Medication Management for Chronic Non-Cancer Pain

 

A comprehensive treatment plan that includes different treatment modalities along with medications can help you live better with chronic pain. You may use over-the-counter or prescription medications. It can take some time and trial and error to work out the best treatment plan for you. Work with your doctor to find the best medication for you, and to use it safely and effectively. The Goal of treatment in chronic pain is to help you improve function and control the pain with minimal side effects.

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Your Treatment Plan

Depending on your situation and the type of pain, you may take medications:

  • To help break the pain cycle.
  • At times when pain is more intense than usual.
  • For daily relief.
  • Before activities that tend to trigger pain.
  • To decrease sensitivity to pain and help you gain function.

There are four major groupings of medications for the treatment of chronic pain:

Non-opiods. These include the commonly used medicine acetaminophen as well as the non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen, naproxen sodium, and ketoprofen. They all help control pain but NSAIDs also help relieve inflammation. These drugs are available over-the-counter. Some NSAIDS are available by prescription only.  Care must be advised with NSAID use given evidence that they increase the risk of stroke and MI in patients who have experienced a recent MI (heart attack).

Acetaminophen can cause liver damage if taken above the recommended dose. NSAIDs may cause stomach problems and ulcers. None is addictive.

Opioids. This includes drugs such as oxycodone, hydrocodone, codeine, morphine, and others. They may be used to treat acute pain or severe chronic pain. Opioids are available only by prescription. These medications are effective for managing chronic pain but do have side effects and can be addictive.  It is estimated that approximately 10-30% of patients do not respond well to treatment with opioids.  Therefore, a limited trial with an opioid is used to suggest whether or not pain and function are opioid-responsive.  Extended release opioids allow for pain control on a long-term basis with less focus on “clock-watching” and other pill-taking behaviors.  There is generally a slower progression of tolerance, and it often circumvents “mini-withdrawals” that occur as short-acting agents wear off.  They tend to produce greater patient satisfaction on a long-term basis and those patients are able to develop a more active coping strategy.