Drug Therapy in Pain Management

Drug therapy is a central part of the treatment of acute and chronic pain. The aim is to relieve pain, improve quality of life and restore physical function. The medications used depend on the cause, intensity and duration of the symptoms.

Not every type of pain is treated with the same medication. Pain caused by inflammation, nerve damage, muscle tension, osteoarthritis, herniated discs or chronic diseases requires different drugs and dosages.

What Types of Pain Are There?

Before starting drug therapy, it is important to determine which type of pain is present:

• Acute pain (for example after injuries, surgery or infections)

• Chronic pain (for example back pain, osteoarthritis, fibromyalgia)

• Inflammatory pain (for example arthritis or tendon inflammation)

• Nerve pain / neuropathic pain (for example sciatica, polyneuropathy, phantom pain)

• Muscle and joint pain

• Cancer pain

• Headaches and migraine

• Cramping pain

Different medications are used depending on the type of pain.

Step 1: Mild to Moderate Pain

For mild to moderate pain, so-called non-opioid pain medications are usually prescribed.

Paracetamol / Acetaminophen

Paracetamol is commonly used for:

• Headaches

• Toothache

• Fever

• Mild joint and muscle pain

Advantages:

• Usually well tolerated

• Gentler on the stomach than many other pain medications

• Suitable for fever

Important:

• Taking too much can damage the liver.

• The maximum daily dose should never be exceeded.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

The most important NSAIDs include:

• Ibuprofen

• Diclofenac

• Naproxen

• Etoricoxib

• Celecoxib

These medications have:

• Pain-relieving effects

• Anti-inflammatory effects

• Fever-reducing effects

They are commonly used for:

• Back pain

• Osteoarthritis

• Joint pain

• Inflammation

• Muscle tension

• Herniated disc symptoms

Possible side effects:

• Stomach pain

• Heartburn

• Stomach ulcers

• Increased risk of gastrointestinal bleeding

• Stress on the kidneys and heart

For this reason, NSAIDs are often combined with stomach-protecting medication when taken for a longer period.

Metamizole (Novalgin)

Metamizole is often used for more severe pain or cramping pain.

Suitable for:

• Colic

• Severe back pain

• Cancer pain

• Fever

Special features:

• Also has an antispasmodic effect

• Often well tolerated

Rare but important side effect:

• Severe reduction of certain white blood cells (agranulocytosis)

Step 2: Moderate Pain

If non-opioid painkillers are not sufficient, weak opioids may be used.

These include:

• Tramadol

• Tilidine

• Codeine

These medications are often used for:

• More severe back or joint pain

• Pain after surgery

• Cancer pain

• Chronic pain

Possible side effects:

• Fatigue

• Nausea

• Dizziness

• Constipation

Important:

Weak opioids should only be taken under medical supervision and should not be used long term without regular monitoring.

Step 3: Severe Pain

For very severe pain, strong opioids may be necessary.

These include:

• Morphine

• Oxycodone

• Hydromorphone

• Fentanyl

• Buprenorphine

Areas of use:

• Severe cancer pain

• Severe chronic pain

• Pain after surgery

• Severe nerve pain

These medications may be administered as:

• Tablets

• Drops

• Patches

• Infusions

• Injections

Pain Patches

Fentanyl or buprenorphine patches release medication continuously through the skin and are especially suitable for chronic pain.

Advantages:

• Continuous pain relief

• Practical for elderly or dependent patients

• Fewer dosing errors

Medications for Nerve Pain

Nerve pain often responds poorly to ordinary painkillers. Therefore, special medications are used.

Antidepressants

Certain antidepressants can reduce pain even when no depression is present.

Frequently used:

• Amitriptyline

• Duloxetine

Suitable for:

• Polyneuropathy

• Sciatica

• Fibromyalgia

• Phantom pain

Antiepileptic Drugs

These medications calm overactive nerves.

They include:

• Gabapentin

• Pregabalin

• Carbamazepine

They are commonly used for:

• Nerve pain

• Shingles

• Phantom pain

• Trigeminal neuralgia

Drug Therapy for Specific Pain Conditions

Back Pain

Possible medications:

• Ibuprofen

• Diclofenac

• Metamizole

• Muscle relaxants

Osteoarthritis and Joint Pain

• NSAIDs

• Pain-relieving gels or ointments

• Cortisone for inflammation

• Hyaluronic acid or injections

Migraine

• Paracetamol / Acetaminophen

• Ibuprofen

• Triptans

• Anti-nausea medication

Cancer Pain

• Combination of opioids and non-opioid medications

• Additional medication for nerve pain

• Pain pumps or infusions

Phantom Pain

• Antidepressants

• Antiepileptic drugs

• Opioids

• Infusion therapies

Additional Medications in Pain Therapy

Depending on the situation, additional medications may be helpful:

• Stomach protection medication (for example pantoprazole)

• Medication against nausea

• Medication against constipation caused by opioids

• Muscle relaxants for muscle tension

• Cortisone for inflammation

• Sedative medication for sleep disturbances

Herbal and Natural Pain Remedies

In addition to conventional medications, herbal preparations may also be used.

Frequently used medicinal plants include:

• Willow bark

• Devil’s claw

• Arnica

• Turmeric

• Ginger

• St. John’s wort

These remedies may help with mild to moderate pain, but in cases of severe pain they usually do not replace professional medical treatment.

Important Advice Regarding Medication

• Pain medication should always be taken according to a doctor’s instructions.

• The dosage should never be increased without medical advice.

• Many pain medications may interact with other drugs.

• For chronic pain, a combination of different medications is often helpful.

• Long-term treatment should be monitored regularly by a physician.

Individual Pain Therapy Through Our Private Medical Home Visit Service

Our private medical home visit service in Frankfurt am Main and throughout the Rhine-Main region provides an individual treatment plan for every patient.

We take into account:

• Type and cause of the pain

• Age and pre-existing medical conditions

• Current medication

• Tolerance and side effects

• The need for rapid pain relief

Possible services include:

• Private doctor home visits

• Acute medication therapy

• Pain infusions

• Care for patients with chronic pain

• Treatment for back pain, joint pain, nerve pain and cancer pain

Available 24 hours a day at: 0152 06 05 69 69

Please note: This information is intended for general educational purposes only and does not replace a personal medical examination or treatment by a physician.