Guest Blog Post by:  Dr. Thomas Cohn of Minnesota Physical Medicine

Pain is the number one reason people go to the doctor. When we are in pain, we stop doing activities, which slows healing. Once we slow down, we start developing secondary problems, and we enter a cycle that trends downward. The overall goal of any treatment is to break the pain cycle so that healing can begin.

Pain can be associated with many problems, including:

• Injury
• Inflammation
• Deconditioning
• Degeneration of joints
• Depression

It is wonderful if one can nurse a painful condition, heal and have no subsequent problems. However, when simple treatments like rest, ice, and heat do not work, taking the next step is reasonable. The sooner we return to full health, the less likely secondary problems will occur. Since all medications have potential complications, the less we use, the safer it will be in the future.

Types of Medication

Common classes of medications that are used to manage pain include:

• Anti-inflammatory medications
• Analgesics
• Opioids
• Anti-seizure/neuropathics
• Antidepressants
• Muscle relaxants
• Steroids

Many times, combining medications for desired effects is necessary to provide an optimal solution. If the medical problem cannot be solved permanently, such as degenerative arthritis, then finding a safe long-term solution may be necessary. If treatment needs to include medications, having a good Physical Medicine and Rehabilitation and Pain physician to guide a comprehensive treatment plan would be beneficial.

Anti-Inflammatory Medications

Anti-inflammatory medications are drugs such as Motrin, naproxen, and Celebrex. These medications reduce inflammation, and chemicals in the body that cause nerve irritation and pain. They also reduce swelling of injuries that cause pain. These medications are useful in acute musculoskeletal injuries, and often for chronic inflammatory problems like osteoarthritis. Complications from these medications include stomach irritation and ulcers with bleeding, and they have been found to increase the risk of heart attack and kidney damage.

Anti-depressants & Anti-seizure Meds

Anti-depressants and anti-seizure medications are often considered neuropathics. These medications affect pain by decreasing the sensitivity of the nervous system to the transmission and perception of pain signals. This allows one to be more active without noticing the pain. These medications are used when there is nerve damage, such as from diabetes, or constant spinal irritation from a lumbar disc. Fibromyalgia is best treated with these medications. Like all medications, they do have side affects for some people and finding the most effective drugs with minimal side affects can be challenging.

Muscle Relaxants

Muscle relaxants are broad categories of medications that are supposed to prevent or decrease muscles from becoming too tight. With a variety of injuries including neck and low back pain, muscles tighten to prevent movement and further injury of a painful area. Lack of movement is often counter-productive to healing, and the short-term use of these medications allows one to move more normally with less discomfort. Combining these drugs with physical therapy exercises to restore proper movement is highly effective. These medications are usually only helpful for a short period of time and only a few are meant to be used long-term.

Analgesic Medication

Analgesic medications include drugs like Tylenol, to strong opioid narcotics. These medications affect the ability of the nerves and brain to receive and perceive pain signals. In acute injuries and pain management they are very effective and allow improved restoration of function. However, they are often over-used, highly addictive, easily abused, and can cause numerous complications. These medications are powerful painkillers, but due to their addictive nature, should be used only with caution and close medical supervision.

Steroids

Steroids are very powerful medications used to control inflammation. They can be used on the skin, orally, or injected into inflamed areas including joints and the spine, or along nerves. By decreasing inflammation, they allow healing, and restoration of normal movement. These must be used only by experienced physicians, and be closely monitored to prevent complications.

Pain can prevent normal function. The sooner normal function is restored, the fewer complications that are likely to occur. If the simple solutions are not working, then the proper and judicious use of medications can significantly improve the outcome. A good physician is necessary to combine the use of the right medications and other treatments that will lead to a positive improvement.

Author Bio:  Dr. Thomas Cohn is a pain management and physical medicine doctor at MAPS – Medical Pain Clinics. He is board-certified in physical medicine and rehabilitation with additional board-certification in pain management from the American Board of Anesthesiology (ABA), the American Board of Interventional Pain Physicians (ABIPP) and the American Board of Pain Medicine (ABPM). Read more about pain management tips on his Minnesota Physical Medicine Blog.