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Adjuvant Medications for Pain Management

Table of Contents

Chronic pain and the use of narcotic pain medications are the leading cause of opiate dependency. Vicodin and Percocet are two of the most common medications prescribed to treat chronic and acute pain. Patients and physicians often think that narcotics are the only medications available to effectively treat pain. The longer a patient is on narcotic pain medications, the more they build a tolerance to its effects. This means that they will need more and more of the medication to achieve the same effect. Before long, many patients need opiate medication just to feel normal.
Fortunately, several alternative medications are available that can help control chronic pain. Chronic pain conditions are often best treated with a combination of alternative medications instead of strictly narcotics. Opiate drug dependence can be avoided when narcotics, such as OxyContin and Percocet, are avoided. The three most common alternative medications classes are NSAIDs, antidepressants, and anti-seizure drugs.

NSAIDs

Non-steroidal anti-inflammatory drugs are medications that decrease pain and swelling without the use of steroids. Steroids are generally strong and effective, but they do carry side effects, such as weight gain. NSAIDs decrease inflammation and have good analgesic qualities, but they do have side effects. Stomach upset, kidney problems and blood pressure issues have all been seen with NSAIDs. Common over the counter NSAIDs are Advil and Aleve, but a doctor can prescribe a special type of NSAID called a COX-2 inhibitor. These decrease stomach problems, but many of them have been linked to heart disease.

Antidepressants

Antidepressants have been used and studied for use in chronic pain for many years. The ones studied the most intensively are the oldest ones, such as the tricyclic drugs. An example of this type of drug would be amitriptyline. Tricyclics are used to treat headaches, back pain, nerve pain, migraines, sleep disturbances, and herpes. Selective serotonin reuptake inhibitors, such as Prozac, Lexapro, and Celexa, are other commonly used antidepressants to treat pain. Cymbalta is a selective norepinephrine reuptake inhibitor antidepressant, and it is the first and only antidepressant medication that is FDA approved to treat chronic pain. Some side effects include sedation, weight gain, confusion, and depression.

Anti-Seizure Medications

Anti-seizure medications are commonly used as adjunctive medications. They are used to treat nerve pain mostly, but they also have applications in headache, migraine, radiculopathy, sciatica, and back pain. Chronic nerve pain is characterized by the constant firing of nerves and the release of neurotransmitters into the synaptic gap. This triggers pain signals in the brain, and those signals appear in much the same way as seizure activity. The most researched and commonly used anti-seizure medication for pain is gabapentin or Neurontin, but others such as Topamax and Dilantin are used as well. Lyrica is a member of this class of drugs, and it is the only anti-seizure medication that is FDA approved for diabetic peripheral neuropathy and fibromyalgia pain. These medications do have some side effects, such as weight gain, confusion, sedation, and tingling in the extremities.

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