How many drugs are there to relieve chronic pain

Clinically commonly used chronic pain relief drugs are mainly divided into five categories, namely nonsteroidal anti-inflammatory drugs (NSAIDs), opioid analgesics, anticonvulsant analgesics, antidepressant analgesics and topical analgesics. The applicable scenarios and side effects of different types of drugs vary greatly. There is no absolute optimal choice. They need to be used after evaluation by a doctor based on the type of pain, basic medical history, and tolerance.

If you have ever been to a pain clinic, you will find that at least 30% of patients ask, "Do you want the best painkiller the doctor can give me? The pain is unbearable." But in fact, the word "best" does not exist in chronic pain medication, and even the logic of medication is completely different from that of acute pain.

For example, the most well-known non-steroidal anti-inflammatory drugs are ibuprofen, diclofenac sodium, and celecoxib that we often buy. They are targeted at inflammatory chronic pain, such as osteoarthritis, rheumatoid arthritis, and pain caused by muscle strain. They are frequent visitors to many home medicine cabinets. However, there has been considerable controversy in the industry as to whether this type of medicine can be taken for a long time: Some European and American guidelines believe that patients with chronic osteoarthritis without peptic tract ulcers or abnormal liver and kidney function can take long-term low-dose medication, as long as liver and kidney function and digestive tract indicators are monitored every 3 months; however, many domestic geriatrics departments Gastroenterologists are more inclined to "use as little as possible." I once met a 62-year-old patient with knee arthritis who took ordinary ibuprofen for 3 months in a row. Finally, he was hospitalized for gastric bleeding. He had Helicobacter pylori infection, but he didn't take it seriously. In the end, the pain did not go away and he developed new problems.

What’s interesting is that when many patients receive anticonvulsant and antidepressant drugs, their first reaction is, “Doctor, did you prescribe the wrong drug? I’m here to treat pain, how can you prescribe psychiatric drugs for me?” Last week, I met an aunt in the outpatient department who was suffering from post-herpetic pain. When she got gabapentin, her face turned dark, thinking that I had given her the medicine of another patient. In fact, these two types of drugs are aimed at neuropathic pain - the kind that feels like an electric shock, like a needle prick, and hurts when you touch the skin, such as post-herpetic pain, diabetic peripheral neuralgia, trigeminal neuralgia, and central hyperalgesia such as fibromyalgia. Ordinary painkillers are basically useless, but these two types of "cross-border" drugs are more effective. Of course, it is not without controversy. Many patients will feel dizzy, drowsy, and even a little nauseous after taking pregabalin or duloxetine. Many people feel uncomfortable after taking it for a day or two and then stop privately. The money is wasted and the pain is not relieved. When the old director of our department attends consultations, he will give special instructions to patients who are prescribed this kind of medicine: take half the amount for the first three days and slowly increase the amount. The side effects will subside when the body tolerates them. It takes at least a week to judge whether there is any effect.

When it comes to opioid analgesics, it is estimated that many people’s first reaction is “morphine” and “addiction”, and they avoid them. There was an old man who had advanced lung cancer with bone metastasis. He lay in bed in pain and shed tears. His family prescribed OxyContin, but he refused to take it. He said that after taking it, he would become an "addict" and he would never quit. In fact, in the current three-step dosing specification for chronic cancer pain, opioids are the drug of choice for moderate to severe pain. When used in a standardized manner, the addiction rate is less than 0.03%. There is no need to worry about the so-called "addiction" problem. But for non-cancer chronic pain, such as chronic low back pain and migraine, the consensus in the industry is to strictly limit the use of opioids. In the past, European and American countries were too lax in prescribing opioids to patients with non-cancer pain, which triggered an opioid crisis sweeping the country. In this regard, the country has always been very stuck in this regard. Unless it is severe and refractory chronic pain for which other drugs are useless, opioids will basically not be prescribed to you.

Many pain doctors now prefer to prescribe topical analgesics to patients first, such as Voltaren ointment, flurbiprofen gel patch, lidocaine patch, etc., especially for patients with only localized pain, such as wrist tenosynovitis, knee arthritis, and chronic pain from muscle strain. I met a young man who injured his back while doing gymnastics. He took ibuprofen for more than two months. He suffered from acid reflux and was diagnosed with superficial gastritis. I immediately stopped taking his oral medication, prescribed two boxes of flurbiprofen patch, and added a week of muscle relaxants. A follow-up check this week said that the pain has been reduced by 80%, and his stomach is no longer uncomfortable. However, many people also have misunderstandings when using topical medications. They peel off the patch after applying it for one or two hours and feel it has no effect. In fact, this type of patch usually takes 6 to 12 hours to reach the effective concentration, so you have to be patient.

Oh, by the way, there are also some auxiliary drugs, such as muscle relaxants and methylcobalamin that nourish nerves. They are sometimes used with analgesics. They are not first-line analgesics, but they are very effective for some patients with muscle tension and nerve damage. Don’t be surprised if the doctor prescribes them to you.

After all, chronic pain is a very individual matter. It is also a lumbar pain. Some people can take celecoxib, while others need to add pregabalin. There is no unified standard answer. Don’t blindly buy medicines after checking the information on your own, and don’t always think that painkillers have so many side effects that they hurt you so much that you refuse to take them. The safest way is to go to the pain department of a regular hospital to find out what type of pain you have first, and then choose the medicine that suits you.