DRUG THERAPIES

DRUG THERAPIES ARE NOT A CURE BUT THEY CAN OPTIMIZE PAIN CONTROL AND PROVIDE THE RELIEF NECESSARY TO REGAIN FUNCTION AND ALLOW THE PATIENT TO PARTICIPATE IN PHYSICAL THERAPY.

For Chronic Pain patients drug therapies allow them to regain a balance in their lives and resume many activities they had previously stopped. Here we will simply give some of the basic medication types, an example, and what they are for.  

ANALGESICS:

OPIATE AGONISTS –  These medications attempt to reduce central nervous system activity and thereby reduce pain. Opiate agonists act on opiod receptors to initiate analgesia sedation and euphoria. Commonly used opiate agonists are MS Contin, Morphine, Oxycontin, Opana, & Hydrocodone.  

OPIATE ANTAGONISTS - Opiate Antagonists block and reverse the effects of opiod agonists by competively adhering to opiod receptors. An example of an opiate antagonist is Naltrexone. 

NARCOTICS - Used to mask pain by blocking pain receptors from sending pain messages to the brain. Narcotics are also known as Opiods. These are broken down into three types; CODEINE-BASED MEDICATIONS; the OXYCODONE BRANCH (Oxycontin CR and IR, Percocet, Percodan, etc.); and the HYDROCODONE BRANCH of OPIODS (MS Contin, Vicodin, Lortab, Lorcet, Methadone, and Kadian, for example).

Most Drs will prescribe the ER (extended release) or CR (controlled release) versions of these narcotics for a more evenly distributed release of medicine during the day, and to help the patient sleep better through the night. 

So what is the difference then between the OXYCODONE Branch and the HYDROCODONE Branch If you search the Internet here is what most of the double-blind studies show: OXYCODONE and HYDROCODONE are similar in analgesic effect, but OXYCODONE is generally as effective at 66% of the dosage of HYDROCODONE. Individual medications may vary and each patient will vary slightly as well but it gives you an overall idea.

Also included in the NARCOTICS family is FENTANYL, either in the more common PATCH or the less common  LOLLIPOP FORM, ACTIQ. 

ANTIDEPRESSANTS – ORIGINALLY ONLY USED TO TREAT DEPRESSION, STUDIES HAVE SHOWN THAT THESE MEDICATIONS, BOTH THE NEWER ANTIDEPRESSANTS AND THE OLDER TRICYCLIC VERSIONS, CAN ALLEVIATE PAIN IN CERTAIN SITUATIONS. FURTHERMORE, THEY HAVE THE ADDED BENEFITS OF NOT ONLY HELPING THE PATIENT SLEEP BETTER, BUT ALSO REDUCING SOME OF THE HEADACHES ASSOCIATED WITH CRPS; ALTHOUGH SOME HAVE A TENDENCY TO CAUSE WEIGHT GAIN AND DROWSINESS. PAXIL, ZOLOFT, ELAVIL, PAMELOR, AND TRAZADONE ARE GOOD EXAMPLES OF THESE.

Teenagers need to be especially careful on the dosing here as some studies have linked the use of antidepressants to increased suicide rates. Always talk over these issues with your physician; never stop, increase, or decrease your medications without talking to your Dr or pharmacist. 

WORRIED ABOUT ADDICTION WITH OPIATES? IS THERE A DIFFERENCE BETWEEN ADDICTION AND TOLERANCE?

For more information go to ADDICTION VERSUS TOLERANCE article. 

ANTICONVULSANTS – These medications are used to try and decrease the random neurons firing, thereby decreasing the burning pain and sensitivity associated with CRPS. This can sometimes also decrease the pain. Examples include Tegretol, Topamax, Lyrica, and Neurontin. 

ANTISPASMODICS / MUSCLE RELAXANTS – Muscle spasms are very common with CRPS, typically rolling in nature. The medications used to treat this can include Baclofen, Clonazepam, Flexeril, Soma, and Zanalfex.  Sometimes a Dr may prescribe a benzodiazepine for this; these can include Klonopin, Valium, and Xanax.   

NSAIDS – Used to treat swelling and inflammation. These can include Celebrex and Feldene. Accodring to Dr Timothy Sams, "Most research has demostrated the efficacy of the Cox-2 inhibitors, (Celebrex/Feldene) but has clearly not found them to be better pain relievers tha the older of even nonprescription NSAIDS."  

NMDA RECEPTOR BLOCKERS - THIS WOULD INCLUDE THE DRUG KETAMINE. I would suggest you check out our information on Ketamine and CRPS if you are interested in learning more about this exciting drug therapy.  

TRANSDERMAL MEDICATIONS – Pain Patches, LIDOCAINE and DURAGESIC/FENTANYL. Most important with these are their placement! Check with your physician but typically they are not placed directly over the CRPS-affected area. 

TO READ ABOUT THE SCHEDULES OR CLASSES OF PRESCRIPTION DRUGS, CLICK HERE