NSAIDs, or non-steroidal anti-inflammatory drugs, are usually considered to be the first line of defense for acute pain, especially pain that doesn’t respond to other non-drug treatments.

They also lower fevers and reduce inflammation. This anti-inflammatory effect makes these medicines useful when inflammation is part of the problem, as usually happens in joints diseases. Then, osteoarthritis, rheumatoid arthritis, and headaches are common conditions that NSAIDs treat.

NSAIDs use can lead to gastrointestinal upset and bleeding and may increase the risk of heart disease and stroke.

Pain Doctors prescribe anti-depressants to treat chronic pain associated with diabetic neuropathy, fibromyalgia, neck pain, and low back pain. That doesn’t mean you’re depressed. Anti-depressants are used for other reasons, too. In fact, they help control pain by changing your body’s chemicals.

There are 2 categories of anti-depressants that work well with pain:

• Tricyclic antidepressants (TCAs), Examples of TCAs are amitriptyline hydrochloride (Elavil) and nortriptyline (Pamelor).
• Serotonin and norepinephrine reuptake inhibitors (SNRIs). Examples of SNRIs are duloxetine (eg, Cymbalta) and venlafaxine (Effexor).

.

These medications work to suppress the nerve signals going to your brain so pain messages aren’t transmitted as well. As with anti-depressants, if we prescribe an anti-seizure medication, that doesn’t mean he or she is treating you for seizures. We are looking for the pain management effect. Anti-seizure medications can treat chronic pain caused by diabetic neuropathy and fibromyalgia.

Examples of anti-seizure medications are pregabalin (Lyrica) and gabapentin (eg, Gabarone).

Steroids are powerful anti-inflammatory medications that can be taken orally (eg. prednisone) or injected. Corticosteroids are used to treat migraines, osteoarthritis, rheumatoid arthritis, and low back pain. If prescription-strength NSAIDs haven’t reduced your pain, your doctor may advise you to try corticosteroids. They’re responsible for stopping your body from producing the chemical that causes inflammation. Many times are injected close or in the inflamed joints.

Steroids have certain side effects (eg, weight gain, raising blood glucose, weight gain). You can’t just stop taking them—your dose must be slowly decreased.

Muscle relaxants aren’t typically recommended for treating chronic pain, but they may help with fibromyalgia and low back pain symptoms. These medications are used to reduce aches and pains associated with muscles strains, sprains, or spasms. Muscle relaxants can provide the pain relief you need to manage your daily activities by helping relax tight muscles and improve the quality of sleep you get. Examples of muscle relaxants are carisoprodol (Soma) and baclofen (Lioresal).

In the most extreme pain cases, we could prescribe you an opioid. Due to potent side effects and the risks of tolerance or abuse, you’ll need to be under your doctor’s careful supervision when taking this medication.

Opioids—also called narcotics—are potent painkillers. They provide immediate relief to intense pain by changing your brain’s perception of the pain message. However, opioids are typically prescribed only if other medication options aren’t successful. They may be prescribed for low back pain, neuropathic pain, or arthritis pain, for example. Examples of opioids are oxycodone (Endocet), tramadol (Ultram), and morphine.

The use of opiate analgesics or narcotics is not the answer to the treatment of chronic pain. They can be addicting and can decrease the patient’s ability to cope with pain. When we prescribe opioids, we attach to the highest ethical and medical standards.