TREATMENT OF PAIN
Management of pain is very important on both patient’s perspective and economic perspective. Pain is the most important reason people seek medical attention. About 80% of the doctor visits are primarily because of some pain problem. An appropriate pain management protocol should be made while treating patients who seek medical attention for pain.
An extensive pain protocol plan includes a pain management care path flow chart, a pain assessment tool, an opioid Reference Table, an analgesics table, side effects management sheet, and a non-pharmacologic interventions for psychosocial, spiritual & physical pain flow chart.
The pain therapy depends on the type of pain. As mentioned earlier, for clinical purpose pain is divided in to two types – neuropathic pain and nociceptive pain. The drugs effective for pain control are different in these two types of pain.
The pain medicines used are categorized in to the following types:
- Non steroidal anti-inflammatory drugs
- Alpha 2 adrenergic drugs
- Drugs like antidepressants, muscle relaxant and sleeping pills
- Drugs for neuropathic pain treatment
Non steroidal anti inflammatory drugs:
These are some of the commonly used drugs for pain relief. These are mainly effective for nociceptive pain. Some of the commonly used drugs are acetaminophen, ibuprofen, naproxen, diclofenac and salicylates.
Some of the side effects of these drugs are, gastritis, worsening of asthma and kidney damage if taken for a longer time. The newer COX 2 inhibitors like valdecoxib and rofecoxib have less side effects.
Opioids are effective pain relievers for all types of pain including neuropathic pain. Morphine is the original drug of this class. The other drugs include codeine, fentanyl, meperidine, pentazocine and propoxyphene.
Some of the side effects include addiction, respiratory depression and constipation.
Alpha 2 adrenergic drugs:
These drugs were initially used to hypertension. But these drugs also have sedative properties and have been used to treat pain and anxiety. Some of the drugs of this class are clonidine and tizanidine. These drugs can cause fatigue and dry mouth.
Steroids are very potent anti inflammatory drugs and have widespread use in medicine for both anti inflammatory and their pain relieving effects. In pain management they are most commonly take by mouth to relieve the pain of arthritis and by injection along with local anesthetics in arthritic joints and in the spinal canal to relive back pain.
Steroids should be used very judiciously. In high doses given for more than a few days, they can have various adverse effects including diabetes, osteoporosis and other damage to bones like avascular necrosis to the femoral head.
Drugs for neuropathic pain treatment:
As said earlier opioids are effective for neuropathic pain relief. Neuropathic pain was until recently believed to be resistant to this class of analgesics.
The conventional treatment consists of drugs like anticonvulsants, local anesthetics, neuroleptics, topical analgesics, menthol, and NMDA antagonists.
These were initially meant to treat seizures. But now they are being used for chronic pain management especially neuropathic pain. Some of the anticonvulsants used are carbamazepine, clonazepam, valproate, phenytoin, gabapentin, topiramate and lamotrigine.
Local anesthetics given by mouth are useful for neuropathic pain. The most commonly used one is mexiletine which was originally used for heart rhythm abnormalities. Other drugs used are tocainide and flecanide.
Neuroleptics- Neuroleptics are drugs tradionally used for psychotic illnesses. Two drugs of this class olanzapine and resperidone are found useful to treat chronic pain.
These includes drugs like menthol, lidocaine, EMLA cream and capsaicin. Brand name of good topical analgesic is CryoDerm.
NMDA receptors worsen pain. NMDA receptor antagonists therefore can relieve neuropathic pain. Some of the drugs of this class are methadone, dextromethorphan and ketamine.
Pain is so often associated with depression that it is sometimes is unclear which came first. Regardless treating depression not only elevates mood but also improves the physical functioning.
Some of the drugs of this class include tricyclic antidepressants like amitryptyline, selective serotonin reuptake inhibitors like fluoxetine.
Sleeping pills and muscle relaxants:
Muscle relaxants are prescribed for pain stiffness and muscle spasm. They also have mild sedative properties.
Some of the drugs of this class are carisoprodol, methocarbomol and diazepam.
There are also natural muscle relaxants such as valerian and passiflora, as found in Formula 303.