There are several medications for chronic pain relief

Currently, commonly used drugs for chronic pain relief in clinical practice are mainly divided into 5 categories, plus 2 categories of niche drugs that are only used in special scenarios. There is no so-called "universal drug", and all drugs must match the cause of pain and individual tolerance.

The ones we are most familiar with are ibuprofen and celecoxib, whose scientific name is non-steroidal anti-inflammatory analgesics. Most of the "painkillers" that ordinary people often refer to are them. For chronic pain caused by aseptic inflammation, such as joint pain from ankylosing spondylitis and knee arthritis, taking it is indeed effective, but the side effects are also very clear: long-term consumption can easily burn the stomach, and in severe cases can induce gastric bleeding. People with coronary heart disease may also increase cardiovascular risks. There is currently controversy about its use: Old-school doctors believe that it is best not to take it continuously for more than 7 days, but the new guidelines are aimed at patients who need long-term control of inflammation. As long as liver and kidney function and gastric mucosa are regularly monitored, low-dose long-term use is also allowed, and there is no absolute contraindication.

What many people don’t know is that there are many types of chronic pain that are completely useless with ordinary analgesics, such as neuralgia after herpes zoster and diabetic foot pain. The pain feels like an electric shock, a needle stick, or the wind is unbearable. At this time, doctors often prescribe some medicines that seem to be “wrong” - such as pregabalin and gabapentin to treat epilepsy, and duloxetine and amitriptyline to treat depression. Don’t think that the doctor has prescribed it wrong. Last week, I met a 62-year-old aunt in the outpatient clinic. She had herpes zoster on her left forehead. She had pain for three months after it healed. She took two boxes of ibuprofen at home but it didn't help at all. I prescribed pregabalin plus duloxetine. When she went back and saw the instructions, it was for treating depression and epilepsy, so she threw the medicine away on the spot. Later, her children persuaded her to come back for a follow-up consultation. I explained to her for half an hour before she agreed to try it. After a week of taking it, the pain was reduced by 60%. This type of auxiliary analgesic drug essentially regulates abnormally discharged nerves and relieves neuropathic pain from the root. It is more effective than taking any amount of ibuprofen. However, this type of medicine is also controversial: you may feel dizzy and sleepy in the first 3-5 days after taking it. Some doctors will recommend starting with a small dose and slowly increasing it, and you can tolerate it after the first week. Some doctors think that if the side effects are too obvious, it is better to use local lidocaine patches. There is no need to bear the side effects. Each has its own reasons.

When it comes to topical drugs, they have been the first choice of pain departments in recent years, especially for localized pains such as shoulder and neck pain, knee arthritis, and muscle strains. Products such as Voltaren ointment, flurbiprofen gel patch, and lidocaine patch are directly applied to the painful area. The medicine penetrates and directly acts on the lesion. It is much smaller than the side effects of taking oral medicines that are metabolized throughout the body. I strained my shoulder during fitness training last year, and it hurt for almost two weeks. It was difficult to lift my arm. I started taking ibuprofen, but it felt better when I stopped. I also suffered from acid reflux. Later, I asked a colleague for two boxes of flurbiprofen gel patches, which were all cured after 5 days. Since then, whenever I encounter localized muscle or joint pain, I will first use external medications. Of course, it also has limitations: if it is deep-seated pain, such as a lumbar disc herniation that presses on a nerve root, and the pain radiates from the waist to the legs, external medicine cannot penetrate that deep and is basically useless.

When it comes to painkillers, what everyone is most afraid of are the so-called "addictive drugs", that is, opioids, such as oxycodone, tramadol, and fentanyl patches. Many people wave their hands when they hear them, saying that they can't quit after taking them. I met a 78-year-old man with bone metastasis from lung cancer. His waist and legs hurt so much that he couldn't get out of bed. At first, his children refused to be prescribed Oxycodone, saying they were afraid of addiction. Later, the pain made the man secretly cry, and he finally agreed to use it. After two weeks of using it, he could sit up and video chat with his grandson, and there was no sign of addiction. Nowadays, the clinical attitude towards opiates is actually very clear: the addiction rate of standard opiates for cancer pain patients is less than 4 out of 10,000, which is almost negligible. Priority is given to ensuring the quality of life. ； But for ordinary chronic non-cancer pain, domestic guidelines clearly do not recommend it as the first choice. After all, there is a risk of dependence. However, some European and American guidelines recommend low-dose short-term use when all other drugs are useless. After all, long-term severe pain is more harmful to the body than the side effects of low-dose opiates. There is no completely unified conclusion on this yet.

There is another category that people don’t come into contact with much, which is muscle relaxants, such as eperisone and tizanidine. For example, if you have a stiff neck that hurts so much that you can’t turn your head, or your lumbar muscles are strained to the point where the muscles are as hard as stone slabs, this kind of pain is caused by long-term muscle spasm. Ordinary analgesics are generally ineffective. Take some muscle relaxants to loosen the tight muscles, and the pain will naturally be relieved. However, taking this type of medicine may make you feel weak and drowsy. People who drive or work at high altitudes should not take it, as it may cause accidents.

There are also two types of niche drugs that are only used in special scenarios, such as carbamazepine for trigeminal neuralgia, and CGRP inhibitors, which have been newly developed in recent years to treat refractory migraine. The former is an old drug and is cheap but has some side effects. The latter is effective but costs thousands of dollars per injection and is not covered by medical insurance. It is difficult for ordinary families to afford it in the long term.

Oh, by the way, there is another point that many people get wrong. Chronic pain does not require taking medicine until the pain is unbearable. Taking it regularly and as needed will actually result in a smaller total dose and lower side effects than taking it only when the pain is extreme. In the past, it was always said that "drugs are three-thirds poisonous and can be taken without taking them." Now more and more doctors believe that long-term chronic pain can lead to poor sleep, depression, and decreased immunity. These injuries are much more serious than the side effects of drugs. Of course, the premise is that you must take them according to the doctor's instructions and don't increase the dosage on your own.

In fact, at the end of the day, chronic pain is a very "private" problem. There are only a few types of medicines, but none of them are effective for everyone. I have seen people take half a tablet of ibuprofen for a day, and I have seen people still feel pain after using all the medicines. If the pain persists for more than 1 month, don’t blindly buy medicines on your own. Go to a pain department to find out whether it is inflammation, nerve entrapment or other problems. Only the right medicine will be effective.