chronic pain relief medications

Currently, chronic pain relief drugs that are clinically recognized as safe and effective can be roughly divided into three categories: non-opioid analgesics, auxiliary analgesics, and opioid analgesics. There is no "magic drug" that suits everyone. Only an individualized plan that matches the cause of pain, individual underlying diseases, and tolerance level, and any drug needs to be coordinated with lifestyle adjustments, can long-term pain relief be achieved and side effects avoided.

When I was rotating in the pain department two years ago, I met a 58-year-old aunt who had been suffering from radiating pain in her right lower limb due to lumbar disc herniation for three years. She was reluctant to go to the hospital, so she kept a drawer of ibuprofen at home. When the pain was severe, she took two pills. In the end, the pain did not stop, and she was hospitalized for gastric bleeding. The first thing she asked me when she arrived at the clinic was, "Are there any painkillers that won't hurt my stomach?" It’s best to remove the root.” This is also the first question asked by almost all patients with chronic pain.

Let’s start with the most familiar non-steroidal anti-inflammatory analgesics, namely ibuprofen, diclofenac, and celecoxib, which are currently the drugs of choice for chronic musculoskeletal pain (such as degenerative arthritis, fasciitis, and mild to moderate lumbar protrusion pain). In fact, there has been controversy in the industry: some doctors believe that as long as there are no underlying diseases such as peptic ulcer or severe coronary heart disease, it is okay to use low doses intermittently for half a year and a year. ； The other group is more conservative and believes that long-term use of even a selective COX-2 inhibitor such as celecoxib will increase the risk of cardiovascular events, and it is best not to use it continuously for more than 2 weeks. My own habit is that when I prescribe it to patients, I will always say "Take it when it hurts, stop when it doesn't hurt, don't take it as a health supplement every day." After all, medicine is three-part poison, and this is really not an old-fashioned saying.

But don’t tell me, this kind of medicine is not effective for all chronic pain. Last year I met a 27-year-old programmer. After the shingles healed, he suffered from neuralgia on his left chest wall for almost half a year. He took ibuprofen at the maximum dose for a week. The pain was so severe that he didn't even dare to turn over, and it was of no use. His type of pain is typical neuropathic pain, which requires the use of "auxiliary analgesics." He was prescribed gabapentin, and after taking it for a week, the pain was reduced by more than half. This type of medicine was originally used to fight epilepsy and anti-depression. It was later discovered that they can regulate the abnormal discharge of nerves and are particularly effective for "pain caused by nerve problems" such as neuralgia and fibromyalgia. They are now the first-line medicine for this type of pain. Of course, there are many controversies: For example, most doctors in the gods recommend pregabalin, which has faster onset of action and fewer side effects. However, the price is several times that of gabapentin, and many grassroots patients not covered by medical insurance cannot afford it. ； There are also antidepressant auxiliary analgesics such as duloxetine. Every time I prescribe it, I have to explain to the patient for a long time, "This does not mean that you have a mental problem, but it can really help you relieve the wandering pain throughout the body." I am afraid that the patient will be conflicted and throw the medicine away and refuse to take it.

As for opioid analgesics, which make people wave their hands in fear when they hear it, they are the most controversial category in the pain department. Many doctors in China have a very conservative attitude: unless it is cancer pain or severe refractory pain that all other drugs are ineffective, they will never touch it, for fear of patients becoming addicted and for fear of taking responsibility. However, many doctors who follow international guidelines believe that as long as the titrated dosage is standardized and sustained-release opioids are used, the probability of long-term addiction in patients with chronic non-cancer pain is less than 1%, which is much safer than everyone thinks. I used to treat an old man with advanced lung cancer. He took OxyContin for pain relief for more than a year. The dosage was adjusted very steadily. He was neither addicted nor had respiratory depression. The only side effect was constipation. Every time he came for a follow-up checkup, he complained to me, "It's harder to poop when taking this medicine than when it hurts." In the end, it was relieved with laxatives. Ordinary chronic pain patients who really need to use opioids can just follow the doctor's advice. There is no need to talk about it, but they must not buy it privately and eat it blindly.

There are also many patients who recommend "pure natural painkillers" and "painkillers imported from Japan" recommended by Aisin Internet celebrities. Don't believe it. I met a little girl this year. She bought the Internet celebrity's painkillers overseas for half a year and suffered from dysmenorrhea. As a result, the transaminase was three times higher than the normal value during the physical examination. She took it to the drug testing center for a check and found that a large dose of unlabeled non-steroidal ingredients was added to it. It was larger than the normal dose of ibuprofen. It hurt the liver and stomach only.

I have been in the pain department for almost 5 years, and my deepest feeling is that chronic pain is never a problem that can be solved by taking medicine alone. You sit for 12 hours a day, and your lumbar spine is so compressed that you can’t straighten it up. No matter how much celecoxib you eat, you can’t stop the recurrence of lumbar pain. ； If you stay up late every day anxious, your nerves will always be tense. No matter how much gabapentin you take, the neuralgia will easily recur. To put it bluntly, medicine is a brake, helping you to interrupt the vicious cycle of "pain → poor sleep → poor mood → more pain". The rest is up to you to change those bad living habits. After all, being able to live without pain is better than anything else, right?