What are the chronic pain relief medications?

The chronic pain relief drugs currently commonly used in clinical practice mainly include over-the-counter acetaminophen, non-steroidal anti-inflammatory drugs, prescription anticonvulsant/antidepressant auxiliary drugs, and opioid analgesics. The drugs chosen for different types of pain vary greatly, and it is definitely not as simple as "taking a painkiller when it hurts."

I have been in the pain department for almost 8 years, and last week I saw a 42-year-old patient with lumbar disc herniation. He had chronic low back pain on and off for 3 years. I couldn't bear it at home, so I took ibuprofen for more than half a year. I was hospitalized for stomach bleeding last week and was discharged from the hospital. My waist still hurts so much that I can't straighten up. When I came to the clinic, I was asked if I could only rely on painkillers to get through the day. This is also a common misunderstanding among most chronic pain patients - they equate all painkillers with "ibuprofen and painkillers", and they don't know that different painkillers require completely different medicines.

Among the most readily available over-the-counter analgesics, acetaminophen, also commonly known as paracetamol, is a relatively mild one. It is effective in treating mild chronic muscle soreness and degenerative arthritis pain. It does not irritate the stomach. It can basically relieve chronic dysmenorrhea and cervical pain that occur occasionally. Go ahead, just be careful not to overdose. This ingredient is added to many compound cold medicines and cough medicines. There was a little girl who had dysmenorrhea and took acetaminophen and cold medicine together for three days. Her liver enzymes soared to more than three times the normal value, and it took her a week to stay in the hospital before they came down. She really needs to be careful.

If it is chronic pain associated with aseptic inflammation such as rheumatoid arthritis or fasciitis, acetaminophen is not enough. At this time, non-steroidal anti-inflammatory drugs such as ibuprofen and diclofenac sodium are suitable. It can directly eliminate local inflammation, which is equivalent to treating Remove part of the painful "root" first, but long-term use of this kind of medicine does have the risk of gastrointestinal tract irritation and increased blood pressure. Patients with gastric ulcers and coronary heart disease must not buy it themselves and take it for a long time. It is best to ask a doctor to adjust the dosage and use it with a gastric mucosal protector.

If your pain is pinprick-like or discharge-like in nature, such as neuralgia caused by herpes zoster or peripheral neuralgia caused by diabetes, then taking the first two medicines is basically useless. I have met many such patients who have taken ibuprofen for several months and were so painful that they could not sleep all night before coming to the hospital. In fact, this kind of neuropathic pain requires pregabalin and gabapentin. Only anticonvulsant drugs or antidepressants like duloxetine are effective. Don’t think that the doctor prescribed the wrong drug. These drugs are not for treating mental illness. They can regulate abnormal nerve discharges, which is equivalent to sparks flying out of your home due to a short circuit. You can’t just wipe away the sparks that splashed out. You have to straighten out the short circuit first. If the pain signal cannot be transmitted, the pain will naturally disappear.

The opioid analgesics that everyone is most afraid of, such as oxycodone sustained-release tablets and morphine sustained-release tablets, are now clinically used as second-line drugs at the end. They are only prescribed for severe cancer pain and refractory chronic pain that cannot be suppressed by other drugs. And as long as the sustained-release dosage form is used strictly in accordance with the doctor's instructions, the addiction rate is less than 0.1%. There is really no need to talk about it. Before There was an old man with advanced lung cancer. He was in so much pain that he couldn't even drink water. His family members refused to take opioids for fear of being addicted. He lost more than 20 pounds in a month. After a long time of persuasion, he agreed to follow the doctor's instructions and take the medicine. After the pain stopped, he could still sit and bask in the sun and play chess with his family members. In the end, his quality of life was much higher, and he did not become addicted.

Another controversial category is cannabinoid analgesics. Some European and American countries have approved them for the treatment of refractory neuralgia and cancer pain. Studies have shown that they have good analgesic effects and have fewer side effects than traditional opioids. However, many scholars have suggested that long-term use will affect cognitive function, especially the brain development of teenagers. Currently, this type of drug has not been approved for the routine treatment of chronic pain in China. Do not buy and use it privately through messy channels, as there are too many safety risks.

As for the "pure natural pain-relieving herbs" and "imported pain-relieving ointments" that are so popular on the Internet, many have not undergone formal clinical verification, and some even secretly add hormones or analgesic ingredients. Long-term use will damage the liver and kidneys. If you really have chronic pain problems, it is best to go to the pain department for an evaluation to find out whether you have inflammatory pain, neuropathic pain, or other causes of pain. Then choose the right medicine, which is much more reliable than buying blindly.