Chronic Pain Part 3
Posted by Eamonn Brady on
Last week I discussed medicines used for chronic pain such as paracetamol, anti-inflammatory drugs and stronger codeine type opioid painkillers. This week I discuss a few other options.
Anticonvulsants
Anticonvulsants for example gabapentin (Neurontin®), pregabalin (Lyrica®) and carbamazepine (Tegretol®) are commonly used to treat epilepsy but they can also help nerve pain. They can stop nerve impulses causing some types of pain. Side effects may be worse in the first few days when your body is getting used to new medication. Side effects can include dizziness; drowsiness; weight gain; rash; dry mouth; feeling sick; and being sick. Less common side effects include swollen legs, blurred vision, headaches, diarrhoea and tremors (movement disorders).
Antidepressants
Antidepressants such as amitriptyline, duloxetine and fluoxetine in addition to helping people who have depression can help others with chronic pain. Amitriptyline can be considered for treatment of fibromyalgia (chronic widespread pain) and nerve pain. Duloxetine can be considered for treatment of nerve pain. Fluoxetine can be considered for treatment of fibromyalgia. They work by interfering with the way nerve impulses are transmitted and ease some types of pain. Different antidepressants have different side effects, and side effects are rare with some of them. When you first start to take amitriptyline or duloxetine you may experience dry mouth; feeling sick; dizziness; urinary retention; constipation; drowsiness; problems sleeping; anxiety; agitation; and problems with your central nervous system. Initial side effects often subside as your body gets used to the medicine.
Triptans (for migraine)
Triptans are highly effective, reducing the symptoms or aborting migraine attacks within 30 to 90 minutes in 70-80% of patients. Triptans target those neural serotonin receptors specifically involved in migraine attacks and can be used in the treatment of migraine with or without aura. All are available in tablet form with some brands also available as fast melt tabs, nasal spray or injection.
Triptans that are prescribed in Ireland include Sumatriptan (Imigran®), Zolmitriptan (Zomig®) and Frovatriptan (Frovex®). Studies indicate that in over 60% of cases, triptans give significant pain relief within two hours. Approximately 30% of patients experience complete pain relief within two hours of taking a triptan. Sumatriptan is especially effective in the treatment of cluster headaches (a severe form of headache more common in men)
Currently all triptans are prescription only in Ireland. Sumatriptan (Imigran®) is now available over the counter in pharmacies in the UK without prescription; in the UK, the patient requires a pharmacist consultation to see if it is suitable for them before they can purchase. There is call from Irish pharmacists for sumatriptan to move to over the counter in Ireland and the HPRA (Health Product Regulatory Authority) are likely to authorise this change at some point in the future.
Self Help
Pain Management Programme
Pain Management Programme (PMP) is a psychologically-based rehabilitative treatment for people with persistent pain. It is delivered in a group setting by an multidisciplinary team of experienced health care professionals working closely with patients. The main aim is to teach a group of patients with similar problems about pain, how best to cope with it and how to live a more active life. For most people, this treatment reduces the disability and distress caused by persistent pain through teaching physical, psychological and practical techniques to improve quality of life. It differs from other treatments provided in Pain Clinics in that pain relief is not the primary goal, although improvements in pain following participation have been demonstrated.
Physical or Physio-Therapy
Physical therapy covers several different treatment types, which can be beneficial for Chronic Pain, especially pain due to musculoskeletal disorders. A Chartered Physiotherapist can help with manual therapy which helps to increase tissue extensibility and range of movement, thereby decreasing pain. Manual therapy can also help with alignment and joint mechanics issues which can also help alleviate pain.
Therapeutic Exercise – such as hydrotherapy can restore joint movement and flexibility and strengthen and condition muscles to help movement thereby reducing pain.
Patient Education – can support physical therapy in a self-help or home-based manner. Reading and learning about their condition can assist in management of their own pain.
Exercise – Staying active can be the key to improving chronic pain symptoms; Any activity that increases mobility can have not only a positive physical benefit but also an affirming mental health benefit also.
Cognitive behavioural therapy (CBT)
CBT is a proven “talking therapy”, the primary aim of which is to how to recognise and manage negative thinking or unhelpful beliefs which lead to increased distress. Generally delivered on a “one to one” basis, the participant is taught techniques and strategies to enable them to challenge their thoughts, change their attitude leading to a change in future behaviour. Through regular attendance, confidence builds, leading to positive goal setting. These goals should relate to achieving resumption of activities previously restricted by pain.
Learning problem solving strategies, stress reductions techniques will help bring a successful outcome.
Disclaimer: Please ensure you consult with your healthcare professional before making any changes recommended
For comprehensive and free health advice and information call in to Whelehans, log on to www.whelehans.ie or dial 04493 34591 (Pearse St) or 04493 10266 (Clonmore).