Medication Management

There are a host of medications that are often prescribed for patients with chronic pain. The classes of drugs include: non-steroidal anti-inflammatory medications (NSAIDs), anticonvulsive medications, antidepressants, muscle relaxants, and opiates. The NSAIDS are both over-the-counter and by prescription. Common over-the-counter medications include Ibuprofen (Motrin) and Advil. Prescription non-steroidal anti-inflammatory medications include Celebrex, Meloxicam, and Naproxen. The major side-effect is gastritis or peptic ulcer disease or gastrointestinal upset. Please note whether you have these conditions before your physician prescribes these medications.

There are two classes of antidepressants that are commonly prescribed; selective serotonin reuptake inhibitors (SSRI’s) and serotonin-norepinephrine reuptake inhibitors (SNRI’s). These help to raise the levels of norepinephrine and serotonin in the brain.. These medications also include Effexor, Venlafaxine, Cymbalta, and Duloxetine. The SNRI’s seem to have fewer side-effects than the SSRI’s and under SSRI’s can reduce libido.

These are often prescribed for the anxiety that frequently accompanies chronic pain. Anxiolytics include Xanax (alprazolam) and Valium (diazepam.) They can be addictive.

Muscle relaxants are also prescribed in chronic pain management for people with muscle spasm as a component of their pain. These include Skelaxin, Robaxin, Flexeril and Soma. Valium is also a muscle relaxant. Baclofen and Zanaflex are also used for continued muscle spasm.

Opiates are pain relieving medications. There are two types: Short acting and long acting medications. Short acting medications, as their name implies, last for relatively short time periods on the order of two to four hours and have a short onset of action. The long acting opiates include Morphine sulfate extended release, Oxycontin, methadone, Opana, Exalgo, and Duragesic. These medications have a much longer duration of action, typically from eight to twenty-four hours, and have a longer onset of action. It is common to utilize both short acting and long acting opiates in patients with severe and intractable pain. Long acting pain medications serve as the base for relief of pain. They are typically taken on a regular schedule, regardless of the patient’s pain level. Short acting pain medications are then utilized for breakthrough pain. Breakthrough pain is the pain that is experienced despite the long acting pain medication. Breakthrough pain medication is utilized on an as needed basis for pain that occurs despite the long acting pain medication.