I do enjoy keeping up to date with the latest in health news and research. To try keep up the latest developments I like to attend an annual pain symposium. At this pain symposium various medical specialities get together to talk about different concepts in pain diagnosis and pain management. It is primarily attended by GP’s, rheumatologists, neurologists and anaesthetist’s so the focus on how to control pain levels for back and neck pain patients is geared towards a pharmaceutical viewpoint.
Why would I attended a pharmaceutical discussion as a chiropractor? As I said I like to be up to date with what patients in pain are going to be prescribed by their doctor. I like to know the evidence and thinking behind different pain medication prescriptions so that I can help guide people if they aren’t finding the right medication or maybe on a dosage that is too weak or strong.
That is why today I want to let you know what kind of information I discovered at this recent pain symposium, in particular, regarding pain medication for a trapped nerve . Please carry on reading if you want to know which is the best nerve pain medication to take or not to take.
Trapped Nerve Pain Pills
When a doctor looks at prescribing pain killer drugs for you they should first ask themselves if the source of the pain is:
- Inflammatory or
This reason you want to know this is so you know what part of your body is telling your brain there is pain.
I’m going to be looking at just one type of pain today, neuropathic pain (nerve pain).
WHO Pain Relief Medication Ladder
The World Health Organisation developed a pain relief ladder protocol to help doctors prescribe better pain relief medication for cancer patients in the 80’s.
The same pain relief ladder can be used for other kinds of pain as well.
However, pinched nerve pain does not tend to respond as well to the WHO pain ladder.
It has been suggested that for a pinched nerve in your neck or diabetic neuropathy pain that other medications be taken by patients.
Nerve Pain Relief Medication Ladder
Here is a guidance to what nerve pain medication steps where suggested at the pain symposium.
First-Line Drug Treatment
Some choices here are:
- Certain Anti-depressants (i.e., tricyclic antidepressants and dual reuptake inhibitors of both serotonin and norepinephrine),
- Certain Anti–epileptics (i.e., gabapentin and pregabalin),
- Topical anesthetics (i.e., lidocaine).
Second-Line Drug Treatment
- Opioid analgesics (i.e., tramadol)
Third-Line Drug Treatment
- Topical capsicum.
As you may have noticed normal anti-inflammatories (NSAID’s) typically don’t feature in nerve pain protocols. However, they may be used to help other pain sources, including inflammatory pain, associated with an injury.
This nerve pain medication protocol is suggested by Finnerup NB et al. which you can read from their research below:[gview file=”http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2996861/pdf/medrep-02-52.pdf”]
I hope this helps you understand why your GP, orthopaedic or neurosurgeon has prescribed you certain medication.
There are many times people ask “why did my doctor give me anti-depressants when I’m in pain?” Well now you know anti-depressants are not always used for just one use.
So speak with your GP to get the correct pain pills you need for your specific pain.
- Finnerup NB, Otto M, McQuay HJ, Jensen TS, Sindrup SH. Algorithm for neuropathic pain treatment: an evidence based proposal. Pain. 2005 Dec 5;118(3):289-305.
- Finnerup NB, Sindrup SH, Jensen TS. The evidence for pharmacological treatment of neuropathic pain. Pain. 2010 Sep;150(3):573-81.