Opiates– These are often referred to as narcotics. They are controlled substances prescribed for pain.
They have significant abuse potential and patients may develop dependence on them. We do not prescribe these medications casually, and we do not prescribe these to every patient we see. Some patients may have medical or social histories that put them at high risk for addiction and abuse of these medications.
Some patients do not have trouble complying with opiate therapy, and it is a viable part of their pain management therapy. All patients who are on opiates will be subject to urine drug testing and prescription monitoring. They also generally need to be seen in clinic more frequently (usually every 1-2 months) than patient who are not on opiates.
Anticonvulsants– These medications can be very helpful for headache syndromes or neuropathy. They
may have side effects such as drowsiness or trouble with concentration.
Antidepressants– There are a few antidepressants that work to inhibit ascending pain signals in the spinal cord.
Anti-inflammatories (NSAIDS)- These medications work against inflammation. They may be very effective for a recent injury of flare-up of your pain. They should be avoided in patients with a history of ulcers, GI bleeding, or kidney problems. Recent warnings have been strengthened regarding the risk of stroke and heart attack with NSAID use.
Muscle relaxers- May be helpful for muscle spasms either from a back or neck problem or a neurological condition. These medications have potential side effects that overlap with the opiates and anticonvulsants.
Topical creams/ointments- These are applied to the skin over the area of pain and may contain multiple medications in the above classes. One advantage of these is that they rarely produce a meaningful blood level of medication and therefore systemic or cognitive side effects are rare.