For many types of pain we fortunately have very good medications.
Recent new understandings of the neurophysiology of pain have led to even more specific and effective medications for some pain problems. In migraine headache, for example, new data on the pathophysiology led to development of a class of drugs called triptans, which are highly effective medications for aborting migraine attacks in the majority of patients.
New understanding of the different subtypes of receptors involved in prostaglandin synthesis (a normal body function that produces inflammation and results in pain) has led to new anti-inflammatory medications (the “cox-2” inhibitors).
Some medications developed for other conditions have proven to be very effective for some chronic pain conditions. Several medications originally developed as antidepressants and anti-convulsants are now commonly used to treat pain. Examples incluce pain associated with nerve damage (such as diabetic neuropathy, or “sciatic” leg pain following a back injury). Low-dose antidepressants may also help reduce chronic abdominal pain associated with functional GI disorders.
Unfortunately, for many chronic pain conditions there is no specific medication yet. Therefore, many people with pain are left with either no good medications for pain control or one of the many narcotic medications that are available.
Due to side effects, especially the development of tolerance, narcotic or opioid mediations have limited utility in chronic pain despite their excellent analgesic properties. Tolerance and dependence are almost inevitable consequences of daily use of these mediations. What this means is that the same amount of the medication will lead to less pain relief over time; and the person may become even more sensitive to pain as their own pain modulation system is suppressed.
If your doctor suggests a narcotic to treat pain from a functional GI disorder, be sure to ask about narcotic bowel syndrome. We are learning that under some circumstances and with some individuals, the use of narcotics can actually cause pain. In about 5−10% of individuals, narcotics may actually sensitize the nerves and make pain worse. This is called narcotic bowel syndrome (NBS).
To limit tolerance, narcotics are best prescribed for use in small doses throughout the day and not only when the pain becomes severe. The aim is for some, but not complete, pain relief. While use of narcotics for chronic pain is sometimes a viable piece of the overall pain management plan, it is not typically enough in and of itself.
In many programs, chronic use of narcotics is recommended only if a small amount of medicine leads to significant pain relief and increased function. However, if increasing daily doses are needed and only a limited amount of pain control is achieved, it is probably time to switch away from narcotics to another pain management strategy.
Adapted from IFFGD Publication #140 by Bruce D. Naliboff, PhD, Clinical Professor of Medical Psychology in the Dept. of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, Los Angeles, CA; Co-director, UCLA Center for Integrative Medicine; and Chief of the Psychophysiology Research Laboratory, West Los Angeles VA GLA Health Care, Los Angeles, CA