There are several medications for chronic pain relief

There is no absolute “optimal choice” among nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, opioid analgesics, auxiliary analgesics, and topical analgesics. The specific choice should be comprehensively judged based on the type of pain, underlying disease, and tolerance.

Last week, the outpatient clinic received a 62-year-old lumbar protrusion patient, Aunt Zhang, who had been suffering from back and leg pain for three years. She was afraid of going to the hospital, so she stocked up on ibuprofen at home. She took one pill when the pain started, and she continued to take it for almost half a year. Last week, she suddenly blackened and passed out and was sent to the emergency room. It was found that a large area of ​​gastric mucosal ulcer was bleeding, which was caused by long-term indiscriminate use of non-steroidal anti-inflammatory drugs. We often say that ibuprofen, diclofenac, and celecoxib all belong to this category. They essentially relieve pain by inhibiting the inflammatory response. They are most effective for chronic pain related to inflammation such as strain, arthritis, and fasciitis. However, the disadvantages are also obvious: long-term oral administration will irritate the gastric mucosa and increase the risk of kidney damage and cardiovascular adverse events. The current guidelines from the European and American Pain Society recommend that this type of patients give priority to topical non-steroidal gels and patches. Transdermal absorption only acts locally, and systemic side effects are more than 80% lower than oral administration. However, many domestic patients always feel that "applying them is not as effective as eating them." They would rather take oral medications with the side effects. There is a big difference in concepts.

If you have gastric ulcer or chronic gastritis and cannot take such irritating painkillers, most people will first choose acetaminophen, which is commonly known as paracetamol. This medicine has a weak anti-inflammatory effect, but little irritation to the gastrointestinal tract. It is effective for mild to moderate chronic headaches, muscle pain, and joint pain. However, special attention must be paid to its liver toxicity. The single daily dose cannot exceed 2g. Acetaminophen is added to many compound cold medicines and cough medicines. It is easy to overdose if taken by yourself. I met a 28-year-old chronic migraine patient before. He took both painkillers and Ganmao Ling when he was in pain. In less than a week, his transaminase level soared to over 300. He just didn’t pay attention to the ingredients.

If the pain is moderately severe and cannot be suppressed by ordinary analgesics, you may use opioids that everyone has heard of, such as oxycodone, morphine, and fentanyl patches. There has always been great controversy about this type of medicine: for chronic cancer pain, the WHO three-step analgesic principle clearly recommends the standardized use of opioids. As long as they are used according to the doctor's instructions on time and in the right amount, the addiction rate is less than 1%. There is no need to bear it because of fear of addiction. ； However, for non-cancer chronic pain, such as chronic low back pain and neuralgia, the academic community is divided into two groups. One group believes that short-term use of small doses can quickly relieve pain and improve the quality of life. The other group believes that long-term use can easily lead to tolerance and hyperalgesia. On the contrary, the more pain you take, the more pain you take. There is also a risk of abuse. Therefore, domestic hospitals are now particularly cautious about prescribing opioids to patients with non-cancer pain, and generally do not use them as the first choice.

Many people may not know that there is a class of drugs that seem to have nothing to do with pain relief, but are actually the first choice for chronic neuralgia—auxiliary analgesics, including anticonvulsants such as pregabalin and gabapentin, and antidepressants such as duloxetine and amitriptyline. When many patients get the medicine and read the instructions for treating epilepsy or depression, their first reaction is that "the doctor prescribed the wrong medicine." In fact, this is not the case at all. For example, neuropathic pain such as postherpetic neuralgia, diabetic peripheral neuralgia, and trigeminal neuralgia are caused by abnormal nerve discharges. Taking ibuprofen and acetaminophen is basically useless. These auxiliary drugs directly regulate the excitability of nerves and reduce the generation of pain signals from the source. There was a 70-year-old man who suffered from chest wall pain for 3 months after herpes zoster was cured. It hurt even when he was wearing clothes. He took ibuprofen for half a month but it didn't help at all. After taking pregabalin for 3 days, he said the pain was so bad that he could sleep through the night. Of course, this type of medicine also has side effects. You may feel dizzy and drowsy when you first start taking it. Generally, you can tolerate it by starting with a small dose and slowly increasing it.

Finally, there is a very complex category of topical analgesics that everyone uses. In addition to the topical non-steroidal patches and gels mentioned above, there are also lidocaine patches, capsaicin creams, and even the traditional Chinese medicine analgesic creams that many people like to use. My own experience is that for elderly people who are older, have many underlying diseases, and take several chronic disease medicines at the same time, it is right to give priority to topical medicines. The systemic side effects are almost negligible. If used correctly, the pain relief effect is no worse than oral medicines. For example, if the pain in the acute stage of herpes zoster is severe, cut a small piece of the lidocaine patch and stick it on the painful area, and it will relieve you in ten minutes, which is faster than taking oral medicines.

Oh, by the way, one more thing, no matter what kind of painkillers you use, don’t just increase the dosage yourself, and don’t buy them just because you hear what others use. The causes of chronic pain are too complicated. For the same low back pain, some suffer from muscle strain and others suffer from nerve compression. The medicines they use are completely different. It’s best to consult a pain doctor for a clear evaluation before choosing. Don’t try and make mistakes with your own body.