Medical treatments

Acetaminophen (Tylenol): Discovered in 1877 it was first marketed in US in 1953. Since then it has become a widely used over the counter pain killer. It is useful to control pain of mild intensity by inhibiting COX and acting on cannabinoid endogenous receptors. Its efficacy as pain killer is comparable to aspirin or other NSAID but it does not have anti-inflammatory effects. When given in recommended doses its side effects are nearly non-existent. It is usually prescribed in combination with other pain killers to achieve better pain relief without increasing side effects.

Non steroid anti-inflammatory agents (NSAID): The most common NSAIDs are aspirin, ibuprofen or naproxen. They reduce synthesis of prostaglandins that cause fever and inflammation, hence their beneficial effects. The balance between their benefits (pain relief) and secondary effects (kidney impairment, gastro-intestinal bleeding or cardiovascular events) must be carefully assessed before starting a chronic treatment with NSAIDs. For otherwise healthy pain patients, short courses with NSAIDs treatments can be of some help.

Antidepressant drugs: Depression occurs as an imbalance between chemical compounds within your brain. When substances like serotonin or noradrenaline are found low in targeted areas of your brain, symptoms of depression may occur. Initially antidepressants were given as a help for patients suffering with chronic pain and concurrent depression but since 1970 it is known that , independently on the emotional impact of chronic pain, the use of antidepressants for treating chronic pain has benefits. Their exact mechanisms are yet to be clarified but they are thought to provide pain relief for certain pain syndromes by increasing the levels of serotonin and or noradrenaline in targeted nervous cells along the pain pathways. Tricyclic antidepressants (amitriptyline-like drugs) are the most useful antidepressants to treat certain types of chronic pain conditions such as neuropathic pain or fibromyalgia. Newer antidepressants with higher potency and less side effects are available for pain management.

Anticonvulsant drugs: The central nervous system operates in a state of balance between excitation and inhibition. Shifts in this equilibrium can lead to excessive neuronal activity. Epilepsy (convulsive disorder) appears to result from an inability of the brain to regulate this activity, rather than from abnormal neurons. Thus, anticonvulsants act to either increase inhibitions or decrease excitations. These principles can be applied to pain management in special that of nerve origin (also known as neuropathic pain). Clearly, neuropathic pain is also due to excessive neuronal activity and the use of anticonvulsants has been undoubtedly advocated as a useful treatment for neuropathic pain conditions (and others such as migraine or fibromyalgia).

Short acting opioids

Oral long acting opioids

Transdermal opioids

Synthetic cannabinoids

Lidocaine

Ketamine

Bisphosphonates

Spine joint injections

Sacroiliac joint injections

Large joints injections (Hip-Knee-Shoulder)

Spinal nerve blocks

Peripheral nerve blocks

Sympathetic nerve blocks

Thermal radiofrequency neuroablation

Chemical neurolysis

Vertebroplasties

Kyphoplasties

Cementoplasties

Transcutaneous nerve stimulation

Dry needling

Intramuscular electrical stimulation

Trigger point injections

Soy-enriched products

Omega 3 fatty acids supplementation

Medical marijuana program