Patient Information: Chronic Pelvic Pain
Many people believe that taking drugs for pain problems is not a good idea. They worry about treating the symptom and not the cause. However, we know that for many types of chronic pain, no one fully knows the cause, or even if they do find a cause (such as arthritis), a cure for it may not yet exist. Some believe that many factors work together to produce chronic pain, rather than a single disease or medical problem. Sometimes we can treat the cause of the pain (for example, trigger points or irritable bowel syndrome), though this often reduces rather than cures the pain. Medications treat pain problems very well. We also urge you to follow all the other suggestions made to you by the pain team. Just as no single factor causes your pain, no single treatment can cure it.
Not all drugs work well for chronic pain. The "ideal" drug would get rid of pain, not cause side effects, would not cost much, and would not become addictive. This drug does not exist, of course, but let's look at some common drugs and see how close they come to being "ideal".
NSAID's -- (non-steroidal anti-inflammatory drugs) -- a large group of drugs that includes many that you likely have heard of, for example, Ibuprofen, Naprosyn, Toradol, Anaprox, Relafen.
• How well do they work? Responses to the drugs vary from person to person and drug to drug. What works well for one person may not help the next. Having so many NSAID's to choose from, we have found that we can almost always find one that will work for a certain patient. Research has also shown that NSAID's work better if taken on a routine basis rather than just when the pain becomes severe.
• Side Effects: Most people have no side effects. The most common side effect is nausea. In rare cases ulcers may develop, most often with high doses. Doctors should use these drugs with caution in patients with kidney disease.
• Addiction Potential: None
• Cost: Variable; some are low cost and some not.
Tricyclic Antidepressants (TCA's) -- for example, Imipramine, Doxepin, Amitriptyline
• How well do they work? Again, responses to the drugs vary. These drugs work in two ways. First they improve sleep. Research has shown that improved sleep causes an increase in levels of "endorphin", a natural pain killer. The second way they work is by causing an increase of a brain chemical called serotonin. We find low serotonin levels in both depressed and chronic pain patients. Often antidepressants help both mood and pain problems. It does not surprise us that many persons with chronic pain (at least half) also complain of depression.
• Side Effects: With the low doses that we use, most patients have few side effects and they improve with time. Feeling groggy in the morning, dry mouth and constipation occur in some patients.
• Addiction Potential: None
• Cost: Most are fairly low cost.
Narcotics for example, Tylenol #3, Codeine, Darvocet, Percodan
• How well do they work? Narcotics work very well for short-lived pain. But for chronic pain, research has shown that they tend to make pain worse, causing the patient to need larger and larger doses. Taking narcotics impairs the body's ability to make its own painkillers, endorphins. Endorphins increase with sleep and aerobic exercise and decrease with lack of sleep and narcotic use. Also, they can interfere with thinking and job success.
• Side Effects: Constipation, dizziness, nausea.
Addiction Potential: Moderate. With routine use such as with chronic pain, it is just a matter of time before one becomes "tolerant" of narcotics, needing higher doses. They also can become habit forming.
Tranquilizers -- for example, Ativan, Xanax, Valium
• How well do they work? Not very well, since they are not really designed to reduce pain. Also, over time they tend to cause sleep problems and increase depression.
• Side Effects: Sedation, dizziness, weakness.
• Addiction Potential: Moderate. As with narcotics, with constant use, patients can become addicted.
IN SUMMARY, NSAID's and antidepressants appear to be the best choices for treatment of chronic pain. Both narcotics and tranquilizer agents cause addiction and can make pain worse over time.
Peer Review Status: Internally
Peer Review Date: 2004