Treatment: Medication

While many non-pharmaceutical treatments exist, for patients who are suffering, the best pain control is often achieved through the judicious use of medications. The most significant factors in addressing pain through the use of drugs are:

1. determining the appropriate medication(s) to use in the given situation

2. determining the dosage(s) that will produce the greatest benefit with the      least amount of negative side effects

Guidance in determining appropriate use of various drugs for the management of pain can be found in the pain ladder tables of the World Health Organization (WHO), the pain categories for which are:

· Mild, infrequent pain

· Moderate pain

· Severe pain

In addition, the Medical Board of California has adopted and published its Guidelines for Prescribing Controlled Substances for Pain.

The second factor in a medication treatment is achieved through a mechanism known as titration.

In chemistry, the word "titrate" is used to refer to the process of adding one chemical to another in small increments to achieve a specific result (for instance, to obtain a certain pH level, or to initiate a specific chemical reaction). In medicine, usage of the word has been expanded to include the gradual changing of the amount or timing of a drug's use in order to achieve the positive results sought while minimizing any negative side effects. For instance, titrating the use of a blood pressure drug may involve increasing the dosage over time and monitoring the BP until the patient falls within some acceptable statistical norm.

Useful drug terms to keep in mind when discussing pain medications (from the MedTerms™ Medical Dictionary):

· Acetaminophen: A non-aspirin pain reliever or analgesic. Acetaminophen   may be given alone to relieve pain and inflammation, or it may be combined   with other drugs, as in some migraine medications, which contain   acetaminophen, a barbiturate, and caffeine.

· Analgesia: The inability to feel pain.

· Analgesic: A drug that relieves pain.

· Aspirin: Once the Bayer trademark for acetylsalicylic acid, now the common   name for this anti-inflammatory pain reliever.

· Corticosteroids: Prescription corticosteroids provide relief for inflamed areas   of the body by easing swelling, redness, itching and allergic reactions.   Corticosteroids can be used to treat allergies, asthma and arthritis. When   used to control pain, they are generally given in the form of pills or injections. Examples include: prednisone (Deltasone), prednisolone (Hydeltrasol), and methylprednisolone (Solu-Medrol). To minimize potential side effects, corticosteroids are prescribed in the lowest dose possible for as short of a length of time as needed to relieve the pain.

· Ibuprofen: A nonsteroidal anti-inflammatory drug (NSAID) that is commonly used to treat pain, swelling, and fever. Common brand names of ibuprofen include Advil, Motrin, and Nuprin.

· Methadone: A synthetic opiate. The most common medical use for methadone is as a legal substitute for heroin in treatment programs for drug addiction.

· Morphine: A powerful narcotic agent that has strong analgesic (pain relief) action and other significant effects on the central nervous system. It is dangerously addicting. Morphine is a naturally occurring member of a large chemical class of compounds called alkaloids. The name, which derives from Morpheus (the mythologic god of dreams) was coined in 1805 by German apothecary Adolf Serturner to designate the main alkaloid in opium. Opium comes from the poppy plant.

· Narcotic: 1. A drug that causes insensibility or stupor. A narcotic induces narcosis, from the Greek "narke" for "numbness or torpor." 2. A drug such as marijuana which is subject to regulatory restrictions comparable to those for addictive narcotics. [Note that the word narcotic as a means of referring to dependency has been rendered obsolete; today, the medical community uses the word analgesic to refer to drugs that cause dependency.]

· Opiate: A medication or an illegal drug that is derived from the opium poppy or that mimics the effect of an opiate (a synthetic opiate). Opiate drugs are narcotic sedatives that depress activity of the central nervous system, reduce pain, and induce sleep. Side effects may include over sedation, nausea, and constipation. Long-term use of opiates can produce addiction, and overuse can cause overdose and potentially death.

· Opioid: 1. A synthetic narcotic that resembles the naturally occurring opiates. 2. Any substance that binds to or otherwise affects the opiate receptors on the surface of the cell. [Note that the words opiate and opioid are often used interchangeably in both clinical practice and applicable literature.]

· Oxycodone: Oxycodone is the active ingredient in OxyContin. Oxycodone is an opioid, a close relative of morphine, heroin, codeine, fentanyl, and methadone.

· OxyContin: A prescription painkiller that has become a popular and dangerous recreational drug. Also called "Oxy" in the street. OxyContin is a time-release morphine-like narcotic intended to relieve chronic pain of moderate to severe proportions. One pill of OxyContin is designed to last 12 hours. The active ingredient in OxyContin is oxycodone, an opioid, a close relative of morphine, heroin, codeine, fentanyl, and methadone.

For more details pain medications, see the Pain Medications article on eMedicineHealth.

In addition to the use of accepted medication treatments, participation in certain clinical trials being done to evaluate the safety and effectiveness of new medications may be made available to select patients. In these trials, new drugs and procedures are being explored for the treatment of various types of pain, especially those associated with arthritis, scleroderma, cancer, and abdominal problems. Patients interested in learning more can find the current list of ongoing clinical trials for pain management (as well as other related information) at the U.S. National Institutes of Health clinical trials website.