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How to manage pain with drugs

The approach has to address two quite separate issues:

What is the medical cause of the pain sensation? If you have suffered an accidental injury such as a wound or broken bone, then the first step will be to stitch the wound or set the bone. Similarly, if you are diagnosed with an illness or disease, a specific course of treatment will be indicated to relieve the problem or reduce its effects.
In parallel to treatment of the underlying cause, what action can be taken to reduce the pain? The aim is to make you as comfortable as possible. If there is a cure for your condition, removal of the cause also removes the pain. In the unfortunate situation where there is no cure, pain management makes the best of a bad job.

Because it is heavily promoted by the pharmaceutical industry as an easy solution to the problem, many people reach for a tablet. There is, however, a psychological issue to consider. If you are unlucky enough to suffer from chronic pain, you can become more worried, alarmed and intolerant of the symptoms you are experiencing as time goes by. This can mean you will be less tolerant of any real (or imagined) side-effects caused by drugs. This is not to accuse you of becoming a hypochondriac, but to recognise that when you get anxious, you can become very interested in how and what you feel (and sometimes, not a little paranoid about what drugs are or are not doing to you).

The phenomenon of pain is comprised of biological, psychological and social components. Thus, the choice of treatment and the way in which it is to be managed should be properly tailored to you as an individual and agreed with you before delivery. There are no mechanistic solutions to pain and the notion that pain is "all in the mind" is insulting to you as the patient. The best approach is holistic, recognising you as a human being with a right to have reasonable control of your treatment. If you think that a drug is not working or producing adverse side-effects, you should be able to discuss it with your doctor and adjust the dosage or change to a different drug.

Some of the analgesics such as paracetamol are sold over-the-counter to treat mild or moderate pain. There are also a range of different delivery systems available including creams, lotions or sprays. Then by prescription, you have access to:

corticosteroids that relieve asthma, arthritis, inflammation, etc.;
opioid-based analgesics such as codeine, fentanyl and morphine contain natural or synthetic opiates. The narcotic opioids can be very effective in the treatment of non-malignant chronic pain when used properly. The clinical evidence shows that up to 15% of patients may become dependent on the more powerful versions of these drugs although it is not clear whether more than a small percentage move past the psychological dependence into full addiction. For example, Buprenorphine was used commonly, but is now little used because of its addictive potential. But Ultram has proved more consistently successful, relatively free of adverse side-effects and with fewer problems of dependence.
nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin , ibuprofen and piroxicam are used in cases of acute pain, or flare-ups in chronic pain, but they are not generally used as a consistent treatment for chronic pain.

To a greater or lesser extent, all these drugs have adverse side-effects. For the most part, these effects are rare, mild and transitory if you use the drugs on a short-term basis. But the longer the period of use or the larger the dosages, the greater the risk of side-effects. The management exercise sometimes requires balancing whether the original pain is more or less bearable than the side-effects of the drugs.