Pain is defined by the International Association for the Study of Pain as ‘an unpleasant sensory and emotional experience, associated with actual or potential tissue damage’.  There are many different types and causes of pain and these can be grouped into several categories to help with pain management;

• Acute pain (sudden onset of pain due to injury or acute gout)
• Chronic pain (persistent pain longer than 3 months due to headache, back pain, arthritis, fibromyalgia 
• Breakthrough pain (sudden increase in pain due to cancer or joint pain in arthritis
• Bone pain (from bone infiltration by leukaemia or cancer)
• Nerve pain (from shingles, after stroke, poor circulation due to peripheral arterial disease or diabetic neuropathy)
• Soft tissue pain (from muscle or ligament inflammation)

Pain Management Decision

The doctor will usually choose the medication most effective for the particular type of pain you have and balance it with your general health and the likelihood of the medication side effects which may affect you.  You can help to monitor the effectiveness and side effects of the treatment by providing regular feedback to your doctor or pharmacist.  You can document your pain using the pain / mood Visual Analog Scale on TELEME app on a regular basis.  You can also describe any factors or events which aggravate the pain.

Most doctors usually recommended a STEPWISE APPROACH (such as WHO ‘Step-Ladder’ approach) to pain management, starting with the milder pain medication (such as acetaminophen or NSAIDs) in the FIRST Step (mild pain score of 1-3), before progressing to a weak opioid (such as codeine, dihydrocodeine or tramadol) for the SECOND Step (moderate pain score of 4-6).  Strong opioids (such as fentanyl, morphine or oxycodone) can only be dispensed by a hospital.  Some pain may be unpredictable and can vary in severity so your doctor may need to modify the treatment to account for these changes.

Types of Pain Medication

These are some medications which you doctor may prescribe for your pain control.  The choice usually depends on your age, your general health condition, type and severity of your pain as well as cause of your pain.

1. NSAIDs

NSAIDs (also known as Non-Steroidal Anti-Inflammatory Drugs such as Ibuprofen, Naproxen, Flurbiprofen. Etodolac, Indomethacin, Mefenamic acid, Meloxicam, Piroxicam and Diclofenac) are effective for mild to moderate pain caused by inflammation or swelling. These drugs are be used for arthritis, back pain, muscle sprains or injury or menstrual pain.

Side effects and risks include nausea, gastritis, stomach bleeding or ulcers.  Long term use can  cause kidney problems, fluid retention, heart attacks or high blood pressure. 

2. Acetaminophen

Acetaminophen (such as Tylenol) is effective for mild to moderate pain such as headache, muscle or bone ache. 

Side effects and risks include risk of kidney and liver damage if taken over long time.

3. COX-2 inhibitors

COX-2 inhibitors (such as Celecoxib and Etoricoxib) are used for arthritis and chronic pain due to strains, back pain or menstrual cramps. They are as effective as NSAIDs with less side effects compared to NSAIDs.

Side effects and risks include gastritis and stomach bleeding (but to a lesser degree compared to NSAIDs).   Long term use may cause fluid retention, kidney damage or high blood pressure.

4. Anti-depressants

Anti-depressant medication (such as Duloxetin, Venlafaxine, Citalopram, Fluoxetine, Sertraline, Paroxetine, Doxepin, Desipramine, Nortriptyline or Amitriptyline) can help relieve neuropathic pain (such as shingles), chronic back pain, menstrual pain and fibromyalgia. It can also help to improve the mood which is often affected by having to suffer from the long-term painful condition.

Side effects and risks include blurred vision, dry mouth, constipation, nausea, tiredness, difficulty passing urine, sexual dysfunction and headache. 

5. Epilepsy medications

Epilepsy medications (such as Gabapentin, Pregabalin or Carbamazepine) can be used to treat post-herpetic (shingles) neuralgia or diabetic neuropathy.

Side effects and risks include nausea, dizziness, tiredness or drowsiness.

6. Steroids

Corticosteroids (such as Prednisolone) provide relief for inflamed areas by reducing swelling, redness and pain. 

Side effects and risks include weight gain, stomach bleeding or ulcer, mood changes, difficulty sleeping, thinning of the bone and skin, worsening of diabetes control, reduced immunity, Cushing’s syndrome and steroid-induced cataract.  The doctor usually prescribes the lowest dose possible for as short of a length of time to minimize these potential side effects.

7. Opioids

Opioid medications (such as Codeine, Fentanyl, Oxycodone, Tramadol and Morphine) are related to drugs derived from opium, such as heroin and morphine. They are used for short duration to provide relief for severe pain due traumatic injury, pain after surgery or palliative cancer care.  Opioids are usually the last resort for chronic pain management. 

Side effects and risks include nausea, drowsiness, constipation, blurred vision, breathing problems, difficult passing urine, dependence, addiction and accidental overdose.  As such, these medications should only be prescribed by doctors with continuous strict supervision.

Discuss your pain management with your doctor or pharmacist. It is important NOT to get addicted or over-reliant on pain medication

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Disclaimer. TELEME blog posts contains general information about health conditions and treatments. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. The information is not advice and should not be treated as such. 

If you think you may be suffering from any medical condition, you should seek immediate medical attention from your doctor or other professional healthcare providers. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this website.