Pharmacologic Treatment of Chronic Pain

Abstract

The pharmacologic treatment of chronic pain can be achieved through a multifaceted approach that enables selection of specific pharmaceutical preparations within a specific drug family, as well as selection between several independent families of drugs. In addition, combinations of drugs chosen from different families can be utilized to maximize pain relief while minimizing undesirable side effects. Several principles should be kept in mind when prescribing medications for the treatment of chronic pain. First, pharmacotherapy is only one part of a comprehensive approach to chronic pain. Pain relief can be augmented by combining physical therapy, psychological assessment, behavior modification, TENS, etc., with appropriate medication. Second, pain medication only reduces symptoms — it does not definitively treat the underlying problem(s). Third, minimize the number and frequency of medications whenever possible. This reduces potential side effects, and confusion regarding dosing schedules. Fourth, use drug combinations that do not have additive side effects. For example, aspirin and ibuprofen both have predominantly gastrointestinal side effects. Using them in combination can put the patient at increased risk of developing gastric or duodenal ulcers. Acetaminophen, however, has lower incidence of ulcerogenesis and, therefore, is a better agent for combining with ibuprofen and/or similar medications. Fifth, side effects may increase over time. Finally, narcotics should be avoided in treatment of chronic pain syndromes, with the possible exception of short-term treatment of acute pain exacerbations.KeywordsSalicylic AcidChronic PainAnthranilic AcidNarcotic AnalgesicChronic Pain SyndromeThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.