Chronic Pain Relief - What Are The Options?

Most current pain relief approaches involve the use of medications and in some cases, adjustments in lifestyle, physical therapy and even acupuncture. Though over the counter medications can be used to treat some forms of chronic pain, prescription strength options are usually more effective in helping chronic pain sufferers to live pain free. It is always important to consult a physician before taking any prescription pain medication but some of the options that you will likely see include: Carisoprodol (Soma), Butalbital (Fioricet), Celebrex, and Tramadol (Ultram).Some extreme cases may also involve the use of a patient controlled drip mechanism that provides a continuous supply of pain medication. Others may benefit from Trigger Point Injections which involve delivering pain medication directly to the muscles. Surgical implants and Electric Therapy are also sometimes used (although mostly in extreme cases).Physical therapy is mainly focused on increasing the body’s flexibility and movement in those suffering with chronic pain. This approach is sometimes combined with electrical nerve stimulation which attempts to interfere with the pain signals being sent to the brain for temporary relief during physical therapy.

Low back pain means a pain or ache somewhere between the bottom of the ribs, at the back, and the top of the legs. The pain often begins suddenly, and may follow an obvious strain or injury, but may seem to come on “out of the blue”, or come on slowly.The pain may travel to or be felt elsewhere. It often goes into the buttocks, but may go further down the leg and even into the foot.The pain may be worse on bending and is often worse sitting, especially in an easy chair. Sometimes turning over in bed and sitting up are agonising. Coughing or sneezing can often make the pain much worse. The muscles of the back may go into painful spasm.Back pain may be combined with pain into the leg, travelling down below the knee, this is otherwise known as sciatica, because the main nerve to the leg (the sciatic nerve) is being irritated by pressure on it.In this section I have been talking about what we term simple or mechanical back pain, which is far and away the most frequent cause of low back pain. There are various other symptoms which may go with back pain, some of which suggest problems other than back problems, and some of which point to the need for more urgent action by you and your doctor. Low back pain is common. The main cause for low back pain is a strain of the muscles, or other soft structures (eg ligaments and tendons) connected to the back bones (vertebrae). Sometimes it is the cushion between the bones (intervertebral disc) which is strained, and which bulges out (herniates) and presses on the nearby nerves (as in sciatica).Exactly what is injured varies from person to person, but you may also get differing theories depending on whom you ask. Thus the poor sufferer may become confused and worried.
Although the experts may not agree on what is causing the problem, there is a surprising amount of agreement on how best to improve the situation.Various other conditions can cause back pain, and if in doubt about what is causing your pain, you should consult your doctor.

Do they work?

They’re likely to help. But if you have short-term back pain, you should probably try a nonsteroidal anti-inflammatory drug (NSAID) first instead of any other type of painkiller. As well as helping with pain, NSAIDs also help with inflammation, so they are often more useful then other painkillers if you have back pain.

What are they?

Painkillers are drugs that relieve pain. You can buy milder ones over the counter, but you’ll need a prescription from your doctor to get stronger ones. There are different kinds of painkillers.NSAIDs, such as ibuprofen, relieve pain, but they also have other actions in your body. So we looked at them on their own. For more information, see Nonsteroidal anti-inflammatory drugs (NSAIDs).Paracetamol is a commonly used painkiller. Your doctors may recommend you try it first to treat your back pain.If paracetamol doesn’t work on its own, then your doctor may prescribe you paracetamol combined with a stronger painkiller called codeine (brand name Co-codamol). Doctors think it’s better to combine drugs in this way than to increase the dose of a single drug. This is because higher drug doses can increase the chance of side effects. If two drugs are used, sometimes a lower dose of each is enough. Also, some drugs work well together.Tramadol (brand names Zamadol, Zydol, Tramake) is another painkiller that might be used for back pain.
Codeine and tramadol belong to a group of drugs called narcotic analgesics (also called opioids). You need a prescription for most narcotic analgesics (although you can get low doses of codeine from a pharmacist). Usually, your doctor will only give you enough of these drugs to last a few weeks. This is because you can get addicted to them if you take them for a long time. Narcotic analgesics come as tablets, liquids, suppositories (capsules that you put inside your bottom) and injections.
Here are some examples of other narcotic analgesics (with brand names) that might be used to treat back pain:

    * Dihydrocodeine (DF118), or dihydrocodeine combined with paracetamol (Co-dydramol)
    * Dextropropoxyphene
    * Hydromorphone (Palladone).

You can buy some painkillers from a pharmacy or supermarket. But stronger ones are only available with a prescription from your doctor.Opioids (pronounced oh-pee-oyds) were first made from the juice of the opium poppy.  But many are now manmade in a laboratory. These are the strongest painkillers and are often the best way of treating cancer pain.  You can only get them on prescription from your doctor.  Many of these drugs are based on morphine because morphine is the most effective painkiller we have.  Used properly, it does not have too many side effects. Very few people are allergic to it or cannot tolerate it. You may worry that you will become addicted to morphine and other morphine based drugs.  This is a common fear, but it is highly unlikely. Sometimes you might need very high doses of these drugs to control your pain.  It is quite safe to take high doses if you need them.  Your nurse and doctor will keep a close watch for side effects.There are different types of opioid painkillers – strong ones and weak ones.  Morphine is a strong opioid and codeine a weak one.  You are usually started on a weak opioid, and then move on to a stronger one if needed.  Non opioid drugs can be mixed with either weak or strong opioids to give you the best pain relief possible.The different types of opioids are listed below.  You may find all this confusing at first.  There are not only different types of opioids, but also different preparations of the same drug.  For example, there are slow acting and fast acting types of morphine.