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Pain treatment: Drug therapies

Kinds of medication

To treat pain, doctors prescribe medications based on pain severity – whether the pain is mild, moderate or severe. Drugs that relieve pain are called analgesics. These drugs need to be taken at regular times to keep a constant level of the active ingredient in your bloodstream. This helps keep the pain from recurring.

Drugs for mild to moderate pain

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) – These are widely prescribed medications that work by reducing fever and inflammation. Many NSAIDs irritate the stomach and can cause bleeding or ulcers in the stomach or gut. For that reason, these medications should be taken with food. NSAIDs can affect blood platelets so that it takes longer for blood to clot and longer for bleeding to stop. Examples of NSAIDs include aspirin, ibuprofen, naproxen and ketoprofen.
  • Paracetamol – Paracetamol is one of the most common analgesics and is also used to treat fever. It does not reduce inflammation as much as NSAIDs. It’s a popular pain medication because it is easily available (from shops and pharmacies) and does not have any dangerous side effects when used at the right dosages. Paracetamol is also often used together with other pain medicines, and is sometimes available as part of a combination pill (for instance, paracetamol plus an opioid analgesic).
  • Cyclooxygenase (COX)-2 inhibitors – COX-2 inhibitors, also called coxibs, treat pain the same way as NSAIDs but do not cause the side effects typical of NSAIDs, like bleeding or ulcers in the stomach or gut. Examples of COX-2 inhibitors include celecoxib and etoricoxib.

Drugs for moderate to severe pain

  • Opioids – Your body produces a natural opioid (endorphin) as a response to danger and injury. Opioid medications, which are some of the oldest drugs known to humankind, work in the same way as endorphins. Opioid drugs are strong analgesics that work by blocking pain messages in the body, affecting the way a person feels pain and helping make pain more tolerable. With proper monitoring and advice from the healthcare team, common side effects (eg, constipation, drowsiness, nausea and vomiting) can be managed well and opioids can be used effectively and safely. Patients taking opioids should be monitored carefully by the healthcare team to ensure pain is well controlled and to avoid concerns over dependence Some examples of commonly used opioids are morphine, oxycodone, fentanyl and tramadol.

Other medications also used in treating pain

  • Antidepressants/anti-anxiety drugs – Taking an antidepressant for pain does not necessarily mean that a person is depressed or mentally ill. Some antidepressants which can help control pain messages in the nerves and work well for neuropathic pain. They may also help to improve mood and relieve anxiety.
  • Anti-epileptics/anticonvulsants – Similarly, anti-seizure medications can help control messages in the nerves and can help with nerve pain.
  • Steroids – Steroids may be useful in some people with severe inflammatory pain. However, steroids should usually be taken in low doses and for short periods to prevent potential side effects.
  • Muscle relaxants – These drugs may decrease muscle pain but often cause sleepiness.

Ways to take medication

There are several ways to take analgesics, and doctors will consider what is best for each patient.

  • Oral/by mouth – This is the most common way of taking pain medications. When a patient’s stomach and intestines are healthy, medicine is usually given by mouth, either as a liquid or a pill. Some oral medications are placed under the tongue or on the inside of the cheek. Oral medicines are also designed to release the active drug in different ways. Most are immediate-release medications, which means that all of the drug is absorbed immediately after it is taken. Some drugs are controlled-release or modified-release medications, which release the active ingredient slowly or after a period of time.
  • Transdermal/through the skin – Some analgesics are available as adhesive patches, which are easily applied on skin. These patches are useful when patients cannot or prefer not to take oral medications.
  • Nasal – Some analgesics are available as a nasal spray.
  • Rectal – When patients cannot take drugs orally, they may be given as rectal suppositories.
  • Intravenous (IV) – Pain medications can be given in a vein from a syringe or as a continuous infusion (like from a drip). This way of administering drugs is used when the drug needs to be absorbed quickly or in patients who cannot swallow or digest medicine or food properly.

o A PCA (patient-controled analgesia) pump can allow patients to control the amount of pain drug they receive according to how much pain they feel. The medical team can program the computerized pump in advance and the preset dose is released directly into the IV drip when the patient needs it.

  • Subcutaneous – Some analgesics are injected just under the skin surface.
  • Intramuscular – Analgesics may be injected more deeply into the muscle.
  • Intraspinal (epidural/intrathecal) – Analgesics can also be injected into the fluid around the spinal cord.
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