Medication Options for Acute and Chronic Pain

There are two primary types of analgesics and the main differences between the Non-narcotic analgesics (Non-opioids) and Narcotic analgesics (opioids) include:

Non-Narcotic Analgesics (Non-opioids)

· Include acetaminophen, asiprin & non-steridol anti-inflammatory drugs (NSAIDs)

· Acts peripherally, directly on injured body tissues

· Affects the chemical changes to affected area, such as inflammation and pain

· Relieve mild to moderate pain and headaches of the musculoskeletal source

· Reduces pain, inflammation, and fever by inhibiting prostaglandins

· Not controlled drugs

· Side effects: Gastrointestinal irritation, renal toxicity, liver damage, and bleeding problems

· Ceiling effect: Once the upper limit has occured, dosage can't be increased for pain relief, therefore, not recommended for chronic pain

· Not habit-forming

Narcotic Analgesics (Opioids)

· Derived from/related to Opium

· Acts on central nervous system

· Decreases the pain awareness in the brain

· Bind to opioid receptors that involve pain signaling and control

· Schedule II/III controlled substance

· Groups include: delta, kappa, mu, and sigma

· Side effects: nausea and vomitting, androgen deficiency, sedation, respiratory depression, physical dependance, tolerance, abuse, addicition, or constipation

· Prolonged use leads to tolerance and need to increase the dose to feel pain relief

· Prolonged use leads to opioid physical dependance, addiction, and tolerance

· Withdrawal symptoms occur when stopping usage or reducing dosage

The effectiveness of opioids is greater than NSAIDs in alleviating pain. Opioids are a lot stronger therefore used when non-opioids aren’t effective for pain relief. At times opioids and NSAIDs are combined to treat moderate to severe pain. Due to the many side effects of opioids, many healthcare providers prefer non-opioids for pain relief.

Acute Pain Management

IV Acetaminophen

IV acetaminophen is used for pain management for both mild to moderate pain and moderate to severe pain when used with opioid analgesics in adults. Commonly, used for postoperative pain relief.

IV Ibuprofen

IV ibuprofen used for both mild to moderate and moderate to severe pain management when used with opioid analgesics in adults. Similar to IV acetaminophen, it is used for postoperative pain relief.

Chronic Pain Management

A multimodal approach is often taken to manage chronic pain. Especially, in prolonged use of opioids that causes many medication-related issues. Below we discuss the options for non-narcotic analgesics for nociceptive and neuropathic pain:

Anticonvulsants

Gabapentin and pregabalin are anticonvulsants that are often the first-line of use for neuropathic pain due to the drug’s effectiveness. Gabapentin has been recommended for pain management of postherpetic neuralgia.

Serotonin and norepinephrine reuptake inhibitors (SNRIs)

A SNRI, Duloxetine, is commonly recommended for pain management of fibromyalgia, diabetic peripheral neuropathy, and chronic musculoskeletal pain. Venlafaxine, aids in diabetic peripheral neuropathy pain relief.

Tricyclic antidepressants

Healthcare providers recommend amitriptyline, nortripyline, and desipramine for pain management of diabetic peripheral neuropathy, postherpetic neuralgia, polyneuropathy, and post-stroke.

Topical NSAIDs

Numerous preparations of topical diclofenac aid osteoarthritis or musculoskeletal pain.

There are many options for pain medications to alleviate pain. You should take the time to better understand the benefits and side effects of using opioid pain medications.