Chronic Pain Treatment

Chronic pain treatment optimally involves a combined pharmaceutical and non-pharmaceutical approach. Pharmaceutical options include a range of classes:

• Opioids, side effect: sedation, constipation, respiratory depression, abuse potential
• NSAIDS: GI ulcers, bleeding, renal impairment
• Serotonin agonists: MI, stroke, peripheral vascular occlusion
• Antiepileptics: sedation, dizziness, cognitive impairment
• Antidepressants: Cardiac arrhythmia, sedation, nausea, dry mouth, constipation, sleep disturbance

Some commonly used pharmaceuticals include:

• Tramadol (ultram): 250-300 microgm q 6hr, binds mu-opioid receptors and inhibits the noradrenaline reuptake inhibitor, has addictive/abuse potential
• Toradol (Ketorolac): 10 mg q 6hr, NSAID, risk of gastritis after 5-7 days
• Vicodin: 5/500 or 7.5/750, hydrocodone and acetaminophen, formulations which use NSAID instead of acetaminophen are also available (Vicoprofen)