chronic pain relief medications

Currently, there is no universal specific drug that can cover all chronic pain scenarios. Clinical practice generally follows the core principles of "prioritizing the cause, stratified drug selection, starting at a low dose, and combining non-drug intervention." There is no absolute "best", only the "most appropriate" according to the individual condition.

Last week, a 28-year-old programmer was admitted to the outpatient clinic. He suffered from migraine on the right side for almost half a year. I searched online for a guide. I first took ibuprofen until I got acid reflux, and then I bought Japanese painkillers from my friend. It worked, but the pain stopped when I stopped taking it. It got even worse. When I came for a checkup, I discovered that his headache was not an ordinary vascular headache at all, but was caused by compression of the sympathetic nerves in the cervical spine. I stopped all painkillers and replaced them with low-dose pregabalin combined with cervical spine rehabilitation exercises. After two weeks of review, there was very little pain.

The first painkillers we ordinary people come into contact with are mostly nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, celecoxib, and diclofenac. They are really effective for chronic pain of musculoskeletal origin, such as mild osteoarthritis, lumbar muscle strain, and fasciitis. But the controversy here is actually not small. Traditional gastroenterology guidelines require that such drugs should not be taken continuously for more than 10 days, otherwise the risk of gastric mucosal damage will triple. However, the new version of the pain department guidelines last year mentioned that as long as gastric mucosal protectors and low-dose selective COX-2 are taken at the same time, Inhibitors (such as celecoxib) are also safe when used continuously for 1 to 3 months. Experts on both sides have large-scale clinical data to support them. Clinics generally weigh the patient's gastrointestinal history. Patients with gastric ulcers will not give priority to prescribing such drugs even if they have mild pain.

Many people don’t know that ordinary analgesics are completely useless for a considerable part of chronic pain, such as post-herpetic neuralgia, diabetic peripheral neuralgia, and trigeminal neuralgia. This type of pain is caused by abnormal discharge of damaged nerves themselves. Instead, anticonvulsants such as pregabalin and gabapentin, and antidepressants such as duloxetine are commonly used in clinical practice. I met an old man who had herpes zoster before. After the rash cleared up, his chest wall hurt so much that he couldn't even touch his clothes. He took ibuprofen for half a month, but it didn't help at all. He also developed a gastric ulcer. Later, he was given a small dose of pregabalin. On the third day, he dared to wear clothes. After a week, the pain was basically bearable. But there are also differences in this area. Doctors in the neurology department are generally worried that long-term use of such drugs will affect cognitive function, especially in elderly patients. Doctors in the pain department mostly believe that the sleep and emotional damage caused by neuralgia is far greater than the minor side effects of the drug. There will basically be no major problems if used in small doses. The current clinical consensus is to use small doses first, and then gradually reduce the pain when the pain is relieved, and patients will not be allowed to take large doses for a long time.

When it comes to analgesics, what everyone is most afraid of are opioids, such as morphine, oxycodone, and fentanyl patches. Previous domestic guidelines have always been to use them if possible, for fear of addiction. In the past few years, Europe and the United States have regarded opioids as the first choice for moderate to severe chronic pain. As a result, in recent years, there have been more and more news about opioid abuse deaths, and now Europe and the United States are also tightening prescriptions. When I attended the National Pain Academic Annual Meeting last year, experts from the Mayo Clinic in the United States were still complaining, saying that they are now required to reduce opioid prescriptions by 30%, and many patients who previously relied on opioids for pain relief now have to switch to combination medications. The current domestic consensus is that only cancer pain and severe refractory chronic pain will be considered for the use of opioids, and they all start with small doses and are strictly monitored. There is basically no abuse, and there is no need to panic too much.

I have been in the pain department for almost 7 years, and I have seen too many people misunderstand the medication for chronic pain. They either refuse to take medication and suffer from pain that makes them unable to sleep and have an emotional breakdown, or they take medication indiscriminately, resulting in liver and kidney damage and gastric bleeding. In fact, many times, medication is not everything at all. For example, for tension headaches and chronic shoulder and neck pain that are common among young people, sometimes if you reduce the time you spend lowering your head in half every day and apply a hot towel for 10 minutes before going to bed, it may be more effective than taking half a box of ibuprofen. Not long ago, there was a little girl who worked in design. She suffered from chronic shoulder and neck pain for 2 years. She had tried all kinds of painkillers. I asked her to raise her desk by 10 centimeters, stretch for 2 minutes every 40 minutes of work, and relax with a fascia gun once a week. She later came for a follow-up consultation and said that she had not taken painkillers for almost a month.

To put it bluntly, chronic pain is a very individual matter. It is also a case of low back pain. Whether it is a lumbar muscle strain or a lumbar disc herniation that presses the nerves. It is a common disc herniation or combined with fibromyalgia. The medication plans are very different. Don’t blindly follow the online guide to buy medicines. If the pain persists for more than 1 month, it is better to go to a pain department or orthopedic doctor to find out the cause first, which is better than anything else. Oh, by the way, I forgot to mention that no matter what painkillers you take, don’t increase the amount casually. It’s best to check your liver and kidney function if you take them for more than a week. This is the most basic precaution.