Naprosyn) and Tolmetin (Tolectin).
Antidepressants: Depression is a natural response to chronic pain and physical impairment. Research has shown a close connection between chronic pain and depression. Studies show that about half of all patients with depression have a pain complaint. Often when depression is treated in chronic pain patients the pain decreases or disappears. The brain chemical serotonin seems to be involved in both mechanisms. Antidepressant medications increase the amount of serotonin in the brain which can help relieve both depression and chronic pain. A common short-term side-effect of antidepressants is sedation which usually lessens after a few weeks. Common side-effects can include: dry mouth, blurred vision, dizziness, constipation and difficulty urinating. Newer antidepressants have less side effects. Antidepressants are not addicting and they may be continued indefinitely unless side-effects are bothersome.
Common Anti-depressants include: Amitryptiline (Elavil), Amoxapine (Ascendin), Desipramine (Norpramin), Imipramine (Tofranil), Trazadone (Deseryl), Bupropion (Wellbutrin), Fluoxetine (Prozac), Nefazodone (Serzone), Paroxetine (Paxil), Sertraline (Zoloft) and Venlafaxine (Effexor), Luvox, Remeron.
Anti-convulsants: While these drugs were originally developed to prevent seizures in epileptic patients, they have been found effective with chronic pain. They act by increasing the firing threshold for nerves traveling to, from, and through the brain. Side-effects of these medications can include: liver and bone marrow damage. Prolonged use of these drugs should be done under careful supervision by a physician.
Anti-convulsants include: Valproate (Depakene), Phenytoin (Dilantin), Carbamazapine (Tegretol), Clonazepam (Klonopin) and Gabapentin (Neurontin).
Anti-Anxiety Drugs: Stress and anxiety can directly increase pain. These medications can reduce muscle tension which may be increasing pain for some individuals. These drugs are addicting in long-term use. They can cause: sleep disturbance, decreased memory, drowsiness, impaired coordination, fatigue and depression. They are better used for only short periods of time and can interfere with learned methods of coping with stress and chronically tight muscles.
Common Anti-Anxiety Medications include: Alprozalom (Xanax), Buspirone (Buspar), Clorazepate Dipotassium (Tranxene), Clonazepam (Klopopin), Ativan and Diazepam (Valium)