Chronic pain requires attention and careful management by both the physician and patient. Using a prescription pain medication that provides long-term effectiveness may minimize side effects and risks, while providing a more convenient dosing schedule. There are several choices available for prescription pain management for long-term pain.
Sustained Release Opiates
Sustained release or controlled release opiate type pain relievers are often the first line of treatment for long-term pain relief. Controlled release tablets and capsules use one of several methods to release only a certain amount of medication over a long period of time. This allows the patient to take fewer pills each day and to take them less frequently. Sustained release opiate medications available include morphine and oxycodone. Several formulations of each are available under brand names and generic formulations and generally last 8 to 12 hours. Sustained release opiates are preferred over short-acting opiates as they allow for longer pain relief but also may decrease the chance for abuse as the side effect of euphoria may be minimized. Common side effects of any type of opiate use include sedation, nausea and the risk of addiction.
Transdermal Patches
Transdermal patches provide medication that is absorbed through the skin in a controlled release manner. Fentanyl patches contain a synthetic opiate useful for many types of chronic pain relief. Fentanyl patches are applied every three days, remaining on the body until the patch is replaced 72 hours later. Fentanyl patches may cause side effects similar to other oral or injectable opiates and require particular care when using them. Patients are advised not to take hot baths, showers, use a hot tub or a heating pad while wearing the patch as heat can increase the absorption rate of the medication which may lead to inadvertent overdose. Some patients may also experience local irritation at the site of application and will need to apply each patch in a different area than the previous patch.
Pain Pumps
Injectable opiate medications may be infused into a vein using an electronic pain pump. Pain pumps may also be used to infuse medications into a central line which has been surgically inserted into the large blood vessels surrounding the heart or directly into the intrathecal area surrounding the spinal cord. Medications commonly used include opiates such as morphine, fentanyl and hydromorphone. Some pain pump regimens may offer a continuous rate of drug release and include the availability of periodic additional doses for times of the day when pain may be more severe. A pain management physician will determine which type of pump, medication and dosing regimen is ideal for the patient.
Non Steroidal Anti-Inflammatory Drugs
Many patients who suffer from chronic pain conditions will use non steroidal anti-inflammatory drugs (NSAIDS) in addition to other methods to manage pain and inflammation. Prescription NSAIDS used for chronic pain may include those available sustained release products such as etodolac, diclofenac and naproxen while meloxicam is a fast-release product that can be taken once daily as it has a long duration of action. While NSAIDs are often considered vital for the management of chronic pain and inflammation, their long-term use may increase the chance for the development of gastrointestinal disease such as ulcers. NSAIDs may also contribute to renal damage; consequently periodic laboratory testing may be advised.
