Treatment for chronic pain
Painkillers are divided into groups. The pain relief is based on 3 steps, depending on the severity of the pain:
- Paracetamol or an NSAID
- A weak-acting opioid such as codeine or tramadol, usually in combination with paracetamol or an NSAID.
- An opioid such as morphine or fentanyl, possibly in combination with paracetamol or NSAID.
In addition to the ‘regular’ painkillers, there are other medications that can be used for pain.
A painkiller that is useful as a self-care product for most types of pain in ‘small’ ailments. It has an analgesic and fever-reducing effect and is available without a prescription.
Side effects: virtually none, also paracetamol is friendly to the stomach.
The substance name is paracetamol, brand names include Paracetamol, Panadol, Sinaspril. It is advisable to take the paracetamol at regular intervals in case of pain. In this way there is a uniform blood level of the drug, which works more effectively in pain. It is also wise to take the paracetamol in addition to eg stronger drugs such as opiates, because you then need a less high dose of these opiates with possibly fewer side effects.
NSAIDs (non-steroidal anti-inflammatory drugs) are painkillers that also inhibit inflammatory symptoms. In addition to anti-inflammatory effects, they also relieve analgesia and reduce fever.
Examples are carbasalate calcium, ibuprofen, acetylsalicylic acid, naproxen and diclofenac. These agents are mainly available without a prescription.
Side effects: inter alia possible damage to the gastrointestinal mucosa, possible reduction of renal function and influence on the effects of some drugs against high blood pressure. NSAIDs have an influence on blood clotting, they should not be used in addition to anti-coagulants
The newer NSAIDs, such as arcoxia, may be safer for the stomach and may be prescribed to people at higher risk for stomach problems.
These are morphine-like agents, they are derived from opium. There are weak-working and strong-working opioids. They are also called opiates. These agents are available as tablets, as suppositories or in plaster form. In severe situations, morphine-like agents are given by injection or infusion, or as a back puncture.
Side effects: drowsiness and constipation. In the more active opiates also: nausea, less deep and less frequent breathing, mood changes (mirth, depression), hallucinations.
With long-term use habituation can occur, but real addiction does not occur when the drug is used for pain. If you have used opiates for a longer period of time, it is wise to evenly reduce them again. If you do not do this, symptoms that are similar to a severe flu may occur. Do this at all times in consultation with your doctor.
Examples are Tramadol (Tradonal, Tramadol, Tramagetic, Tramal), which works slightly stronger than codeine and is sometimes used when NSAIDs can not be used.
Potent opioids are fentanyl, morphine, oxycodone, methadone, palladone and buprenorphine.
These agents can affect driving ability.
Resources for nerve pain
Nerve pain is usually not easy to treat with painkillers. But there is a result with other types of medicines. Namely with anti-epileptic means or antidepressants. These drugs work on the nerves and on the information transfer in the brain. You are therefore not prescribed the medication because you have depression or epilepsy, but because these drugs can have a good effect on nerve pain in often different doses. The effect of all these resources is highly variable. Often the further increase of the dose is limited by the side effects. These agents can affect driving ability.
The best known anti-epileptic drugs used are Lyrica (pregabalin), Neurontin (gabapentin) and Tegretol (cabamazepine).
Side effects: if side effects occur, this will often be in the form of dizziness, drowsiness, headache, and weight gain.
Drugs for depression are often not registered for pain treatment. That is why you often do not find anything about this in the leaflet. It is mainly the old-fashioned anti-depressants (so-called tricyclic anti-depressants) that can be effective such as amitriptyline (Tryptizol, Sarotex), anafranil (Tofranil) and desipramine (Pertofran). The more modern resources from the SSRI group are not or hardly effective against pain. The drug Duloxetine (Cymbalta) occupies an intermediate position and seems to be effective in nerve pain that occurs as a complication of diabetes, chemotherapy or HIV.Most experience is with amitriptyline. This agent is especially effective against burning pain. Because the drowsiness sometimes becomes too severe, the medicine is only taken in the evening. The other side effects that regularly occur are dry mouth, difficulty with sharp vision (close) dizziness, cardiac arrhythmias, and fluid retention. A clear effect can usually only be expected after a number of weeks, while the side effects usually diminish after 2 weeks. When treating pain or neuropathic pain with whatever medication, the intention is that the pain is reduced, that is, reduced to a tolerable level. This should not be at the expense of too many side effects. The advantage must therefore be greater than the disadvantage. On the websites on the right side of this page you can find information about side effects of commonly used medicines within the pain management. In addition, these sites provide information and advice on the use of these medicines and traffic participation.