Pain Medications

Original Editor - Rachael Lowe Top Contributors - Lucinda hampton, Rachael Lowe, Kim Jackson, Sam A. Ayeni and Jin Yoo

What is Pain ?

A definition of pain, according to the subcommittee on taxonomy of the International Association for the Study of Pain and adapted in 1979, is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. It is usually subjective[1].

What Are Pain Medications ?

A pain medication is defined broadly as any medication that relieves pain. Many different pain medicines exist and each one has pros and cons. Certain pains respond better to some medicines than others. People also have a slightly different response to a pain reliever.[2]

The main forms of medication are:

  1. Over-the-counter medicines. Good for mild to moderate pain, commonly prescribed for arthritis and musculoskeletal pain– nonsteroidal anti-inflammatory drugs (NSAIDS), paracetamol, codeine.
[3]

2. Opioids.  These drugs are often prescribed for acute pain that arises from traumatic injury, such as surgery , neuropathic pain – codeine, morphine, tramadol;

[4]

3. Anti-epileptic drugs. These are often used for chronic pain eg neuropathic pain – pregabalin, gaberpentin, carbamazepine;

4. Anti-depressants. Used for chronic pain eg fibromyalgia– amitriptyline, duloxetine[5]

The video clip below gives a good description of pain medication steps using the WHO analgesic ladder

[6]

Physiotherapy use of Topical NSAIDs

A 2019 update of pain medications found that new topical NSAIDs provide localized pain relief and are of benefit for pain relief with minimal systemic effects.

  • Diclofenac sodium (Voltarin) gel- pain relief in hands, elbows and knees if used 4 times a day. Physiotherapists can apply this during a therapy session with the added bonus for the client that little systemic uptake occurs reducing or eliminating the adverse GI, cardiovascular, and renovascular effects of the oral compounds.
  • Diclofenac sodium (Pennsaid) Topical solution- applied 4 times daily is an effective pain relief for knee OA.
  • Diclofenac epolamine (Flector) patch- good for minor aches and sprains.[7]

Statistics

Trends in the Long-Term Care Facilities [8]

  • Systematic review including 40 studies - mainly European countries
  • Showed an increased use of opioids and acetaminophen which moderately correlated (0.59) to an increase in scheduled prescription rates.

Non-adherence in Chronic Pain Patients [9]

  • Systematic review including 25 studies
  • Non-adherence rates in chronic pain patients ranged from 8% - 62% (weighted mean: 40%)
  • Non-adherence common factors
    • Positive association: dosing frequency, poly-medication, pain intensity, and concerns about pain medication
    • Negative association: age, pain intensity, and quality of patient-caregiver relationships
  • Under use
    • Positive association: active coping strategies and self-medication
    • Negative association: perceived need for analgesic medication
  • Over use
    • Positive association: perceived need, pain intensity, opioid use, number of prescribed analgesics, history of drug abuse, and smoking

Physiotherapy- pain medication implications

Remember pain medication is only one part of pain management. Complete pain management needs a three pronged approach.

  1. Pain medication
  2. Physical therapy
  3. Cognitive therapy.[5]

NB Always be alert to the effects of

  • Opiods and Antidepressants, both slow reactions, cause sleepiness, and increase falls risks.
  • Polypharmacy and falls risk

See the good informative links below for further information regarding physiotherapy and pain management.

References

  1. Merskey, H., 1991. The definition of pain. European psychiatry.
  2. Medline Plus. Pain relievers. Available from: https://medlineplus.gov/painrelievers.html (last accessed 7.4.2019)
  3. A Abihu. Over the counter medications: https://www.youtube.com/watch?v=GsfFTcPv5kw (last accessed 8.4.2019)
  4. Mayo Clinic. Avoid opiates for chronic pain. Available from: https://www.youtube.com/watch?v=XQ9u98rALvo&feature=youtu.be (last accessed 8.4.2019)
  5. 5.0 5.1 Australian Pain management association. Medication. Available from: https://www.painmanagement.org.au/2014-09-11-13-35-53/2014-09-13-02-37-18.html (last accessed 7.4.2019)
  6. Dr John Campbell. Pain 11 Analgesia. Available from: https://www.youtube.com/watch?v=XCowQo74CaM&app=desktop (last accessed 8.4.2019)
  7. Nursing 2019. An update on pain medications. Available from: https://journals.lww.com/nursing/Pages/articleviewer.aspx?year=2010&issue=11000&article=00024&type=Fulltext (last accessed 8.4.2019)
  8. La Frenais FL, Bedder R, Vickerstaff V, Stone P, Sampson EL. Temporal trends in analgesic use in long-term care facilities: A systematic review of international prescribing. Journal of the American Geriatrics Society. 2018; 66: 376 - 382. Available from: doi: 10.1111/jgs.15238 [Accessed 18th April 2019]
  9. Timmerman L, Stronks DL, Groeneweg JG, Huygen FJ. Prevalence and determinants of medication non-adherence in chronic pain patients: A systematic review. Acta Anaesthesiologica Scandinavica. 2016; 60: 416 - 431. Available from: doi: 10.1111/aas.12697 [Accessed 18th April 2019]