The sensation of pain involves a complex set of signals, often in response to some type of damage to an area of the body. This could take the form of cutting (e.g., surgical pain), pressure (e.g., a bulging disc in the spine), or nerve injury. This damage causes the body to produce certain chemicals at the injury site which trigger nerves to become active and send signals to the spinal cord. Another set of nerves transmits the signals up to the brain, where even more nerves are used to recognize the signals as pain.
Pain medications work by interrupting these nerve signals. Depending on the type of pain and the individual patient, different types of medications can be used, alone or in combination, to decrease the nerve signals which result in pain.
Patients may be prescribed one, two, or three different medicines to “attack the pain from different angles.”
Pain medication side effects are mild and may include constipation, sleepiness, forgetfulness, or nausea. These side effects will fade away after 7-14 days of medication usage.
If the side effects are severe or you cannot tolerate them, stop the medication and notify our office during regular business hours. If you forget a dose and more than three hours have passed since the dose was due, wait until your next regular dose is due rather than trying to make up the missed dose.
Opiates (Morphine family drugs)
These medicines work primarily in the spinal cord and brain, where they “turn on” special morphine-sensitive nerves. These special nerves cause a muffler effect on pain signals. In other words, morphine family drugs act as “pain mufflers” to decrease the sensation of pain.
Federal and state laws regulate the usage of these medications. Federal law specifies that long-term use is acceptable only for patients with a recognized illness who have no other reasonable options available to them. Many of these medications must be ordered in writing and can’t be telephoned or faxed to the pharmacy. Patients using these medications must be seen regularly by the prescribing doctor. The State of Wisconsin recommends urine checks several times a year to show that the patient is taking the medication as prescribed.
Anticonvulsants (Anti-seizure drugs)
These medications are very effective for some types of pain, especially when nerve injury or abnormality is involved. They work by decreasing the ability of nerves to respond to ongoing pain signals (i.e., chronic pain) but have little effect on nerves that transmit short-term pain signals. Taking these medicines does not prevent a patient from feeling a new pain problem such as a broken bone or cut. Although some patients are reluctant to take this type of medication, these drugs are safe for long-term use and have few side effects. Anticonvulsant medications should be taken exactly as prescribed, never on an “as needed” basis. Patients who take these medicines for pain problems will NOT develop seizures in the future simply because they took these medicines for pain control.
These medicines are often used to treat burning-type nerve pain although they also work for other types of pain as well. They act by increasing naturally occurring body chemicals that turn off pain signals. Antidepressants usually take 2-4 weeks to reach full effectiveness, and will continue to work for several weeks after patients stop using them.
These medicines work by preventing the body from making the chemicals that start the whole pain process. They also work in the brain to mask pain signals which are already being received by the brain. Although these medicines can be used “as needed,” they are more effective when taken regularly. They should be taken with a full meal to lessen the chance of stomach injury. If you have been diagnosed with heart disease or suspect heart disease, please take one baby aspirin per day with this medicine.