chronic pain relief medications

Currently, there are no specific drugs that can cure all types of chronic pain in clinical practice. Commonly used relief drugs mainly include four categories: nonsteroidal anti-inflammatory drugs, neuromodulatory drugs, opioid analgesics, and topical preparations. The core principles of drug selection are "matching the cause, stepped administration, and joint attenuation." All drug programs need to be combined with non-pharmacological means such as life intervention and physical therapy to achieve long-term and stable pain control.

When I was rotating in the pain department two years ago, I met Aunt Zhang, a 52-year-old patient with lumbar disc herniation. She had been suffering from chronic low back pain for three years. She had been going to the drug store to buy ibuprofen. The pain was so severe that she took two pills at a time. As a result, she had a sudden gastric bleeding last month and was hospitalized. It was found that the gastric mucosa had been burned out by long-term consumption of non-steroidal anti-inflammatory drugs. This type of medicine is the most familiar ones like Fenbid, Diclofenac, and Celecoxib. It has a direct effect on chronic inflammatory pain of musculoskeletal type. However, there is a lot of difference in the use of this type of medicine in the industry: many geriatricians advocate not using it if possible. After all, the risk of gastrointestinal bleeding and cardiovascular events will increase by 2-3 times after long-term use. Many elderly people have gastric ulcers and high blood pressure, and the probability of getting into trouble is too high. ； However, many doctors in grass-roots pain departments feel that if the patient is in pain so much that he cannot sleep or walk, and the acute phase can be overcome in three to five days in the short term, the advantages far outweigh the disadvantages, so he cannot be forced to carry it, right? The current general consensus is that it is best not to eat continuously for more than 7 days. If you have digestive tract problems, try to choose COX-2 inhibitors such as celecoxib, which can reduce the risk of gastric damage.

What particularly impressed me was that after Aunt Zhang was discharged from the hospital, she adjusted the pain relief plan. When she got the prescription, she pointed at the instructions for gabapentin and duloxetine and looked confused: "Doctor, I just have back pain, how can you prescribe me medicine to treat mental illness and epilepsy?" ”In fact, this is also a misunderstanding among many patients and even non-specialists. Chronic pain that lasts for more than 3 months is mostly accompanied by neuropathic changes - just like nerves that are constantly "leaking". Ordinary anti-inflammatory drugs cannot suppress it at all. Anticonvulsants such as gabapentin and pregabalin are specifically used to stabilize abnormal nerve discharges. Low-dose antidepressants can regulate the transmission of pain signals in the central nervous system. On the other hand, most patients with long-term pain are accompanied by anxiety and depression. When their mood is good, their pain will be significantly reduced. Of course, there has always been controversy over this direction. Many people think, "Why should I take antidepressants if I don't have mental illness?" Even some grassroots doctors feel that cross-indication medication is illegal. However, the International Association for the Study of Pain (IASP) has listed these two types of drugs as first-line recommendations for chronic pain such as neuropathic pain and fibromyalgia. As long as the indications are strictly evaluated and the dosage is started at a low dose, the benefits are far higher than the risks.

When it comes to opioids, many people's first reaction is "addiction". This thing really goes to two extremes at home and abroad: it is generally stigmatized in our country. Both patients and many non-specialist doctors feel that they should never touch it unless it is absolutely necessary. I used to manage a senior patient with bone metastasis from lung cancer. The old man was in so much pain that he hit the railing on the bed. His family members refused to use morphine, saying they were afraid that he would become an "addict" if he took it. They finally agreed after a long time of persuasion. After adjusting the dose of sustained-release morphine, the old man was able to sit up and read newspapers and video chat with his grandson during the last period of time. He didn't suffer much when he left.； Europe and the United States have previously experienced an opioid abuse crisis. Doctors prescribed it at will. Many people with chronic back pain also took OxyContin, and countless people became addicted. The current consensus is actually very clear: try not to use opioids for chronic non-cancer pain. Patients with cancer pain and end-stage pain should use sufficient amounts. As long as they take sustained-release dosage forms on time and do not take short-acting injections casually, the probability of addiction is less than 0.1%. There is no need to stop eating due to choking.

In fact, many people don’t know that if it’s just localized chronic pain, such as shoulder and neck strain, tenosynovitis, or mild osteoarthritis, you don’t need to take oral medications at all. You can just use topical non-steroidal creams or lidocaine patches. Transdermal absorption can directly act on the painful area, and systemic side effects can basically be ignored. I strained my waist while doing deadlifts in the gym, and the pain lasted for almost two weeks. I found it troublesome to take oral medication, so I applied Voltaren cream twice a day and added a lidocaine patch. After three days, I was able to move around normally. It was more effective than taking ibuprofen.

By the way, don’t believe the “ancestral traditional Chinese medicine painkillers” and “pure plant painkillers” sold on Duoduo.com. I have met at least 5 patients in the past two years. They took this medicine for half a year, and finally found out that they had femoral head necrosis and gastric bleeding. When they were tested, they found that large doses of dexamethasone and ibuprofen were secretly added to them. They cost a few yuan and sell you hundreds of yuan. The pain can be stopped, but the side effects can kill half of your life. Don’t buy them randomly.

To be honest, chronic pain is essentially a chronic disease like high blood pressure and diabetes. Don’t expect to get rid of it completely by taking one medicine, and don’t take medicine blindly on your own. Find a pain doctor in a regular hospital who can adjust a plan based on the cause of your pain and physical condition, and then cooperate with rehabilitation and adjust your living habits. This is more reliable than any miracle medicine.