Pain Medication

Which medication for what kind of pain?

The choice of which medication is indicated in a pain patient depends on whether the pain is caused by inflammation (nociceptive pain) or is due to a disorder of the nervous system (neuropathic pain).

The nature of the pain, together with the results of both general physical and neurological examinations, will help to distinguish between these two types of pain.

In case of the prolonged existence of a nociceptive source, sensitisation phenomena (hyperalgesia, allodynia) may occur. This will require different medication from the NSAIDs indicated.

Some pain medication is specific for a certain diagnosis, such as, migraine and cluster headache.

Moreover, the prescribed medication is also dependent on additional factors, such as, fear and depression that can negatively influence the pain.

Pharmacological treatment

In acute nociceptive pain (first three months):

  • NSAIDs
  • Paracetamol
  • COX-2 inhibitors

In chronic nociceptive pain (more than three months):

Although NSAIDs are frequently prescribed and used in chronic pain, there is no scientific evidence regarding the positive effect of this medication on such pain. The same can also be said of (weak) opioids, such as tramal.

In the case of morphines, short-term treatment is advised (up to three months), and always in combination with medication for constipation.

  • Tricyclic anti-depressive drugs
  • Weak opioids
  • Opioids

In neuropathic pain:

Depending on the findings of the neurological examination for neuropathic pain, various kinds of medication can be prescribed. No brand names are mentioned below:

  • Anti-convulsive drugs: (pain from touching; pins and needles; changed sensation; spontaneous flashing pain; spontaneous and continuous burning pain).
  • Anti-arrhythmic drugs: (pins and needles; changed sensation; spontaneous flashing pain; spontaneous and continuous burning pain).
  • Tricyclic anti-depressive drugs: (pain from touching; pins and needles; changed sensation; spontaneous flashing pain; spontaneous and continuous burning pain).
  • Topical anaesthetics: (pain from touching; change sensation).
  • Baclofen: (pain from touching).
  • Opioids: (pain from touching).
  • Clonidine: (pain from touching).
  • NMDA antagonists: (pain from touching; changed sensation).