There are a wide variety of medications available to use. Few work for everyone and most have side-effects that will often vary between people. Clearly there is no point taking a medicine that does not help. However changing to an alternative may help. Clearly it is up to the person with pain to decide what helps and what does not. We aim to provide you with the information you require to decided on what is best for you.
What follows is an outline of the types of medication available. There is no discussion of side-effects here but clearly these will be discussed in the consultation
The World Health Organization’s Acute Pain Ladder
This provides the framework for using “pain killers” of increasing strength for increasing pain.
The bottom “rung” of the ladder is where we place drugs such as paracetamol and some of the antiinflammatory drugs such as neurofen or ibuprofen.
The second rung of the ladder is the use of weak “opioid” medication such as cocodamol, codydramol, codeine and tramadol. Some of these preparations may contain paracetamol so care should be taken to avoid overdose.
The final rung contains drugs such as morphine, fentanyl, buprenorphine and oxycodone. Care should be taken to understand that true addiction is very rare with these drugs whilst physical dependence and tolerance may occur.
Interestingly not all of these medicines need to be swallowed. Some are available as patches that stay on for up to a week before needing to be replaced.
Other Medication Used for Pain Treatment
There are four other groups of medicines commonly used to treat pain.
One of the most widely used families of medication is the old fashioned tricyclic antidepressants. These are not prescribed to treat depression but only pain. They act by having four beneficial actions.
a. They help people sleep and give a good quality of sleep unlike alcohol and other sleeping tablets.
b. They help the muscles of the body relax during sleep.
c. They help people cope with pain.
d. They act as pain killers through mechanisms that are poorly understood but probably rely on helping the body’s natural mechanisms.
Another group of medicines are the anticonvulsants. Although originally used for treating epilepsy these have been found to help some of the pains originating in the nerves. Exactly how they work is not clear but they seem to act by calming nerves that are more active than they should be. The two that we use are either Pregabalin or less commonly Gabapentin.
The third group of medicines is the antiarrhythmics. In fact these are usually the type that are also local anaesthetics. As with the anticonvulsants above they can be of help in some nerve pains although their use varies across the country. Usefully they may be used as plasters
The final group of medicines are those to reduce muscle spasm. These are usually taken by tablet although not always. Drugs such as diazepam (valium) and Baclofen are typical
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