What are the chronic pain relief medications?

Chronic pain relief drugs commonly used in clinical practice are far more than the familiar ordinary painkillers such as ibuprofen. They range from topical and oral preparations that can be purchased without a prescription to neuromodulatory and opioid drugs that require a doctor's prescription. They have their own applicable scenarios for different types of chronic pain.

Last week, I met a 42-year-old patient with lumbar disc herniation in the pain department. He had suffered from back pain and numbness in his legs on and off for almost three years. When he had pain, he went to the pharmacy to buy ibuprofen. After taking it for almost a year, not only did he suffer from gastric reflux and fever, but the pain relief effect was also poor. It got worse and worse, so I gave him low-dose pregabalin combined with topical flurbiprofen gel patch. After a follow-up visit half a month later, I said that the pain level had dropped from the worst 7 points to 2 points, and he was basically unaffected by picking up the children and doing housework.

The most familiar ones like ibuprofen and diclofenac sodium are non-steroidal anti-inflammatory analgesics. They are very effective in treating chronic pain associated with inflammation, such as osteoarthritis, muscle strain, and fasciitis. They can be purchased in pharmacies, but it is really not recommended that you take them by yourself for more than one month. There are still disagreements in the industry about whether this type of drug can be used for long-term chronic analgesia for more than 3 months: some scholars believe that as long as liver and kidney function and gastrointestinal reactions are regularly monitored, the benefits of low-dose use outweigh the risks. ； Others feel that the benefits of long-term use of anti-inflammatory drugs will be offset by the risks of gastrointestinal damage and kidney damage, and they recommend switching to other types of analgesics. The patient I mentioned just now is a typical case of gastric mucosal damage caused by long-term indiscriminate consumption of non-steroidal drugs.

If your pain is like someone pricking you with a small needle, or a pulsing pain like an electric shock, such as post-herpetic pain, diabetic peripheral neuralgia, trigeminal neuralgia and other neuropathic pain, ordinary ibuprofen is basically useless. Pregabalin and gabapentin are commonly used in clinical practice. Drugs that target ganglionic nerve signals sometimes also prescribe antidepressants such as duloxetine. Don’t think that the doctor is prescribing the wrong drug. The neural pathways of chronic pain and emotions already overlap. Using small doses of these drugs can simultaneously regulate pain signals and emotional states, and the pain relief effect is much better than using analgesics alone.

If it is severe cancer pain, or refractory severe chronic pain that cannot be suppressed by all other drugs, you can also use opioids as directed by your doctor, such as morphine and oxycodone. Many people are afraid of taking them for fear of addiction. In fact, as long as they are administered according to the standard ladder, the addiction rate for medical analgesia is less than 1%, and there is no need to suffer the pain. However, there is currently a lot of controversy in the industry about whether opioids can be used for non-cancer chronic pain. Europe and the United States have had many problems due to opioid abuse before. The domestic consensus is that only severe refractory non-cancer chronic pain that is ineffective with conventional treatments will be considered for low-dose use, and strict follow-up monitoring is required.

There are also topical analgesic preparations that many people ignore, such as Voltaren ointment, flurbiprofen gel patch, loxoprofen sodium patch, etc. They can be directly applied or applied to the painful area. Most of the drugs work locally, and systemic side effects are much smaller than oral drugs. For example, knee pain after dancing too much, shoulder and neck pain after sitting at the desk for a long time. Applying a patch is much safer than taking oral analgesics. If your skin is not prone to allergies, it is a priority.

By the way, one more thing, the cause of chronic pain is very complex. Don’t blindly take medicines by yourself. It is best to go to the pain department to find a doctor to understand the source of the pain, and then choose the corresponding medicine. It is effective and safe. It is much better than blindly trying medicines on your own.