TREATMENT OF PAIN
Management of pain
is very important on both patient’s perspective and
economic perspective. Pain is the most important
reason people seek medical attention. About 80%
of the doctor visits are primarily because of some
pain problem. An appropriate pain management
protocol should be made while treating patients who
seek medical attention for pain.
An extensive pain protocol plan
includes a pain management care path flow chart, a
pain assessment tool, an opioid Reference Table, an
analgesics table, side effects management sheet, and
a non-pharmacologic interventions for psychosocial,
spiritual & physical pain flow chart.
The pain therapy depends
on the type of pain. As mentioned earlier, for
clinical purpose pain is divided in to two types –
neuropathic pain and nociceptive pain. The
drugs effective for pain control are different
in these two types of pain.
Pain killers:
The pain medicines used are
categorized in to the following types:
-
Non steroidal anti-inflammatory drugs
-
Alpha 2 adrenergic drugs
-
Steroids
-
Drugs like antidepressants, muscle relaxant and sleeping pills
-
Drugs for neuropathic pain treatment
Non steroidal anti inflammatory drugs:
These are some of the commonly
used drugs for pain relief. These are mainly
effective for nociceptive pain. Some of the
commonly used drugs are acetaminophen, ibuprofen,
naproxen, diclofenac and salicylates.
Some of the side effects
of these drugs are, gastritis, worsening of asthma
and kidney damage if taken for a longer time.
The newer COX 2 inhibitors like valdecoxib and
rofecoxib have less side effects.
Opioids:
Opioids are
effective pain relievers for all types of pain
including neuropathic pain. Morphine
is the original drug of this class. The other drugs
include codeine, fentanyl, meperidine, pentazocine
and propoxyphene.
Some of the side effects
include addiction, respiratory depression and
constipation.
Alpha 2 adrenergic drugs:
These drugs were initially used
to hypertension. But these drugs also have sedative
properties and have been used to treat pain and
anxiety. Some of the drugs of this class are
clonidine and tizanidine. These drugs can cause
fatigue and dry mouth.
Steroids:
Steroids are very
potent anti inflammatory drugs and have
widespread use in medicine for both anti
inflammatory and their pain relieving effects. In
pain management they are most commonly take by mouth
to relieve the pain of arthritis and by injection
along with local anesthetics in arthritic joints and
in the spinal canal to relive back pain.
Steroids should be used very
judiciously. In high doses given for more than a few
days, they can have various adverse effects
including diabetes, osteoporosis and other damage to
bones like avascular necrosis to the femoral head.
Drugs for neuropathic pain treatment:
As said earlier opioids are
effective for neuropathic pain relief. Neuropathic
pain was until recently believed to be resistant to
this class of analgesics.
The conventional treatment
consists of drugs like anticonvulsants, local
anesthetics, neuroleptics,
topical analgesics, menthol, and NMDA
antagonists.
Anticonvulsants
These were initially meant
to treat seizures. But now they are being used
for chronic pain management especially
neuropathic pain. Some of the anticonvulsants used
are carbamazepine, clonazepam, valproate, phenytoin,
gabapentin, topiramate and lamotrigine.
Local anesthetics
Local anesthetics given by
mouth are useful for neuropathic pain. The most
commonly used one is mexiletine which was originally
used for heart rhythm abnormalities. Other drugs
used are tocainide and flecanide.
Neuroleptics- Neuroleptics are
drugs tradionally used for psychotic illnesses. Two
drugs of this class olanzapine and resperidone are
found useful to treat chronic pain.
Topical analgesics
These includes drugs like
menthol, lidocaine, EMLA cream and capsaicin. Brand
name of good topical analgesic is
CryoDerm.
NMDA antagonists
NMDA receptors worsen pain.
NMDA receptor antagonists therefore can relieve
neuropathic pain. Some of the drugs of this class are
methadone, dextromethorphan and ketamine.
Antidepressants:
Pain is so often associated
with depression that it is sometimes is unclear
which came first. Regardless treating depression not
only elevates mood but also improves the physical
functioning.
Some of the drugs of this class
include tricyclic antidepressants like amitryptyline,
selective serotonin reuptake inhibitors like
fluoxetine.
Sleeping pills and muscle relaxants:
Muscle relaxants are prescribed
for pain stiffness and muscle spasm. They also have
mild sedative properties.
Some of the drugs of this class
are carisoprodol, methocarbomol and diazepam.
There are also natural muscle
relaxants such as valerian and passiflora, as found
in
Formula 303. |
