Chronic Pain Management: Medications

Chronic pain

In chronic pain, we have strong evidence that our pain modulation system is not working well. Instead of
suppression, the system may be over-sensitized so that even normal sensations trigger pain transmission and suffering.

As a result of the pain, patients may also have increased levels of anxiety and depression, decreased quality of life, fear of further pain and disability, sleep loss, and withdrawal from social and pleasurable activities. Both ancient and modern medicine has evolved a variety of ways to help cope with chronic pain and maybe even return the system to more normal functioning.

For many types of pain we, fortunately, have very good medications.

Recent new understandings of the neurophysiology of pain have led to even more specific and effective medications for some pain problems. In migraine headaches, for example, new data on the pathophysiology led to the development of a class of drugs called triptans, which are highly effective medications for aborting migraine attacks in the majority of patients.

A new understanding of the different subtypes of receptors involved in prostaglandin synthesis (a normal body function that produces inflammation and results in pain) has led to new anti-inflammatory medications (the “cox-2” inhibitors).

Some medications developed for other conditions have proven to be very effective for some chronic pain conditions. Several medications originally developed as antidepressants and anti-convulsants are now commonly used to treat pain. Examples include pain associated with nerve damage (such as diabetic neuropathy, or “sciatic” leg pain following a back injury). Low-dose antidepressants may also help reduce chronic abdominal pain associated with functional GI disorders.

Unfortunately, for many chronic pain conditions, there is no specific medication yet. Therefore, many people with pain are left with either no good medications for pain control or one of the many narcotic medications that are available.

Side Effects of Pain Medications

Due to side effects, especially the development of tolerance, narcotic or opioid medications have limited utility in chronic pain despite their excellent analgesic properties. Tolerance and dependence are almost inevitable consequences of the daily use of these medications. What this means is that the same amount of the medication will lead to less pain relief over time, and the person may become even more sensitive to pain as their own pain modulation system is suppressed.

Talking to Your Doctor about Chronic Pain:

chronic pain
Learn more about how to speak with your doctor about the pain you are experiencing

Adapted from, “An 8-Step Approach to Chronic Pain Management”– IFFGD Publication #140 by Bruce D. Naliboff, PhD, Clinical Professor of Medical Psychology in the Dept. of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, Los Angeles, CA; Co-director, UCLA Center for Integrative Medicine; and Chief of the Psychophysiology Research Laboratory, West Los Angeles VA GLA Health Care, Los Angeles, CA

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