Before prescribing pharmacological treatment for different types of pain, it is important to analyze the patient’s history, physical and mental state, data from the clinical examination, and last but not least, information from imaging and laboratory tests.
In the case of acute pain, the group of non-steroidal anti-inflammatory drugs is of primary importance, but it is important to choose them based on the exclusion of the possibility of an active ulcer or acute gastritis. Oral corticosteroids also have their role in reducing inflammation, but their use is associated with many more side effects, especially with long-term use, if necessary. Short courses do not create a risk of complications – within 1 week to 10 days. It is preferable to keep the dose low.
Representatives of non-opioid analgesics are also important for acute pain symptoms – they often take paracetamol as a medicine. However, when taking large amounts of it, it leads to liver toxicity.
Anti-inflammatory topical – locally acting medications from the group of non-steroidal anti-inflammatory drugs are particularly effective in musculoskeletal pain, as their application under the influence of ultrasound improves the penetration of the active ingredient into the deeper layers.
Muscle relaxants are also suitable medications, as they also find a place in the treatment of chronic pain.
Muscle relaxants or muscle relaxants are medications that are used in the treatment of muscle spasms and/or chronic spasticity. They relax muscle tension and eliminate spasms and pain. The exact mechanism of action of muscle relaxants is associated not with the direct action on the muscle, but on the spinal nerves that conduct signals and lead to excitation. A common side effect of muscle relaxants is drowsiness.
Anticonvulsants are a group of medications that have significant effects in the treatment of various chronic pain conditions, including trigeminal neuralgia, neuropathy, fibromyalgia, myelopathy, and others.
These drugs are used especially in the absence of an effect from treatment with the above-mentioned groups of pain relievers.
Gabapentinoids are used – gabapentin, pregabalin, as well as classic antiepileptics – valproic acid, carbamazepine.
The mechanism of action is different for different medications, some block sodium and/or calcium channels, and some potentiate GABA activity. Blockade of voltage-gated sodium channels leads to stabilization of the neuronal membrane and thus reduces synaptic impulses. In addition, there is a decrease in the release of the amino acid glutamate, which is an excitatory neurotransmitter.
In the case of chronic pain, the application of antidepressants is also appropriate, mainly in the cases of the treatment of chronic back pain and neuropathies. Tricyclic antidepressants and serotonin-norepinephrine reuptake inhibitors are usually prescribed.
Norepinephrine plays a key role in mediating pain information, even more so than serotonin. It is necessary to combine the double action to achieve a better effect.
Only serotonin-specific reuptake inhibitors do not have the necessary properties to reduce pain and are not prescribed for chronic pain syndromes.
The most common side effects of tricyclic antidepressants are blurred vision, dry mouth, constipation, urinary retention, tachycardia, and more, with prolonged use there is weight gain, and in some cases, sexual dysfunction may also occur.
Discontinuation of treatment should not be abrupt but with a gradual reduction of the dose over 2-3 weeks.
References:
I. Lambev, N. Boyadzhieva; Pharmacology, Arso Publishing House, 2010
The material is informative and cannot replace consultation with a doctor. Before starting treatment, you must consult a doctor.
