Medications

Medications play an efficient role in the treatment of pain. Your doctor may prescribe several medications to help reduce pain and associated symptoms that are caused by unhealthy conditions or deformities.

When health care professionals prescribe a medication regimen, the precise needs of the patient are considered in the treatment of chronic pain including: severity of pain, prior treatments and medical history of the individual. The main aim of prescribing medications is to reduce the pain and increase the comfort level of the patient and reduce the danger of misuse or abuse of medications.

Non-Steroidal Anti-Inflammatory Drugs:

These are the most commonly prescribed medications to treat chronic conditions of pain. These medications have robust analgesic effects without concern for toxicity or dependence. With the dual action of analgesic and anti-inflammatory properties, these medications help alleviate pain and inflammation.

Long-term use of NSAIDs may result in indigestion, dyspepsia, drowsiness, skin bruising, high blood pressure, fluid retention, headache, skin rashes, reduced kidney function, ulcers, and gastrointestinal bleeding.

Neuromodulating Medications:

Pain pathways involve the nervous system and may be responsive to neuromodulating medications such as anti-epileptic medications and anti-depressants which work at the level of the brain and spinal cord.

Your doctor will assess your pain complaints to determine whether or not your pain may be responsive to these types of medications.

Opioid Pain Medications:

Opioid pain medications are not prescribed as first line medications for the treatment of chronic pain. Opioid or narcotic administration is widely rejected in the treatment of chronic back pain due to possible toxicity, physical dependence, and the loss of efficacy due to developmental tolerance, psychological dependence or addiction.

In special circumstances, opioids may be prescribed for patients with chronic nonmalignant pain by specialized clinics. Long-term opioid therapy should be considered only as the last treatment option in cases of pain unrelieved by non-opioid medications, therapy, chiropractic treatment and lifestyle changes. Patients should be informed of the potential side effects of opioids and follow-up with their doctor regularly to assess the patient’s response to the medication. Patients are often required to sign an opiate contract prior to initiating chronic opioid therapy.

Neuromodulating Medications:

Pain pathways involve the nervous system and may be responsive to neuromodulating medications such as anti-epileptic medications and anti-depressants which work at the level of the brain and spinal cord.

Your doctor will assess your pain complaints to determine whether or not your pain may be responsive to these types of medications.

Injections:

Some steroid injections performed under fluoroscopic guidance are beneficial in relieving neck and back pain related to inflammation. These include:

  • Epidural Steroid Injections
    • A steroid and local anesthetic agent are injected around the spinal nerves to alleviate pain and inflammation related to the intervertebral discs and nerves.
  • Sacroiliac Joint Injections
    • A steroid and local anesthetic agent are injected into the affected sacroiliac joint.
  • Facet Joint Injections
    • A combination of a steroid and local anesthetic agent are injected into the affected facet joint.
  • Medial Branch Blocks for Facet Joint Pain
    • A combination of a steroid and local anesthetic agent are injected near the nerve supplying innervations to a specific facet joint to eliminate pain from that joint.
  • Hip Joint Injections
    • A combination of a steroid and local anesthetic agent are injected into the hip joint.

Over-the-counter pain relievers: Over-the-counter pain relievers are medications available without a doctor’s prescription. They include acetaminophen, Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and topical pain relievers.

  • Acetaminophen (Tylenol) and NSAIDs help to reduce fever and alleviate pain caused by general muscle aches and stiffness. Moreover, NSAIDs can also reduce inflammation. NSAIDs help relieve pain by reducing the level of prostaglandins (hormone-like substances) that cause pain.
  • Topical pain relievers (Aspercreme, Ben-Gay, and Capsaicin) include creams, lotions and sprays that are applied to the skin of painful muscles or joints to ease pain.

Antidepressants: Antidepressants are drugs that are prescribed for the treatment of pain and emotional conditions. They are also prescribed to treat chronic pain that fails to respond to other treatments. Antidepressants work by altering the levels of neurotransmitters (natural chemicals) in the brain, increasing the feeling of well-being and relaxation.

Anticonvulsants: Anticonvulsants are drugs used in the treatment of seizures. They are also used to treat some types of pain caused by nerve irritation or nerve damage. Anticonvulsants are usually effective in treating pain radiating into the arms and legs.

Corticosteroids: Corticosteroids are used to reduce swelling caused due to inflammation. When used to control pain, corticosteroids can be prescribed in the form of pills or injections.

Muscle relaxers: Muscle relaxers are drugs that are commonly used to treat acute muscle problems. Sometimes, they can help treat painful muscle spasms. These medications help in reducing muscle tone and tension in skeletal muscles. Some muscle relaxers have direct effect on the skeletal muscle fibers, while others work at the level of the spinal cord.