Chronic pain management
By Andy Stergachis, PhD, BPharm Jun 24, 2022 • 3 min
Chronic pain affects millions of Americans.
Chronic pain is commonly defined as any pain that lasts longer than three to six months or past the time of normal tissue healing. Chronic pain can start after an injury or due to a health condition, such as arthritis. Chronic pain may affect people to the point that they cannot work, eat properly, take part in physical activity or fully enjoy life. Relief from chronic pain can have important beneficial effects on sleep, tiredness, depression, quality of life and work. Chronic pain is a major medical condition that can and should be treated.
There are many options for treating chronic pain. Treatment options may include over-the-counter drugs and topical treatments, prescription medications, injections, acupuncture, transcutaneous electrical nerve stimulation (TENS) and prescribed exercises. Some people find relief for their chronic pain from alternative therapies, such as massage, meditation and cognitive behavioral therapy, which is a form of talk therapy that helps people identify and develop skills to change negative thoughts and behaviors.
Several types of medicines are used to treat chronic pain. Treatments for chronic pain include many different types of prescription-strength or over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs). Some NSAIDs, such as aspirin, ibuprofen and naproxen, may be obtained over the counter. Another over-the-counter NSAID is diclofenac gel that can be applied to the skin for the temporary relief of pain from osteoarthritis pain.
The pain reliever Tylenol (acetaminophen) may also be recommended for chronic pain. Many over-the-counter medications and some prescribed pain relievers have acetaminophen as one of their ingredients. Taking too much acetaminophen can damage the liver and even cause death.
While not approved for this indication by the U.S. Food and Drug Administration (FDA), tricyclic antidepressants may be helpful in controlling pain, including amitriptyline and nortriptyline. Gabapentin and pregabalin (Lyrica) can be helpful for some kinds of nerve-type pain.
Opioids are commonly prescribed for pain. Opioids have serious risks, including overdose and opioid use disorder. Recently, the Centers for Disease Control (CDC) recommendeds that nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain. The CDC also recommends that doctors should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient. Growing in popularity is a multi-modal approach to pain management. A multi-modal approach to pain management combines different pain relief methods tailored to your needs and concerns. Less reliance on opioids is one of the benefits of a multi-modal approach to pain management.
Gabapentin for neuropathic chronic pain
Gabapentin (brand name: Neurontin) is often prescribed off-label for certain types of chronic pain as an alternative to opioids. Originally approved as a treatment for epilepsy, gabapentin has been shown to be useful in the treatment of certain types of chronic pain, particularly pain that comes from damaged nerves, also called neuropathic pain. Specifically, the U.S. FDA has approved gabapentin for postherpetic neuralgia in adults, or pain following an episode of shingles.
Chronic neuropathic pain can be associated with several different conditions, including chronic pain after an injury, due to diabetes, or following an episode of shingles. Symptoms of neuropathic pain can include burning or shooting pain, tingling, numbness or a feeling of "pins and needles."
A review of 37 studies reported that gabapentin can provide good levels of pain relief to some people having pain after shingles or due to diabetes, the latter being an off-label use of gabapentin. The same review found that evidence for other types of neuropathic pain is very limited. The authors of the report concluded that gabapentin is helpful for some people with chronic neuropathic pain.
Patients who are prescribed gabapentin may be directed to slowly increase their dosage over several days to a dose of 1,800 mg per day. If you do not experience a benefit from gabapentin, your doctor may recommend discontinuing the medicine. If your doctor recommends that you discontinue gabapentin, your dose will need to be gradually decreased. Abruptly stopping gabapentin can make your symptoms worse and also lead to side effects. It is important to talk with your doctor if you are considering stopping gabapentin.
Dizziness and drowsiness are common side effects of gabapentin. Drowsiness is more likely to occur when you first start taking gabapentin. Be sure to discuss gabapentin side effects with your doctor and pharmacist and let them know about any side effects that you are experiencing.
The good news is that there are many ways to manage and treat chronic pain. Your doctor and pharmacist can answer your questions about relief from chronic pain to help you live a fuller life.
Published June 2022.