Chronic pain may be the result of inflammation or injury to skin or superficial tissues, termed as nociceptive pain. Chronic pain may also be the result of injury or damage to nervous system itself, termed as neuropathic or neurogenic pain.
Nociceptive pain is generally restricted to a particular location and is of short duration. Nociceptive pain can be treated with anti-inflammatory and analgesic medications, such as non-steroidal anti-inflammatory drugs (NSAIDS) and opioid analgesic. Neuropathic pain, however, is treated in different manner, using medications that act on neurochemicals and irritable nerves (e.g. antidepressants, anticonvulsants agents).
Nociceptive pain medications: Nociceptive pain is generally treated with pain relievers (analgesic) such as acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDS) like aspirin, ibuprofen, ketoprofen and naproxen sodium.
Neuropathic pain medications: Neuropathic pain is associated with injury to the nerve. Neuropathic pain responds best to anti-convulsants, tricyclic anti-depressants, and selective anti-depressants medications. The medications act by blocking brain’s neurotransmitters. Gabapentin (Neurontin) is the oldest agent available. It is a tranquilizing and should be initiated at very low dose. Newer anticonvulsants that are also effective include topiramate (topamax) and tiagabine (gabitril).
The US FDA (Food and Drug Ddministration) recently approved the use of new anticonvulsants drug, Lyrica (pregablin) and Cymbalta (duloxetene hydrochloride) for the treatment of neuropathic pain. Lyrica is also been shown effective in treatment of diabetic neuropathy and postherpetic neuralgia. This drug can be given less frequently than gabapentin(twice daily versus three times daily).
In June 2007, Lyrica (pregablin) became the first FDA-approved drug for the treatment of pain associated with fibromyalgia (inflammation of the fibrous or connective tissues of the body), a year later, in June 2008, Cyambalta (duloxetene hydrochloride) became the second. Both Lyrica and Cymbalta reduce pain and improve function in people with fibromyalgia.
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