What are the chronic pain relief medications?

Chronic pain relief drugs commonly used in clinical practice are mainly divided into two categories: over-the-counter and prescription. The most familiar non-steroidal anti-inflammatory drugs such as ibuprofen and acetaminophen, as well as topical analgesic preparations such as Voltaren ointment and flurbiprofen gel patch are the first choice for most people to deal with chronic muscle and joint pain. The prescription category covers anticonvulsants that regulate nerve discharge, antidepressants with both mood regulation and analgesic effects, and opioids with stronger analgesic effects.

I met a 48-year-old freight driver at the outpatient clinic a while ago. He suffered from chronic low back pain caused by lumbar disc herniation for almost two years. At first, he thought it would be troublesome to go to the hospital, so he carried ibuprofen in his pocket all year round. When the pain was severe, he would take two pills. As a result, he ate it directly last winter. He was hospitalized for gastric ulcer bleeding, but the pain did not subside but instead caused new problems. Later, he was adjusted to low-dose pregabalin combined with topical flurbiprofen gel patch, and combined with twice-weekly rehabilitation training, the return visits in the past two months basically did not affect his normal work.

Speaking of which, many people have deep misunderstandings about chronic pain medication. They either think that "drugs are three parts poisonous" and refuse to take them, or they just stare at one medicine until they die. In fact, the suitable medicines for different types of chronic pain are quite different. For example, if you have neuralgia caused by herpes zoster or peripheral neuralgia caused by diabetes, taking ibuprofen will have basically no effect. You have to use anticonvulsant drugs such as gabapentin and pregabalin to "calm" the abnormally discharged nerves so that the pain can really be reduced.

Speaking of which, we have to mention the issue of the use of opioids, which has been very controversial. One school of thought believes that for patients with chronic severe pain such as advanced cancer pain, the standardized use of opioids as needed can greatly improve the quality of life. As long as they are used according to the doctor's instructions, the risk of addiction is far lower than everyone's inherent impression.； The other group insists that non-cancer chronic pain should be avoided as much as possible. After all, long-term use is prone to side effects such as tolerance, constipation, and drowsiness, which will reduce the quality of life. The current clinical practice is basically based on this principle. Ordinary patients with chronic pain will basically not be prescribed opioids at the beginning.

There are also many people who are confused when they receive a prescription for antidepressants such as duloxetine and venlafaxine, thinking, "I am in pain and I am not mentally ill, why are you prescribing this for me?" In fact, chronic pain that lasts for a long time is often accompanied by anxiety and poor sleep, and bad moods will in turn amplify the pain experience. These two types of drugs It can not only regulate emotions, but also block the transmission of pain signals in the central nervous system. I once met a 62-year-old aunt with fibromyalgia. She had been in pain for three or four years and was reluctant to leave the house. She cried at home every day. After taking half a tablet of duloxetine for half a month, she could go downstairs to dance square dance with her old sisters. The effect was particularly obvious.

Of course, no matter what medicine you use, it must be regulated. Don’t just take over-the-counter medicines casually. The academic community is still debating whether long-term use of large doses of NSAIDs will increase the risk of cardiovascular events. It is generally recommended that people take over-the-counter analgesics by themselves for no more than a week. People with peptic ulcers and poor liver and kidney function must tell their doctors in advance not to buy blindly. If the location of the pain is relatively localized, such as only knee pain or shoulder pain, priority is given to using topical patches or ointments. The local effect is not slow in taking effect and the systemic side effects are small. It is much safer than taking oral medications.

In fact, chronic pain is a problem caused by many factors. It cannot be completely solved by taking medicine alone. Only by correcting bad posture, doing rehabilitation training, and adjusting work and rest can we really control the pain and avoid unnecessary suffering.