Chronic Pain - Anti Inflammatory Medications

When treating a patient who has a chronic pain syndrome, the first group of medications utilized are the anti-inflammatories. These medicines decrease the inflammation and swelling at the tissue site. They do this by blocking certain physiologically active substances.

For example, these pain substances, prostaglandin, substance P and histamine  can cause small arteries to dilate with subsequent edema or fluid formation. Soft tissue, muscle, and nerve cells become irritable inflamed and hyper excitable. The anti-inflammatory medications inhibit this inflammatory process. The most potent anti-inflammatories are the corticosteriods. Examples of these meditations would include Cortisone, Prednisone, and Decadran. They are utilized in a whole host of severe medical inflammatory conditions such as, collagen vascular diseases (lupus, rheumatoid arthritis) polymyositis or reflex sympathetic dystrophies. They are very beneficial.

However one of the problems with steroids is the fact that with long term use, you may develop many side effects. Examples of the side effects include changes in fat distribution, weight gain, electrolyte abnormalities. exacerbation of diabetes, ulcers, cataracts and suppression of the immune system. Therefore these medicines should only be utilized in the most serious conditions if prescribed long term. They may be used intermittently without any major problems. This can occur in the form of oral tablets utilized for periods of 10 days such as a Medrol dose pack or in the form of injections, trigger point injections to break up muscle spasm, injections into joints to decrease fluid formation or injections into the spinal canal (an epidural block) to decrease nerve swelling.

The other group of medications in this category would be NSAID’s (non-steroidal anti-inflammatory drugs). There are a whole host of NSAIDs. Most commonly recognized would be Aspirin or Motrin. There are over 30 different medications utilized today. Many sold over the counter under various brand names. If one anti-inflammatory medication does not help it does not necessarily mean that another anti-inflammatory will likewise prove ineffective.

There are 4 major groups, the salicylates example Aspirin, the propionic acids example Motrin, Indoles example Indomethacin, femanetes example Peostil. If one wants to stay with a non-habituating medication then it reasonable to try different groups of anti-inflammatories before giving up on this group. Common side effects include gastrointestinal irritation which occurs in approximately 10 percent of individuals. GI bleeding in 1 percent with more than three months usage, transient inhibition of platelets necessary in preventing bleeding or fluid retention in up to 10%. Therefore chronic use of these medications is not benign. They have also been implicated in chronic renal failure, hepatic disorders and serious gastrointestinal bleeds. NSAID’s should not be combined on a chronic basis with the corticosteriods because of combined gastrointestinal irritation. However they may be combined for chronic pain with the opiates and have an additional effect. Combinations like Celebior and Vioxx are new medications without significant GI side affects and equal efficiency.

Finally Acetaminophen (Tylenol) is not a NSAID. It has no anti-inflammatory properties, however it is utilized in pain management. It does decrease perception of pain primarily by its effect on the brain pain center. There has been much press about side affects specifically related to Acetaminophen. Chronic use at high doses can cause liver failure, particularly when combined with alcohol the adverse liver effects become multiple. Much like NSAID’s Acetaminophen is not totally free of problems, not totally safe.