Pain: Treatment

There are many drugs aimed at preventing or treating pain. Nonopioid analgesics, narcotic analgesics, anticonvulsant drugs, and tricyclic antidepressants work by blocking the production, release, or uptake of neurotransmitters. Drugs from different classes may be combined to handle certain types of pain.

Nonopioid analgesics include common over-thecounter medications such as aspirin, acetaminophen (Tylenol), and ibuprofen (Advil). These are most often used for minor pain, but there are some prescriptionstrength medications in this class.

Narcotic analgesics are only available with a doctor's prescription and are used for more severe pain, such as cancer pain. These drugs include codeine, morphine, and methadone. Contrary to earlier beliefs, addiction to these painkillers is not common; people who genuinely need these drugs for pain control typically do not become addicted. However, narcotic use should be limited to patients thought to have a short life span (such as people with terminal cancer) or patients whose pain is only expected to last for a short time (such as people recovering from surgery).

Anticonvulsants, as well as antidepressant drugs, were initially developed to treat seizures and depression, respectively. However, it was discovered that these drugs also have pain-killing applications. Furthermore, in cases of chronic or extreme pain, it is not unusual for an individual to suffer some degree of depression; therefore, antidepressants may serve a dual role. Commonly prescribed anticonvulsants for pain include phenytoin, carbamazepine, and clonazepam. Tricyclic antidepressants include doxepin, amitriptyline, and imipramine.

Intractable (unrelenting) pain may be treated by injections directly into or near the nerve that is transmitting the pain signal. These root blocks may also be useful in determining the site of pain generation. As the under-lying mechanisms of abnormal pain are uncovered, other pain medications are being developed.

Drugs are not always effective in controlling pain. Surgical methods are used as a last resort if drugs and local anesthetics fail. The least destructive surgical procedure involves implanting a device that emits electrical signals. These signals disrupt the nerve and prevent it from transmitting the pain message. However, this method may not completely control pain and is not used frequently. Other surgical techniques involve destroying or severing the nerve, but the use of this technique is limited by side effects, including unpleasant numbness.

— Julia Barrett