Understanding the Psychological Impact of Chronic Pain continued...
But negative emotions can be a result of chronic pain as well as a cause. "If you had always been an active person and then you developed chronic pain, you might become depressed," says Roger Chou, MD, associate professor of medicine at Oregon Health & Science University in Portland and a leading expert on chronic pain. "Depression is common in chronic pain patients, but people who think chronic pain is ‘all in the head’ are not being realistic."
Because chronic pain affects all aspects of your life, it’s important to treat chronic pain both medically and emotionally.
"People with chronic pain shouldn’t assume that they have to tough it out," says Russell K. Portenoy, MD, chairman of pain medicine and palliative care at Beth Israel Hospital in New York City and past president of the American Pain Society. "And they should not be satisfied with a doctor who doesn’t want to treat it aggressively."
Drugs Used to Control Chronic Pain
A wide variety of over-the-counter and prescription medicines have been shown to help ease chronic pain, including:
• Pain relievers. Many pain patients get some relief from common pain medicines such as acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and analgesics like aspirin, ibuprofen, ketoprofen, and naproxen. These drugs are considered safe, but they are not risk-free. For example, taking too much acetaminophen can cause liver damage or even death, especially in people with liver disease. NSAIDs can cause ulcers and raise the risk for heart attack and kidney trouble.
• Antidepressants. Several drugs approved by the FDA to treat depression are also prescribed by doctors to help relieve chronic pain. These include tricyclic antidepressants such as amitriptyline (Elavil), imipramine (Tofranil), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Sinequan), and nortriptyline (Pamelor). The pain-relieving effect of tricyclics appears to be distinct from the mood-boosting effect, so these drugs can be helpful even in chronic pain patients who are not depressed.
Other antidepressants used to treat pain include venlafaxine (Effexor) and duloxetine (Cymbalta), which the FDA has approved to treat fibromyalgia and diabetic nerve pain. These drugs are members of a class of medications known as serotonin and norepinephrine reuptake inhibitors (SNRIs). They seem to be about as effective at treating chronic pain as tricyclics, but are less likely to cause dry mouth, sedation, urinary retention, and other side effects.