chronic pain relief medications

Currently, clinically recognized chronic pain relief drugs can be divided into three categories: over-the-counter analgesia, prescription anti-inflammatory, and neuromodulation. There is no "panacea" that is suitable for all pain. They need to be selected based on pain triggers, basic medical history, and individual tolerance. The overall analgesic effectiveness ranges from 60% to 85%. Long-term use must strictly follow medical advice to avoid risks such as addiction and organ damage.

When I was rotating in the pain department two years ago, I met an old man named Zhou who had been suffering from lumbar protrusion for 10 years. He had been taking ibuprofen at home for three years. When the pain was severe, he would take two pills at a time. Eventually, he was admitted to the hospital for stomach bleeding. His waist still hurt so much that he couldn't straighten up. Later, he was adjusted to a low-dose pregabalin combined with topical flurbiprofen gel patch, and the pain was finally stabilized at 1 to 2 points (out of 10), and he could buy groceries and pick up his grandson normally.

Many people's understanding of chronic pain is still "just take an ibuprofen when it hurts." To be honest, over-the-counter analgesics are indeed the easiest for ordinary people to obtain, such as acetaminophen, ibuprofen, and diclofenac sodium gel. They are quick to treat mild muscle strain pain and menstrual period pain, and they are also cheap. But the difference here is actually not small: many doctors in community hospitals will tell you that as long as you take it within the prescribed dosage, you will be fine. However, the consensus of the pain department of tertiary hospitals is that it is best not to take these oral NSAIDs for more than 14 days in a row. People with Helicobacter pylori infection and chronic nephritis may suffer from gastric mucosal damage and increased creatinine even if they only take one pill a day for two or three months. Believe it or not, last month I met a 28-year-old programmer in the outpatient clinic. He suffered from migraines and was taking Sanli every day for pain. After half a year, his creatinine was twice the normal value and he didn’t even dare to drink coffee.

If the pain is severe, or if you have underlying gastrointestinal diseases and cannot take ordinary analgesics, doctors will usually prescribe COX-2 inhibitors, such as celecoxib and etoricoxib, which have little gastrointestinal irritation. Many patients with chronic pain after orthopedic surgery and degenerative osteoarthritis have good feedback after taking them. But if you ask a cardiologist, they will most likely pour cold water on you: this type of drug is unfriendly to people with coronary heart disease and those who have missed stents. Long-term use will increase the risk of cardiovascular events, and medical history must be repeatedly evaluated before prescribing.

When it comes to painkillers, many people's first reaction is "will they be addictive?" What they are actually talking about is opioids, such as morphine, oxycodone, and fentanyl transdermal patches. At present, the industry's attitude toward this type of drug is also quite polarized: some experts believe that chronic non-cancer pain should never be used, as it is easy to become dependent and abused. There have been many cases in China where OxyContin was used to treat lumbar prolapse and eventually became addicted. ； But another school of thought believes that as long as the indications are strictly controlled and patients with cancer pain and patients with severe chronic pain in whom other drugs are ineffective use it in a standardized manner, the benefits far outweigh the risks. I used to take care of an aunt with advanced lung cancer. At first, her family refused to let her use it because she was afraid of addiction. The pain caused her to cry all night. Later, she used a small dose of OxyContin according to the three-step analgesic plan. In the last few days, she was able to sit up in the sun and video chat with her granddaughter, and she did not become addicted.

There is another type of drug that many people would be confused by—how can antidepressant and antiepileptic drugs also be used to relieve pain? For example, pregabalin, gabapentin, duloxetine, etc. In fact, many chronic pains are not caused by inflammation at all, but by nerve sensitization. Just like if you dropped your touch-screen mobile phone, it was obviously not turned off, but nothing happened when you clicked it. It doesn't matter how much you change the battery and charge it. You need to calibrate the touch screen. For conditions such as post-herpetic neuralgia, fibromyalgia, and trigeminal neuralgia, taking ibuprofen is useless even if the stomach bleeds. Using this type of neuromodulator can suppress the pain. I met an old lady who suffered from post-herpetic neuralgia. The pain was so painful that she cried when she rubbed her skin while wearing clothes. She took three weeks of loxetine plus pregabalin, and then she was able to dance on her own.

To be honest, the most common pitfall I have encountered in the past few years is "if others take it and it works, I will follow suit." Aunt Zhang downstairs takes celecoxib and her waist no longer hurts. If you have coronary heart disease, you will also buy two bottles. It's no wonder that there is no problem. There are also many people who increase the dosage when they feel pain, and stop taking the medicine when it no longer hurts. Sudden discontinuation like pregabalin can easily cause rebound pain, so it is safe to reduce it gradually.

In fact, chronic pain can no longer be solved by taking medicine alone. I usually remind patients when I prescribe medicine. With rehabilitation training, physical therapy, and even necessary psychological counseling, many people can gradually reduce the medicine or even stop taking it. After all, medicine is a three-part poison, so use it as little as possible, but if it hurts so much that you can’t sleep or eat, don’t just stop taking the medicine. Long-term pain can do more damage to the body than the side effects of medicine.