Medication Evaluation
A Medication Evaluation can be performed to assess your regimen of medications to help optimize control your chronic pain. Our goal is to decrease your pain, increase your functional ability, and to improve your quality of life.
Many different classes of medications may be recommended to help control your pain depending on the type of pain that you are experiencing. Your provider may recommend one or several of these medications to try to help control your pain.
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Types of Medications:
Muscle Relaxants:
Muscle relaxants are a broad class of medications designed to decrease pain due to muscle spasms. They are also used to reduce spasticity that is seen with neuromuscular disorders. Muscle relaxants are more effective for acute pain, but may have a role in the management of chronic pain for some patients. The most common side effect from muscle relaxation is sleepiness. Common muscle relaxers include cyclobenzaprine (Flexiril, Amrix), tizanidine (Zanaflex), metaxalone (Skelaxin), and methocarbamol (Robaxin).
Anti-inflammatories:
Anti-inflammatories reduce pain by reducing inflammation and swelling. The most common anti-inflammatories are the NSAIDS. Common NSAIDs include diclofenac (Voltaren), ibuprofen (Advil, Motrin), Mobic (Meloxicam), and naproxen (Aleve).
Other inflammatories are Cox-II inhibitors such as Celecoxib (Celebrex) are used because they are typically easier on your stomach lining.
Corticosteroids are the type of steroid used for inflammation. They are typically derived from prednisone and include oral and injectable forms.
Anti-convulsants:
Anticonvulsants (also referred to as anti-epileptics or anti-seizure medications) are a class of medications that have multiple uses in our realm for treatment of headaches, and neuropathic pain. Common anticonvulsants used for pain management include gabapentin (Neurontin, Grails, Horizant), pregabalin (Lyrica), and topiramate (Topamax, Trokendi).
Anti-inflammatories:
Anti-inflammatories reduce pain by reducing inflammation and swelling. The most common anti-inflammatories are the NSAIDS. Common NSAIDs include diclofenac (Voltaren), ibuprofen (Advil, Motrin), Mobic (Meloxicam), and naproxen (Aleve).
Other inflammatories are Cox-II inhibitors such as Celecoxib (Celebrex) are used because they are typically easier on your stomach lining.
Corticosteroids are the type of steroid used for inflammation. They are typically derived from prednisone and include oral and injectable forms.
Anti-depressants:
Antidepressants are a class of medications originally designed to treat depression, however many of these medications are very effective in treating chronic pain. They can work at the spinal cord and brain level to to reduce the intensity of pain signals. Common antidepressants used in pain management include amitriptyline (Elavil), nortripyline (Pamelor), milnacipran (Savella), and duloxetine (Cymbalta).
Acetaminophen:
Acetaminophen (Tylenol) is not an NSAID and does not reduce inflammation, but rather is a pain reliever. It typically works well when combined with an opioid medication -- with the combination of the two medications providing more relief than if they were taken separately.
Opioids/Opiates/narcotics:
These are what most people refer to as "pain pills" and are usually prescribed for severe pain. Opioids work by decreasing the perception of pain that the patient feels.
Common side effects include nausea, vomiting, sedation, respiratory depression, constipation, itching (pruritus), and euphoria.
Opioid medications can also be highly addictive and have withdrawal symptoms if stopped abruptly. Common opioid medications include Hydrocodone (Norco, Vicodin, Lortab), Oxycodone (Percocet, Oxycontin), Morphine, Dilaudid, Methadone, and Fentanyl.
There is growing evidence regarding negative consequences of long-term use of these medications. These medications are most effective when used short-term for acute/new pain rather than long-term for chronic conditions.