What are the side effects of chronic pain relief medications

Different types of chronic pain relief drugs have quite different core side effects. Non-steroidal anti-inflammatory drugs, which are most commonly encountered by the public, are most likely to damage the stomach and kidneys. Opioid analgesics are recognized to be prone to constipation and have a low probability of addiction, while auxiliary analgesics commonly used for neuropathic pain can affect mental status or metabolism.

To be honest, I have been in the pain department for almost five years, and the most I have seen are patients who have problems with taking non-steroidal anti-inflammatory drugs indiscriminately. Last month, I just admitted a 62-year-old patient with lumbar disc herniation. He had pain in his waist and legs for almost three years. He didn’t think it would be troublesome to go to the hospital, so he bought ibuprofen at the drugstore and stocked it. When it hurt, he took two pills for more than half a year. This time, he was admitted to the hospital for emergency treatment of gastric bleeding, and the vomit was all brown. Many people think that this "ordinary painkiller" has no side effects, but this is not the case. Long-term use will not only repeatedly irritate the gastric mucosa, but also increase the risk of kidney function damage for elderly people with underlying diseases such as hypertension and diabetes, which is more than two or three times higher than that of ordinary people.

Don’t think that only commonly used over-the-counter analgesics have pitfalls. Controversies about side effects of opioids prescribed clinically for moderate to severe chronic pain have never stopped. Many patients shake their heads when they hear the word opium, fearing addiction. In fact, sustained-release dosage forms are currently used clinically. If they are taken strictly according to the doctor's instructions, the addiction rate is less than 1%, which is far less scary than everyone thinks. But one side effect that is almost unavoidable is constipation. I once had an aunt with advanced cancer pain, and the pain relief effect of taking OxyContin was particularly good. However, she was constipated for almost two weeks, and switching between Kesel and Lactulose did not work. In the end, I adjusted the dosage and added a special opioid laxative to relieve the pain. There are also a small number of patients who experience nausea and dizziness in the first few days after taking it. Most of them can tolerate it in about a week. If they really can't tolerate it, it can be solved by changing the medicine. Of course, there are currently different voices in the academic community. Some scholars believe that even at low doses, long-term use of opioids may change the body's pain threshold and make the pain more and more stubborn. Therefore, for patients with chronic non-cancer pain, we generally do not use opioids as the first choice.

If you have neurogenic chronic pain such as trigeminal neuralgia or post-herpetic neuralgia, the doctor will most likely not prescribe the first two types, but will use anticonvulsant or antidepressant auxiliary analgesics. The side effects of these drugs are more "invisible". Many patients will feel groggy in the first three or four days after taking it, as if they were hungover the day before, and they will walk unsteadily. There are also many people who have a better appetite and gain weight after taking it. I met a 28-year-old girl with trigeminal neuralgia before who gained 8 pounds after taking pregabalin for three months. She sat in the clinic crying and asked for a change of medicine. She said that her boyfriend could hardly recognize her.

In fact, the more patients you come into contact with, the more you feel that there is no need to treat the side effects of painkillers as a scourge. Nowadays, clinical medicine rarely relies on a single drug to control chronic pain. Most of them will be combined with physical therapy and psychological counseling programs to keep the dosage to the minimum. As long as you don’t buy and eat randomly, increase or decrease the dosage without permission, most of the side effects are within the controllable range. After all, the insomnia, anxiety, and weakened immunity caused by long-term pain can cause much more damage to the body than the controllable side effects.