Medication Management

Medication management is an important part of our pain practice when deciding which medication management is right for the patient, helping him or her to keep track of the prescribed and over-the-counter medications being taken as well as helping to reduce the amount of medication ingested. Although common, pain is so complex and subjective that it is difficult to diagnose and treat. Chronic pain may be the result of inflammation or injury to somatic or visceral tissue, or the result of injury or damage to the nerve itself. Pain due to inflammation is most commonly treated with anti-inflammatory and analgesic medications such as nonsteroidal anti-inflammatory drugs (NSAIDS) and opioids. Neuropathic pain is treated differently using medications that act on neurotransmitters and excitable nerves including antidepressants and anticonvulsants.

Pain due to inflammation and injury is also called nociceptive pain and is linked to tissue damage. Injury to a specific area can cause intact nerves to report damage to the brain and pain is experienced. Nociceptive pain can be sharp, dull, or aching and may radiate to other sites of the body. Nociceptive pain is generally responsive to, and first treated with, nonsteroidal anti-inflammatory drugs (NSAIDs). Opioids may be considered for more severe or refractory pain. Neuropathic pain has very different root causes, and subsequently has very different treatment options from other types of pain. Remedies for nociceptive pain, such as NSAIDs and opioids are only marginally effective on neuropathic pain. Neuropathic pain seems to respond best to the membrane-stabilizing medications such as anticonvulsants and antidepressants, which work by blocking the brain’s neurotransmitters. The antidepressant medications also have beneficial effects of improved mood, decreased anxiety, and improved sleep cycles. These medications are not addictive, and when appropriately managed have few side effects.

When patients suffer from a variety of ailments and pain, it is possible that different doctors will prescribe medications that conflict with other medications or need to be taken on a very specific schedule. It is possible that without a professional to take an overview of all of the medications being taken including prescriptions, over the counter medicine, and vitamins and supplements the patient will not be able to ensure that everything will work together and not cancel each other out or cause unwanted side effects.