What is medication management?

Medication management is the use of medications to help control your chronic pain.  The goals of medication management are to decrease your pain, increase your functional ability, and to improve your quality of life.  Many different classes of medications may be used to help control your pain depending on the type of pain that you are experiencing.  Your Austin pain management doctor at Capitol Pain Institute may use one or several of these medications to try to help control your pain.

Opioids

Opioid-based pain medications work by activating the Mu-opioid receptor primarily located in the central nervous system or peripheral nervous system.  Opioids work by decreasing the perception of pain that the patient feels.  Common side effects include nausea, vomiting, sedation, respiratory depression, constipation, itching (pruritus), and euphoria.  Opioid medications can also be highly addictive and have withdrawal symptoms if stopped abruptly.   Opioid medications are sometimes referred to as narcotics, although that is technically incorrect.  Narcotics refers to illegal medications.  Common opioid medications include Hydrocodone (Norco, Vicodin, Lortab), Oxycodone (Percocet, Oxycontin), Morphine, Dilaudid, Methadone, and Fentanyl.

Anticonvulsants (Antiepileptics)

Anticonvulsants (also referred to as anti-epileptics or anti-seizure medications) are a class of medications that have multiple uses including treatment of epilepsy, other seizures, bipolar disorder,  headaches, and neuropathic pain.  Common anticonvulsants used for pain management include gabapentin (Neurontin, Grailse, Horizant), pregabalin (Lyrica), and topiramate (Topamax, Trokendi).

Antidepressants

Antidepressants are a class of medications that are designed to primarily treat depression, however many of these medications are very effective in treating chronic pain.  More specifically, the tricyclic antidepressants and the serotonin-norepinephrine re-uptake inhibitors (SNRIs) have been shown to help reduce pain in chronic pain patients.  Presumably, the ability of specific antidepressants to help reduce chronic pain comes from their ability to increase the concentration of norepinephrine in the central nervous system.  This allows the brain to reduce the intensity of pain signals that it receives from the body.  Common antidepressants used in pain management include amitriptyline (Elavil), nortripyline (Pamelor), milnacipran (Savella), and duloxetine (Cymbalta).

Anti-inflammatories

Anti-inflammatories reduce pain by reducing inflammation and swelling.  The most common anti-inflammatories are the NSAIDS, which inhibit prostaglandin synthesis by blocking the cyclooxygenase (COX) enzyme.  Common NSAIDs include diclofenac (Voltaire), ibuprofen (Advil, Motrin) and naproxen (Aleve).  Acetaminophen (Tylenol) is not an NSAID and does not reduce inflammation.

Muscle Relaxants

Muscle relaxants are a broad class of medications that are designed to reduce pain due to muscle spasms.  They are also used to reduce spasticity that is seen with neuromuscular disorders.  Muscle relaxants work on the central nervous system by mimicking the action of GABA.  Muscle relaxants are more effective for acute pain, but may have a role in the management of chronic pain for some patients.  The most common side effect from muscle relaxation is sedation. Common muscle relaxers include cyclobenzaprine (Flexiril), tizanidine (Zanaflex), metaxalone (Skelaxin), and methocarbamol (Robaxin).