Pain medications can often help reduce chronic pain. Ongoing optimisation and management of pain medications is important to maximise pain relief and minimise side effects.
Not all pain medications work for everyone, so getting medications and doses correct requires a pain specialist and a common sense management approach.
It is sometimes preferable to take two or more pain medications in low doses, rather than just one pain medication in a big dose. This is because different pain medications work differently in the body but can all cause side effects; so rather take a few medications at lower doses so they cause less side effects but work on different parts of your body to help you with pain control. This is called acting synergistically.
We normally start with low doses and gradually increase them. It can sometimes take up to a month before you feel the benefits of some of the pain medications used, so be patient.
Your pain specialist will assess your medications and work with you to get the doses and combinations correct.
We also work with you and guide you in managing your own pain medications so you can adjust them depending on your needs e.g. if you have a pain flare-up, it may be sensible to increase your medications for a short period of time.
Sometimes a medicine loses some or all of its effects over a long period of time. This is called tolerance. If this happens, you may need to take more of the medication, change medications, or add new medications. We will work with you to get the best out of your medications for effective pain relief.
NEUROPATHIC PAIN MEDICATIONS
We manage your pain relief medications (analgesic), which include neuropathic pain medications that focus on reducing nerve pain. These might include:
- Muscle relaxants
- Orphenadrine (Norflex)
- Simple pain relief medication like paracetamol and anti-inflammatory medication
- Tricyclic antidepressants (TCA)
- Amitriptyline (Endep)
- Nortriptyline (Allegron)
- Serotonin Noradrenaline Reuptake Inhibitors (SNRI) antidepressants
- Duloxetine (Cymbalta)
- Venlafaxine (Effexor)
- Tricyclic antidepressants (TCA)
- Anti-epileptic agents
- Gabapentin (Neuronotin)
- Pregabalin (Lyrica)
- Palmitoylethanolamide (PEA)
- Tapentadol (Palexia)
- Other neuropathic pain medication:
Sometimes we give pain medications by IV infusion which means it is given intravenously (via an IV drip) over a few hours or even a few days. These medications include ketamine infusion, magnesium infusion and lignocaine infusion. We only use these infusions in carefully selected patients with chronic pain.
We do not use ketamine infusions for depression treatment.
It is also far safer to use non-opioid pain medications in chronic pain because painkillers (opioid medications) may not help reduce the pain and carry serious risks. Opioid medications include:
Following an initial prescription, your GP will continue to manage your pain medications and ongoing prescriptions. You should review the ongoing need for your medications every 6-12 months.
Sometimes pain medications can be made up into creams that can be applied to areas of the body where you experience chronic pain. This is an example of the ‘off-label use’ use of pain medications. They work well for some people and have very few, if any side effects.
We work with compound pharmacies that are able to make up combinations of pain medications that can be tailored to your pain condition. Medications that can be made into creams include:
- Amitriptyline cream
- Baclofen cream
- Capsaicin cream
- Clonidine cream
- Gabapentin cream
- Ketamine cream
- Lignocaine cream
The term “off-label use” refers to registered medicines that are used in a manner not listed in the approved prescribing guidelines such as those released by the Therapeutic Goods Administration (TGA) in Australia, or the New Zealand Medicine and Medical Devices Safety Authority.
Some medications are used in an off-label fashion for example medications used in children or cancer medications. Some pain medications are also used in an off-label fashion. These may include steroids injections into the epidural space or pain creams and ointments. If you’d like more information about this please talk to your pain specialist.
Remember, be safe with medicines. Read and follow all instructions.
Medicines Line is a telephone service providing consumers with information on prescription and over-the-counter medicines. Call 1300 MEDICINE (1300 633 424).
Information provided by Medicines Line includes:
- how a medicine works
- how to take medicines
- side effects
- interactions with other medicines
- medicines during pregnancy and breastfeeding
- medicines for children
- storage of medicines
- how to obtain consumer medicine information (CMI) for your prescription medicines
- referrals to reliable services and support organisations, e.g. support organisations for people with your health condition
- promotion of the quality use of medicines and provision of information that is independent, evidence-based, appropriate and safe
- encouraging responsible use of medicines by increasing public awareness about medicines
- Dworkin RH et al. Recommendations for the Pharmacological Management of Neuropathic Pain: An Overview and Literature Update. Mayo Clin Proc. 2010 Mar; 85(3 Suppl) : S3-S14.