Pain medications are often used by your doctors to help reduce chronic pain. Medications work best when combined with other types of treatment such as nerve blocks and physical therapy to increase your level of physical activity.
Ongoing review of your pain medications is important to maximise pain relief and minimise side effects. Your pain specialist will assess your medications and work with you to get the doses and combinations correct. We also work with you and guide you in managing your own pain medications so you can adjust them depending on your needs.
It is preferable to take two or more pain medications in low doses, rather than just one pain medication in a big dose. This is because various pain medications work differently in the body but all can cause serious side effects. Taking a few medications at lower doses reduces side effects and allows them to work on different parts of the pain in combination to significantly reduce pain.
Medications commonly used for the treatment of pain
Anti-inflammatories eg. celecoxib (Celebrex), ibuprofen (Brufen, Nurofen), diclofenac (Voltaren), indomethacin (Indocid), meloxicam (Mobic)
naproxen (Naprosyn), ketoprofen (Orudis)
These medications work on nerve pain. Anti-neuropathic pain medications might include:
Tricyclic antidepressants (TCAs) like amitriptyline (Endep) and nortriptyline (Allegron).
Serotonin-noradrenaline reuptake inhibitor (SNRIs) antidepressants like duloxetine (Cymbalta), venlafaxine (Effexor) and desvenlafaxine (Pristiq)
Benzodiazepines eg diazepam (valium)
It is also far safer to use non-opioid pain medications in chronic pain because opioid medications may not help reduce the pain and carry serious risks. Opioid medications include:
Sometimes pain medications are creams or ointments that can be applied to areas of the body that cause chronic pain. This is an example of off-label use of pain medications. They work very well for some people and have very few, if any side effects.
We work with compound pharmacies that are able to make combinations of pain medications that can be tailored to your pain condition. Medications that can be made into creams include ketamine, gabapentin, amitriptyline, clonidine, and lignocaine.
There are topical patches that work well for nerve pain:
capsaicin (Qutenza) – will be available soon
Sometimes we give pain medications by infusion over a few days as an in-hospital treatment. These medications include ketamine and lignocaine infusion. We only use these treatments in carefully selected patients with chronic pain for whom oral pain medications have failed.