Medication

Medication can be an important part of pain management; however it is just one part. As you have three legs on a stool, so there are three main components to comprehensive pain management. One is medication, two is physical therapy and three is cognitive therapy. Getting the best from medication will involve also putting the other two strategies into practice.

Pain management is extremely complex. Professor Michael Cousins has remarked that it is more complicated than all the other organs put together because it involves the central nervous system, made up of the spinal cord and the brain.

The reality for many with chronic pain is that the pain may be felt in one area but be produced in a completely different area. For example, a long ago foot injury is likely to have healed. The pain though, may be as strong as ever. A process called central sensitization may have occurred whereby physical changes have occurred to the nerve and other cells in the spinal cord. This leads to the brain receiving faulty input from the spinal cord resulting in severe pain which can't be completely stopped. Given this complexity, perhaps the extraordinary thing is that a single medicine ever works.

The main forms of medication are:

• Over-the-counter medicines – nonsteroidal anti-inflammatory drugs (NSAIDS), paracetamol, codeine;

• Opioids – codeine, morphine, tramadol;

• Anti-epileptic drugs – pregabalin, gaberpentin, carbamazepine;

• Anti-depressants – amitriptyline, duloxetine

Unfortunately there is no medication that will take all the pain away. However, there have ben significant medications developed in recent years, and some exciting developments on the horizon. One example is Professor Maree Smith's EMA401 drug, which has been tested in six countries and published in the Lancet, with results to date showing 60% of trial participants receiving at least 30% reduction in pain relief for their neuropathic pain - but drugs such as this have a number of years of clinical trials before being seen in our local pharmacies.

Amitriptyline

Anti-epileptic drugs

Combination pain relievers

Non Steroidal Anti-Inflammatory Drugs (NSAIDs)

Opioids

Over the counter (OTC) medicines

Pregabalin