Medication Management

Our pain doctors have a number of tools they can use to help patients manage, and sometimes eliminate pain. These tools include a number of specialized, minimally-invasive procedures; exercise, physical therapy, and occupational therapy as well as medications. Medications used for pain management have various purposes. As part of a comprehensive pain management plan, our providers might prescribe one or more of the medications described here.

Narcotics
Narcotics are usually prescribed for severe pain. These medicines range from mild to extremely potent. Among the mild narcotics are brand names such as Darvocet®, Darvon®, and Ultram®. Moderately potent drugs include hydrocodone, whose brand names include Lortab®, Lorcet®, and Vicodin®. The most potent narcotics are oxycodone, whose brand names include OxyContin®, Percodan®, Percocet®, Tylox®m and Demerol®, morphine and methadone. The appropriate potency and amount needed for management of your pain will be determined by your doctor.

Narcotics have the potential to be habit-forming. Many people who are prescribed narcotics worry about becoming addicted to them. Your interventional pain physician is very aware of these addiction risks, and will monitor you and test you to make sure you are taking these powerful drugs as prescribed. Model guidelines have been developed for using controlled substances for treating pain. The major features of these guidelines are: a comprehensive evaluation of the patient, a written treatment plan, informed consent and agreement for treatment including a controlled substances agreement, periodic review, appropriate consultations as necessary, maintain medical records, and compliance with controlled substances loss and regulation. It is very important that you follow your prescribing instructions. Working together, you and your doctor can make sure that the narcotics prescribed to you are safe and effective.

NSAIDS
The most commonly used drugs are called non-steroidal anti-inflammatory drugs (NSAIDS). In their mildest form, these drugs are available over-the-counter. They include aspirin and ibuprofen. Prescription NSAIDS include Lodine®, Daypro®, Celebrex®, Vioxx®, and Bextra®. Aspirin has been around for generations and its use as a pain reliever and fever reducer is well-established. Ibuprofen is also available over-the-counter in generic form and brand names such as Advil®, Motrin®, and Nuprin®. Ibuprofen is a proven pain reliever and fever reducer. It also helps reduce inflammation, a common cause of pain. Acetaminophen, available both generically and as the brand name Tylenol®, is not an NSAID, but it is also easily available over-the-counter. It is a well-established pain reliever and fever reducer; however, it lacks the anti-inflammatory ability of NSAIDS. Doctors commonly prescribe acetaminophen along with an NSAID. Your doctor will tell you if that is the right combination for you.

Other Pain Management Medications
As part of your overall treatment plan, other medications might be prescribed for you. Muscle relaxants have not been shown to be effective for chronic pain management because muscle spasm is not likely to be the cause of chronic pain. However, in some patients, a muscle relaxant is needed. Your doctor will make that determination. Antidepressants are often prescribed for patients with chronic pain. A patient does not have to be clinically depressed to benefit from taking an antidepressant. But living with pain is more than just physical—the psychological aspect is just as important. Patients diagnosed with depression usually receive higher doses of antidepressants than those who are not depressed. Antidepressants have been proven to be helpful for managing chronic pain due to nerve ending damage. Anticonvulsants, such as medicines used for epilepsy or other seizures, have proven to be helpful for dealing with pain caused by nerve injury or damage.

Which Medications Are Right For Me?
Medication management is one of the many ways your interventional pain physician will help you manage, and perhaps even eliminate your pain. Your doctor will take into account the intensity and duration of your pain and other important factors, such as your age, other medical problems you might have, and the other medications you are taking. Deciding the pain medications and dosages that are right for you is very individual. Oftentimes, one drug will work well for one patient but not another. That is why it is so important that you communicate with your doctor about the relief you are getting from whatever is prescribed to you.

Remember: pain-relieving drugs are just one aspect of your treatment plan. Your interventional pain physician takes a multidisciplinary approach to helping you manage your pain. Every aspect of your treatment is equally important. Follow your doctor’s orders and like many others who have seen an interventional pain physician, it is hoped you too will soon enjoy relief from, and maybe even elimination of, your chronic pain.