Chronic Pain: OTC or Prescription Medicine?
Prescription Drugs: Not Always the Next Step continued...
Possible side effects of antidepressants include dry mouth, blurred vision, constipation, weight gain, and/or sexual problems such as the inability to achieve orgasm.
Another class of drugs used for pain relief is antispasmodics. Antispasmodics work by relaxing the smooth muscle of the gut. These drugs are used to treat irritable bowel syndrome, diverticular disease, and other digestive conditions as well as menstrual pain and interstitial cystitis.
Antispasmodic drugs include:
- Chlordiazepoxidem/clindium (Librax)
- Dicyclomine (Bentyl)
- Glycopyrrolate (Robinul)
- Hyoscyamine (Anaspaz, LevBid, Levsin, NuLev)
- Propantheline (Pro-Banthine)
Side effects of antispasmodic medication may include constipation, headache, blurred vision, drowsiness, difficulty sleeping, and decreased sweating or thirst.
Some anticonvulsants are used for pain caused by nerve damage associated with diabetes and shingles, as well as for fibromyalgia pain. These medications may include:
- Carbamazepine (Tegretol)
- Gabapentin (Neurontin)
- Lamotrigine (Lamictal)
- Oxcarbazepine (Trileptal)
- Phenytoin (Dilantin)
- Pregabalin (Lyrica)
- Topiramate (Topamax)
- Valproic acid (Depakene)
- Zonisamide (Zonegran)
Experts aren't exactly sure how these medications ease pain. Anticonvulsants are thought to block pain signals from the central nervous system.
Side effects of anticonvulsants may include headache, confusion, skin rash, nausea or vomiting, loss of appetite, or weight gain. If you are pregnant or thinking about getting pregnant, be sure to let your doctor know as taking certain anticonvulsant drugs during pregnancy may increase the risk of birth defects.
Narcotic pain drugs, also called opioids, have a proven record of effectiveness, but many people have concerns about their side effects, particularly the undesirable side effect of becoming physically dependent on them.
"The dose necessary for continued pain relief often increases with opioids and can lead to side effects," says Minzter. "They can cause constipation, sedation, sweating, increased sensitivity to pain, and dependency, among other problems. Nevertheless, they play an important role for some people. For them, pain relief outweighs the negative consequences."
Due to the risk of becoming physically dependent on them, opioid drugs are often a last resort for people who have tried several other pain relievers and who still have severe pain.
The opioid drugs listed below relieve moderate to severe pain caused by a variety of illnesses, including cancer, and some are used for pain following surgery.
- Butorphanol (Stadol)
- Acetaminophen/codeine (Tylenol-Codeine No. 3)
- Fentanyl (Duragesic)
- Hydrocodone (Vicodin)
- Hydromorphone (Dilaudid)
- Methadone (Dolophine)
- Morphine (Astramorph)
- Oxycodone (OxyContin)
- Propoxyphene (Darvon)
Tramadol (Ultram) may be appropriate for people with moderate to moderately severe pain. Tramadol is in a class of drugs called opiate agonists. The extended-release version of this medicine is only prescribed for people who need medication around the clock to relieve their pain.
The most common side effects of tramadol include nausea, vomiting, constipation, lightheadedness, dizziness, drowsiness, headache, or weakness.
Intrathecal therapy is a method of delivering pain medication directly to the spinal cord via a "pain pump." This medication delivery system is used for long-term pain that has not responded to non-invasive pain relief methods.