Columnists

Newest Medications Used To Treat Spinal Pain

Issue 6.14

In my medical practice I obtain a patient’s history, physical exam and imaging to diagnose spinal problems that are causing pain.  Treatments are best used as a multi-modal approach.  With the end goal being pain relief and increased function, I prescribe medications, order physical therapy and perform interventional procedures such as epidural steroid injections and radiofrequency ablation to treat spinal pain.  I typically leave surgery of the spine as a last resort, reserved for patients who do not respond to the more conservative treatments.  I am commonly asked from patients, if there are any new pain medications to treat chronic pain.  Most patients hope there are more options out there than a percocet or an aspirin!  Here is a summary of some of the newer pain medications that we commonly use to help patients treat their pain.

NSAIDs or non-steroidal anti-inflammatory medications are commonly used to treat pain. NSAIDs are medications such as ibuprofen (Advil, Motrin), and naproxen (Aleve).  If taken excessively, NSAIDs can damage the kidneys or increase the risk of gastric bleeding.  But used sparingly, NSAIDs are a good treatment for inflammatory pain.  Some newer NSAIDs that I commonly prescribe in my clinic are celecoxib (Celebrex) and meloxicam (Mobic).  They tend to have a lower side effect profile than some of the other NSAIDs.

Opiate medications are a class of strong pain medicines that are commonly used to treat pain.  Most of my patients despise the nausea and “goofy feeling” that these types of medications can cause.  Hydrocodone (Lortab), and oxycodone (Percocet), are two of the most commonly prescribed opiate pain medications and are typically combined with acetaminophen (Tylenol).  A newer opiate is tapentadol (Nucynta).  Nucynta is an opiate and norepinephrine reuptake inhibitor that is typically better tolerated.  In other words, Nucynta typicallyhas less side effects than other opiate medications including less nausea, drowsiness and constipation.

Antidepressants have long been known to help patients with chronic pain.  Chronic pain can certainly increase the risk of a patient developing depression and conversely depression can worsen pain symptoms as well.  Even patients that no signs of depression can have pain relief from an antidepressant.  One of the more widely used newer antidepressants used to treat pain is duloxetine (Cymbalta).  Cymbalta is a serotonin-norepinephrine reuptake inhibitor similar to the other commonly used antidepressants.  Cymbalta is typically very well tolerated, with the most common side effect being transient nausea when first starting this medication.

Like the antidepressant class of medications, anticonvulsants have historically treated neuropathic pain very well.  Neuropathic pain is the burning, sciatic type of pain from spinal stenosis or painful numbness felt with diabetic peripheral neuropathy.  An older medication, gabapentin (Neurontin), is the main medication used in this category.  However, a newer stronger anticonvulsant, pregablin (Lyrica), is typically better tolerated by patients.  The most common side effects of these medications include dizziness, drowsiness, lightheadedness, and fatigue.

Most patients benefit from the synergy of combining two or three classes of medication to treat pain.  When combining two or three medications together we can typically use smaller doses, and thus have fewer side effects.  Research has also shown better pain relief when combining medications as well.  Finally, if you have chronic pain and have not tried some of these medications, I recommend that you talk with your primary care physician or schedule a consultation at our clinic.

Dr. Court Empey is a board certified interventional pain and spine specialist and founder of Desert Pain Specialists in St. George,Utah.  (435) 216-7000.

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