What are the chronic pain relief medications?

Currently, the drugs used clinically to relieve chronic pain mainly include three categories: nonsteroidal anti-inflammatory drugs, opioid analgesics, and anticonvulsant/antidepressant auxiliary analgesics. There are also topical preparations that have been recommended in recent years. There is no panacea. The selection must match the type, degree and basic physical condition of the pain to be safe and effective.

I previously followed up an uncle in the pain department who had been suffering from lumbar prolapse pain for almost 4 years. At first, I stocked a drawer full of ibuprofen at home. When the pain was severe, I would take two pills. After more than a year of stomach bleeding, he was hospitalized. His waist was still so painful that he couldn't get out of bed. Later, when he came to the doctor for investigation, I found out that his pain was not just local pain. I suffered from aseptic inflammation of my head and neuropathic pain caused by abnormal discharge of compressed nerve roots. Later, I changed the oral anti-inflammatory drugs to flurbiprofen gel patch attached to my waist, and added a small dose of pregabalin. It only took more than half a month to say that the pain was so bad that I could go downstairs for a walk, and my stomach no longer suffered from acid reflux. There are now studies that believe that long-term oral administration of non-steroidal anti-inflammatory drugs may affect articular cartilage repair. Therefore, it is generally not recommended for patients with osteoarthritis to take oral medications for more than 3 weeks. Doctors will weigh whether they should be used and for how long based on your inflammation. There is no one-size-fits-all statement.

Speaking of which, someone must have encountered similar questions. Before, some patients saw the duloxetine I prescribed and asked me with the pill box, "I just have pain and it's not mental illness. Are you prescribing the wrong medicine?" In fact, this type of drug, originally used for antidepressants and anticonvulsants, has long been classified as neuropathic pain in the pain guidelines of various countries. First-line medication is used - for many people with chronic pain for a long time, the pain transmission path will be like a wire that has been rubbed repeatedly. When the insulation is worn out, it will "leak" everywhere. The light touch of clothes can turn into pain. This kind of medicine can help you stabilize abnormally discharged nerves. It is not a random prescription.

There are also opioid analgesics that everyone has heard of, such as morphine and oxycodone. The current clinical consensus is that patients with cancer pain should use them according to the step-by-step standard. The probability of addiction is less than one thousandth. Instead, they have to bear the pain and cannot eat or sleep well, and the quality of life in the later period will be much worse.； But for non-cancer chronic pain, this type of drug is generally not the first choice. After all, long-term use is easy to tolerate, and there are side effects such as constipation and drowsiness. Ordinary people do not need to take this risk.

If you only have mild to moderate chronic pain, such as shoulder and neck pain after sitting for a long time, or seasonal leg pain, and do not have gastric ulcers or liver and kidney problems, you can just take acetaminophen or celecoxib occasionally. It is also recommended to give priority to topical Voltaren cream and loxoprofen sodium patch, which can be directly applied to the painful area and have much less systemic side effects. There are also calcitonin and bisphosphonates, which have been used more and more in recent years, specifically for systemic chronic bone pain caused by osteoporosis. They are not conventional analgesics. You need to check your bone density before using them. Don’t buy them blindly. To be honest, the causes of chronic pain are too complicated. Sometimes the pain is just a symptom. For example, in the early stage of pancreatic cancer, epigastric pain will occur repeatedly. Taking painkillers will delay the condition. If the pain has not been relieved for more than 1 month, you should first go to the pain department to find the cause. Don’t take medicine randomly to cause other problems.