Drugs and Medications for Chronic Pain

As part of your treatment plan to deal with your chronic pain, your doctor may have you try certain drugs and medications. An important note: Before taking any drug or medication, always consult your doctor first to see if it's the best option for you.

Drugs and medications come with a progression: you never start out with the largest dose possible of the strongest medicine. Instead, you start with over-the-counter medications to help control your pain and other symptoms. Unfortunately, many chronic pain sufferers have found that medications such as Tylenol and Aleve aren't enough for their pain.

Chronic pain patients usually need prescription medication, which is the next step on the progression of drugs and medications. What the doctor prescribes is dependent on your pain level, treatment goals, and general health. He or she will take into consideration other medications (and herbal remedies and supplements) that you're taking. Be sure to tell your doctor about everything you're on because of possible drug interactions.

Regardless of what drug your doctor prescribes, you'll start on the lowest possible dose. If that works to relieve your pain, then you've found the right medication and dosage. If it doesn't, then the doctor may consider increasing your dosage or trying another medication.

There are many types and brands of medications available. Some general categories for medications used for chronic pain are:

• Anti-depressants: You don't have to be depressed to be prescribed anti-depressants. They can block the brain from receiving pain messages, so they are a reasonable option for chronic pain sufferers. It's also thought that anti-depressants may increase the amount of endorphins in your body, and endorphins are a natural pain suppressant.
  
  However, it's true that chronic pain often involves an emotional component, especially as the pain seems to take over a patient's life. Pain can make it harder to do things you once enjoyed; that, combined with fatigue and other effects of chronic pain, can lead to depression. Anti-depressants may be prescribed as part of a comprehensive treatment plan that seeks to help you deal with all components of chronic pain.
  
  
• Muscle relaxants: If your chronic pain is caused by muscle sprain, strain, spasm, or tension, you may take a muscle relaxant. This medication may help give you the pain relief you need so that you can work on strengthening your muscles through physical therapy and exercise.
  
  
• Neuropathic agents: For chronic pain caused by nerve problems (neuropathic pain), doctors may prescribe neuropathic agents. They specifically target the nerves, and they change the way that the brain receives and interprets pain messages.
  
  
• Non-steroidal anti-inflammatory drugs (NSAIDS): NSAIDs fight inflammation, just as steroids do, but they do it without any steroids. They work by blocking certain enzymes in your body—the ones that help create inflammation.
  
  
• Opioids (Narcotics): In the most extreme cases, and only under careful supervision, your doctor may also prescribe an opioid, such as morphine or codeine. Opioids are also called narcotics. They work by attaching to opioid receptors on the surface of the brain, spinal cord, and gastrointestinal cells. They then can block pain messages from getting to the brain. Opioids also change the brain's interpretation of pain by affecting the way that pain signals are transmitted.
  
  
• Pain relievers: Prescription-strength pain relievers—also called pain killers or analgesics—do just what their name implies: they relieve pain. They don't reduce inflammation. Instead, pain relievers work by blocking the brain from receiving pain signals from your nerves. If the nerve cells can't transmit pain messages as they normally do, then your brain won't be aware of the pain, and you either won't feel it or won't feel it as severely. Most pain relievers belong to one of the above categories (opioids, NSAID, etc.).
  
  
• Steroid medications: Steroids are very strong anti-inflammatory medications. If you've tried prescription-strength non-steroidal anti-inflammatory drugs (NSAIDs) and they haven't reduced your pain, the doctor may have you try steroid medications. They stop the body from producing the chemical that cause inflammation, so they're used for chronic pain patients with an inflammatory condition, such as arthritis.
  
  Your body gets used to the steroid medication, so you cannot simply stop taking them. You have to give your body time to readjust by tapering your dosages. This is an important point to keep in mind if you take or are considering taking steroid medications.