Supplemental Medications for Chronic Pain
When conventional pain drugs don't work for chronic pain, non-conventional medications may be the next option.

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What do drugs for depression and for epilepsy have in common? Both sometimes are used to treat chronic pain. The list of adjuvant pain medications is always growing. This may be good news when typical pain drugs don't work. Adjuvant pain drugs are medications that are used for other conditions, but can also be used for pain management. These drugs can enhance the current pain drugs you might be taking or they can work on their own. They are used when pain-specific drugs don't work. Doctors may prescribe them "off label".

The United States Food and Drug Administration (FDA) approves drugs for specific uses. Some adjuvant drugs are approved for treating certain kinds of pain. Some are not. That does not mean they are not safe or don't work. It means they haven't been officially tested for that condition.

What are the different types of adjuvant pain medications?
There are several categories of adjuvant pain drugs. Antidepressants and anti-seizure drugs are the most common types.

Antidepressants
Chronic pain and depression often appear together. So it's no surprise that they share medication. Antidepressants increase levels of chemicals in the brain that dull pain. They are generally taken at a lower dose when used for pain.

There are three categories used for chronic pain:

  • Tricyclic antidepressants. Examples are amitriptyline, nortriptyline and desipramine. These often help against nerve pain, including damage caused by diabetes. They can also be used for fibromyalgia, arthritis and low back pain. Side effects include drowsiness, confusion and heart problems. Seniors and people with heart conditions may need to avoid tricyclics.
  • Selective serotonin reuptake inhibitors (SSRIs). These include fluoxetine and paroxetine. SSRIs have fewer side effects than tricyclics. They may be used for headaches.
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs). Duloxetine is approved to treat several painful conditions. These are osteoarthritis, low back pain, fibromyalgia and nerve damage from diabetes. Milnacipran, another SNRI, while not used to treat depression, is in this class of medication. This drug is also used to treat fibromyalgia.

Anti-seizure medications
Drugs used to treat epilepsy are often prescribed for nerve pain. When damaged, nerves send out pain signals. Anticonvulsants work by decreasing these signals.

Pregabalin is approved for use on post-shingles pain and fibromyalgia. It's also used when diabetes has caused nerve damage. Gabapentin is approved for use with pain after shingles. Side effects include dizziness and sleepiness.

What other types of medications are used for pain?
Treatments depend on the cause of pain. Here are some options:

  • Topical agents are applied directly to the skin. Patches containing lidocaine are approved to treat pain from shingles. Creams containing capsaicin are also used to relieve shingles pain as well as nerve damage from diabetes. But it can cause a burning or stinging sensation when applied.
  • Corticosteroids, such as prednisone, reduce inflammation. They can help ease some forms of nerve and bone pain. Side effects include fragile skin and lowered immunity.
By Emily A. King, Contributing Writer
Created on 12/19/2012
Updated on 01/31/2013
Sources:
  • American Chronic Pain Association. Practice guidelines for low back pain.
  • Food and Drug Administration. News release.
  • National Diabetes Information Clearinghouse. Diabetic neuropathies: The nerve damage of diabetes.
  • American Chronic Pain Association. ACPA resource guide to chronic pain medication & treatment.
Copyright © OptumHealth.
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