Pain medications are used to treat a wide variety of conditions.

Each class of medications works via a different method and knowledge of the particular properties of a medication enables us to tailor its use to target the specific condition requiring treatment.

Inflammatory pain

Non-steroidal anti inflammatory drugs (NSAIDs)

This class of medications are designed to reduce inflammation. Whilst generally considered safe for use in most people, there are some potential side effects. The most common problems are gastrointestinal upset, heartburn (acid reflux) and peptic ulceration, acute exacerbation of asthma and effects on kidney function. Some anti-inflammatories are also known to increase the risk of sudden cardiac events (eg. heart attack) and stroke, particularly in patients with known cardiac risk factors such as high blood pressure, high cholesterol and obesity.

Nonselective vs Cox-2 inhibitors?

There are different subtypes of NSAIDs that have slightly different side effect profiles. Early/traditional NSAIDs were nonselective in their action and are known to cause increased acid production in the stomach, leading to increased risk of acid reflux and peptic ulceration. Cox-2 inhibitors were subsequently developed in an attempt to reduce this potentially dangerous side-effect of anti inflammatories by acting more selectively on the anti inflammatory pathways in the body. Whilst there is a slightly lower risk of acid reflux with selective Cox-2 inhibitors, the trade-off is that these anti-inflammatories carry a higher risk of cardiac side effects than nonselective NSAIDs.

How long should I use NSAIDs?

It is best to consult with your doctor before using NSAIDs. In general, short courses (2 weeks or less) are preferred. Prolonged use of NSAIDs increases the risk of having serious side-effects.

Nerve pain

Nerve pain can occur for a number of reasons. These include direct nerve compression (eg. a from a spinal disc prolapse/bulge) or from an abnormal pain syndromes that can occur following a local injury.

When these problems occur, early treatment to reduce nerve hyperactivity is important. This is because when pain continues for a long period, the central nervous system becomes more and more sensitive to pain impulses whilst becoming more and more resistant to efforts aimed at quietening them down.

Endep (amitriptyline)

Endep has traditionally been utilised for its antidepressant properties. In smaller doses, however, endep has the ability to quieten down hyperactive nerves and reduce nerve pain. The most common side effect of endep is drowsiness.

Lyrica (pregabalin)

Initially introduced as an anti-seizure medication, lyrica is also effective in reducing nerve pain. It tends to cause less drowsiness than endep but can occasionally cause mood problems in those with a history of depression.

Finch’s paste

Finch’s paste is a mixture of three medications (amitriptyline, gabapentin and ketamine) in a topical cream that is rubbed onto a body part affected by a pain syndrome. All three medications reduce the sensitivity of peripheral nerve receptors to block pain signals from reaching the central nervous system. The paste can be used in conjunction with oral medications (eg. lyrica or endep) in pain syndromes where nerves become hyperactive. The rationale is to block pain signals from both ends. The paste blocks the peripheral nerve impulses whilst the oral medications block pain impulses at the central nervous system.

Other painkillers

Paracetamol (panadol), tramadol and opiates (eg. codeine) are often used to treat pain.

Unlike NSAIDs or medications to treat nerve pain, these are less specific and simply reduce the body’s perception of pain. Though widely used, all of these medications have potential side-effects and should only be used as directed. However as a general rule, paracetamol is considered the most safe of these and is the best choice as first line pain relief for most conditions. As always though, like the tv commercials constantly remind us, “if pain persists, please see your doctor” :)