chronic pain relief medications

There is no universal optimal solution for chronic pain relief drugs. The currently recognized core principle in clinical practice is "stratified matching and individualized selection." Only by selecting a combination of drugs based on the type, degree of pain, and history of underlying diseases can the best relief effect be achieved with the lowest risk of side effects.

When I was rotating in the pain department last year, I met a 62-year-old patient with lumbar disc herniation. He had been suffering from chronic back pain for 5 years and never dared to come to the hospital. When the pain was severe, he would go to the drugstore to buy ibuprofen. At most, he would take 6 tablets a day. In the end, the pain did not stop and he had gastric bleeding and went to the emergency room. After a gastroscopy, he found out that there were several holes in the gastric mucosa.

In fact, there are too many people like this aunt who take NSAIDs as "universal painkillers". After all, these drugs can be purchased without a prescription and are widely advertised. Everyone assumes that they are safe. However, there are actually two schools of thought in the academic community regarding the use of this type of drug: One school advocates not using it if possible, and believes that long-term use of even low doses will increase the risk of peptic tract ulcers and cardiovascular accidents, especially for those over 65 years old with high blood pressure and stomach problems. The risk can be increased by 3 to 5 times. ； The other group advocates that "regular low-dose medication is worse than on-demand sudden medication." If the pain has affected sleep and daily activities, instead of taking a large dose until the pain is unbearable, it is better to take a small dose every day. On the contrary, the overall side effects will be lower and the pain control effect will be better.

When it comes to painkillers, many people’s first reaction is that “opioids will become addictive if you touch them.” This misunderstanding really delays too many people. There was an old man with advanced lung cancer who cried all night long because of the pain. His children firmly refused to be prescribed morphine drugs, saying they were afraid that he would become addicted and eventually become an "addict." Finally, we repeatedly showed them the guideline data, saying that the opioid sustained-release preparations standardized for chronic moderate to severe pain have an addiction rate of less than 0.3% before they agreed to try it. The old man slept all night long after using it. Of course, the opposition to the routine clinical use of opioids is also very reasonable: after all, if control is not strict, there is indeed a risk of abuse. The opioid crisis in the United States in the past few years is a bloody example. Therefore, the prescription of this type of drug in China is extremely strict. Only patients with moderate to severe cancer pain, severe neuropathic pain, or postoperative chronic pain can use it as prescribed by the doctor. It is impossible to prescribe it casually.

What many people don’t know is that the first choice medication for many chronic pains is not traditional analgesics at all, but anticonvulsant and antidepressant drugs. The uncle who received the treatment last month for post-herpetic neuralgia turned black when he received the prescription for pregabalin and said, "I'm not crazy, why are you prescribing psychiatric medication for me?" 」, explained to him for a long time that neuralgia is like nerves discharging randomly. Ordinary painkillers are equivalent to putting a seal on the door and cannot block the current inside. Pregabalin and other drugs directly install voltage regulators in the circuit, specifically regulating the abnormal discharge of nerves. The effect on neuralgia is ten times better than ibuprofen, so I took the medicine with hesitation. A week later, I went back to the doctor and said that the pain was so bad that I could go downstairs for a walk. Of course, some doctors do not recommend this type of medicine as the first choice. After all, some people may experience dizziness and drowsiness as side effects. For people who drive or do fine work, it may affect their lives. They must be evaluated first before choosing.

Oh, by the way, don’t believe those "Japanese painkillers" and "pure natural painkillers" that are advertised by purchasing agents. I have seen several patients take the so-called special back pain drugs purchased by purchasing agents, and the hormone levels in their blood were found to be ridiculously high. Some of them added a large dose of diclofenac. You feel the effect is particularly good after taking it, but in fact, you have taken a strong drug, and you don't know why when you take it and develop osteoporosis and stomach bleeding.

In the past two years, the guidelines have increasingly recommended the use of topical analgesics, such as lidocaine patches and low-concentration capsaicin patches, especially for muscle and joint pain in the elderly. They can be applied to the painful areas. The systemic side effects are almost negligible. The only drawback is that they are a bit expensive, costing dozens of dollars per patch. Many people think it is not cost-effective and would rather take oral medications. In fact, the money spent to treat stomach problems is enough to buy dozens of patches.

In fact, at the end of the day, everyone’s experience of chronic pain is completely different. Whether you have low back pain from sitting for a long time, peripheral nerve pain from diabetes, or cancer pain from tumors, the medication regimen is vastly different. Don't buy blindly from online lists, and don't go to the hospital until you can't bear the pain. Tell the doctor clearly how long you have been in pain, how it hurts, and whether you have any other problems. It's better than anything else.