There are several medications for chronic pain relief

Currently, there are five categories of clinically recognized core medications for chronic pain relief. There are also three categories of auxiliary medications that can be used in combination with special pain scenarios. There is no unified standard for specific drug selection. It must be comprehensively judged based on the type of pain, basic medical history, and tolerance level. There is no absolute "optimal analgesic."

When I was rotating in the pain department clinic two years ago, I met an aunt Zhang who had suffered from lumbar disc herniation for three years. When the pain was severe, she went to the pharmacy to buy ibuprofen and took it for half a year. In the end, the pain did not go away and she ended up with stomach bleeding and was hospitalized. This was because she did not understand the scope of application and risks of different painkillers.

The most common ones are nonsteroidal anti-inflammatory drugs (NSAIDs) that are in everyone’s medicine cabinet, which are usually the mainstay of ordinary painkillers. Ibuprofen, diclofenac sodium, and celecoxib all belong to this category. This type of medicine has the best effect on chronic pain induced by inflammation, such as osteoarthritis pain, muscle strain pain, and inflammatory pain caused by lumbar protrusion compression of nerve roots. It can be significantly relieved after taking it for half an hour. There is still controversy in the industry about the long-term use of this type of drug: one school of thought believes that as long as it is controlled at the minimum effective dose, patients without underlying gastric problems can take it as needed for a long time. ； The other group emphasizes that even low-dose long-term use can increase the risk of peptic tract ulcers, renal damage, and cardiovascular events. The patients I come into contact with usually remind me that it is best to take it with a gastric mucosal protective agent if it is taken for more than 7 consecutive days. People with a history of gastric ulcers and reflux esophagitis should try not to use it if possible.

If the pain is more severe, for example, it has affected sleep and daily activities and cannot be suppressed by ordinary painkillers, such as moderate to severe cancer pain and post-herpetic neuralgia, opioid painkillers will be used clinically. OxyContin and Thelenin are commonly used. This type of drug is actually more controversial. Many patients in China think of addiction when they hear the word "opioid" and refuse to take it. They refuse to take the drug even if they are in pain all night long. The current consensus among the global pain academic community is that as long as doctors strictly follow doctor's instructions and take standardized doses, the addiction rate of chronic pain patients taking opioids is less than 0.1%, which is far lower than everyone knows. However, you should pay more attention to the side effects. Many people will experience constipation and dizziness after taking it. Don’t force it. Ask a doctor to prescribe some laxatives and adjust the dosage to relieve the pain. Don’t stop taking the medicine casually and delay the pain relief.

There is also a class of anticonvulsants that were originally used to treat epilepsy and are now also first-line drugs for chronic neuralgia. Pregabalin and gabapentin both belong to this class. The kind of post-herpes pain that hurts like an electric shock and even hurts when you touch the skin, and the peripheral nerve pain caused by diabetes. Ordinary painkillers have no effect at all. Switching to this kind of medicine can often have miraculous effects. There was an old man in his 70s who suffered from shingles pain for half a year. He even cried when clothes rubbed against his skin. After taking pregabalin for three days, he was able to walk downstairs normally. The only thing to note is that you may feel a little drowsy when you first start taking it. If you usually drive or operate precision instruments, you must tell your doctor in advance to adjust the dosage.

Many patients are stunned when they see antidepressants when they receive a prescription, wondering whether the doctor prescribed it wrong: "I just have pain and I'm not mentally ill, why are you prescribing this?" ”In fact, antidepressants such as duloxetine and amitriptyline have long been included in the routine medication list for chronic pain. They can regulate pain signal transmission in the central nervous system, and can also improve the anxiety and depression caused by long-term torture of chronic pain. They are particularly effective for pain without detectable organic disease such as fibromyalgia, chronic tension headache, and chronic pelvic pain. Nowadays, many patients are resistant to this and feel that taking it "makes them mentally ill". In fact, there is no need to have this psychological burden. In small doses, it will not affect mood and cognition at all, it just modulates pain signals.

There is also a type of external preparations that is often ignored by everyone. Flurbiprofen gel patch, Voltaren cream, and lidocaine patch are all included. For local knee joint pain, shoulder and neck pain, and muscle strain pain, external preparations are much safer than oral medications, and there are basically no side effects on the liver, kidneys, or digestive tract. Many people say that the patch is of no use. Most of the time it is because the patch is in the wrong position, or if the patch is applied for two or three days, the active ingredients have evaporated, and of course it is useless. Generally, the patch needs to be replaced every 12 hours, and it must be accurately applied to the location where the pain is most obvious to be effective.

As for auxiliary medication, there is no unified standard. If you have neck and shoulder strain pain where your neck is as hard as a slate and your muscles are tight, combining it with a muscle relaxant such as eperisone will be twice as effective as taking painkillers alone. ； If osteoporosis causes bone pain all over the body, adding calcitonin can relieve the pain from the root. There are currently different opinions in the industry regarding the use of Chinese patent medicines. Most doctors in the Western medicine system believe that most blood-activating and analgesic Chinese patent medicines lack large-scale evidence-based medical evidence and are not recommended as first-choice medicines. ； Doctors with a background in traditional Chinese medicine believe that as long as the syndrome differentiation is accurate, the combination of them can often achieve the effect of 1+1>2 for chronic pain caused by factors such as cold-dampness and blood stasis. My own experience in clinical practice is that as long as the preparation is produced by a regular pharmaceutical company and has the national drug approval, it can indeed be used as an auxiliary option as long as liver and kidney function contraindications are eliminated. However, it is definitely not recommended for everyone to buy the "ancestral pain relief remedies" promoted in WeChat Moments and small advertisements. Many of them secretly add large doses of hormones and painkillers, which are effective in the short term but can damage bones in the long term.

After all, there is really no fixed formula for taking medicine for chronic pain. I have seen a 20-year-old boy who also suffered from lumbar prolapse pain take one ibuprofen and go play ball. But another aunt with a history of gastric ulcer had to use pregabalin plus topical patch to suppress the pain. If you are really in pain for more than a month, don't randomly try medicines on your own. See a pain doctor for an evaluation before choosing. It is much more trouble-free and less painful than buying random medicines on your own.