Drug treatment for pain

Although there are risks of side-effects, the benefits of drug treatments generally outweigh the risks. Drug treatments include:

Painkillers

Types of painkillers (analgesics) include:

• simple analgesics like paracetamol
• more complex analgesics, which are chemically related to morphine (sometimes combined with paracetamol, e.g. co-codamol, co-dydramol)
• tramadol, oxycodone, slow-release morphine, or patches containing fentanyl or buprenorphine.

Non-steroidal anti-inflammatory drugs (NSAIDs)

Types of NSAIDs include:

• aspirin or ibuprofen tablets, which you can buy over the counter at chemists and supermarkets without a prescription
• diclofenac, naproxen or indometacin tablets, which are available with a doctor’s prescription
• gels or creams which can be applied to the painful joint (for example, ibuprofen, diclofenac)
• a newer type of NSAID commonly called ‘coxibs’ (e.g. celecoxib), which are designed to control pain and inflammation.

Coxibs are less likely to cause indigestion and stomach ulcers sometimes linked with older NSAIDs.

Steroids

Steroids can be given as:

• steroid tablets (usually prednisolone), which are often prescribed because nothing else works, as in polymyalgia rheumatica (PMR)
• steroid injections either into the joint itself or into soft tissues around the joint.

Drugs for nerve pain and chronic pain syndromes

Drugs for nerve pains and chronic pain syndromes can include:

• tricyclic antidepressants, e.g. amitriptyline or dosulepin, which are prescribed to be taken at night – these drugs act partly by improving sleep and partly by helping the brain to control sensations coming from the upper body and limbs
• neuromodulatory drugs, e.g. gabapentin, carbamazepine and pregabalin, that act on the nervous system – these can help control some types of pain, especially when the pain is caused by nerve damage.

Nerve blocks and other injection techniques for pain

Injections to block pain by a direct action on a nerve or on the spinal nerve root are becoming more widely available. They usually combine a local anaesthetic with a steroid.
They’re not suitable for all types of pain, but they’re sometimes helpful for:

• osteoarthritis of the small facet joints between the bones of the spine
• compression of nerves in the lower spine.

Special scans such as magnetic resonance imaging (MRI) or computerised tomography (CT) are usually needed to decide the exact site for the injection. The specialist can then place the needle accurately by following an x-ray image, which is displayed on a screen.
These treatments are for symptom control and aren’t cures.

Other pain-relief treatments

Other pain-relief treatments and therapies include:

• a heat pad, heated rice pad or a hot-water bottle
• an ice pack or a cold-water compass
• massage (with or without creams that create a sense of warmth)
• rest and good quality sleep – disturbed or unrefreshing sleep can increase pain, so speak to your doctor if you have this problem.

These techniques are often helpful after an injury and for sudden flare-ups of arthritis or back pain.

Manual techniques

Physiotherapists, osteopaths and chiropractors may use a variety of different manual techniques, including:

• manipulation and stretching
• technologies such as ultrasound, laser or interferential treatment
• exercise programmes to strengthen muscles and improve general fitness.

It’s important to go to a qualified practitioner, preferably with the guidance of your doctor.
In some conditions, for example back pain, the Alexander technique may also help. The Alexander technique teaches awareness of posture and relaxation to reduce muscle tension.

Transcutaneous electrical nerve stimulation (TENS)

TENS is a technique that uses small pulses of electricity to produce a tingling sensation. It aims to disrupt pain signals by reducing the sensitivity of the nerve endings in the spinal cord.
Some people find it very effective, especially when the pain is due to nerve damage.
It’s best to get advice from a physiotherapist on where to position the pads, the frequency and strength of the pulses and the length of treatment.

Acupuncture

Acupuncture is used by doctors and other practitioners, often with very good effect. Very fine needles are inserted into specific points in the body. It’s thought to work by diverting or changing painful sensations sent to the brain and by stimulating the body’s own pain-relieving hormones (endorphins and encephalins).

Psychological techniques and relaxation

Psychological techniques are often used in pain management clinics. Pain is never a purely physical phenomenon, and learning to think differently about pain and altering your behaviour can sometimes be helpful, especially with chronic pain.
Relaxation techniques are helpful in many conditions. They work both by relaxing tense and painful muscles and by relieving the anxiety that makes pain more difficult to bear.