What are the chronic pain relief medications?

Currently, the core of chronic pain relief drugs commonly used in clinical practice are divided into three categories: nonsteroidal anti-inflammatory analgesics, opioid analgesics, and anticonvulsant/antidepressant auxiliary analgesics. The drugs suitable for different pain types vary greatly, and it is not recommended to purchase and take them by yourself.

I have been in the pain department for almost five years, and I have met too many patients who have problems with their random medication. Last month, there was an old man who had been suffering from knee arthritis for three years. He secretly took the "Japanese painkiller medicine" he bought for most of the year. When he checked, he already had large ulcers on the gastric mucosa. In fact, the core ingredient of that medicine is ibuprofen, which can be bought for a few yuan in China. It is the most commonly used non-steroidal anti-inflammatory analgesic. This type of drug is indeed effective in relieving mild to moderate musculoskeletal chronic pain, such as lumbar muscle strain, osteoarthritis, and fasciitis. There are also selective COX-2 inhibitors such as celecoxib that are less irritating to the gastrointestinal tract. However, there is no research on the maximum use period of this type of drug. There has been controversy in the industry. Some scholars believe that it is best not to take it continuously for more than 2 weeks to avoid gastrointestinal and cardiovascular risks. Others believe that as long as it is combined with a gastric mucosal protector and taken at a low dose, there will be no obvious problems if it is maintained for 1-3 months. The details still depend on the patient's basic physical condition.

If the pain has reached moderate to severe levels, such as chronic pain from advanced cancer or severe post-herpetic neuralgia, which cannot be suppressed by ordinary non-steroidal drugs, opioid sustained-release analgesics may be used, such as OxyContin and morphine sustained-release tablets. Many patients are afraid of becoming addicted when they hear about opiates. In fact, they follow the doctor's advice and use sustained-release dosage forms to provide analgesia to patients with chronic pain. The addiction rate is less than 1 in 1,000. Instead, they endure the pain and refuse to take it. On the contrary, they are prone to pain sensitization, and the nerve pain becomes more and more "delicate". Later, when clothes rub against the skin, they feel distressed. Of course, the use of opioids is also controversial. Many people in Europe and the United States have died due to opioid abuse in the past few years. The current consensus in China is that patients with chronic non-cancer pain should strictly evaluate the indications, use them in low doses, and combine them with other auxiliary drugs to minimize the dosage of opioids.

Many people don’t know that there are auxiliary analgesics. They always think that painkillers are ibuprofen and morphine. In fact, for neuropathic chronic pain, such as trigeminal neuralgia and peripheral neuralgia caused by diabetes, ordinary analgesics are useless. Instead, you need to use drugs such as gabapentin and pregabalin, which are originally used for anticonvulsants, or antidepressants such as duloxetine to regulate nerve sensitivity. There was an old man who had been suffering from diabetes for ten years. His feet hurt so much that he couldn't sleep all night long. He took ibuprofen at home for almost a month, but it didn't help at all. After coming to the outpatient clinic for evaluation, he was prescribed a small dose of duloxetine plus pregabalin. After just one week of taking it, he was able to sleep through the night. Even he thought it was magical.

To be honest, taking medication for chronic pain is really not that simple. You don’t just buy analgesics when you feel pain. The same is true for lower back pain. If it is muscle strain, taking ibuprofen will help.