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Common sources of chronic pain include back problems, injuries, joint disorders, headaches, arthritis, sinus pain, overuse syndromes, and tendinitis. Chronic pain is also a symptom of many types of advanced cancer. Many symptoms accompany chronic pain, which can arise as a result of the pain, such as poor sleep quality, irritability, depression, insomnia, and mood changes.

Pain can become worse due to the “wind-up phenomenon.” This condition is related to nerve fibers, which transmit the pain signals to the brain. The fibers become trained or programmed to deliver pain signals better over time, just as the muscles get stronger with training. The intensity of signals increase over and above what is necessary to get the brain’s attention. Therefore, the pain feels worse than it should, even when the illness or injury is improving.

The goal of treating chronic pain for both the patient and the doctor is no more pain. They both seek to find the cause of the pain, so the pain can be cured and the patient can resume a normal without the need for medication. However, some types of pain are lifelong, which means that pain medication is likely to be necessary for the rest of the patient’s life.

Neuropathic pain is intense in nature, so medications are frequently the first line of treatment. Most studies have proved that opioid analgesics and NSAIDs are not effective for relieving neuropathic pain. There are basically three types of medicines used to treat nerve pain. These are:

. Tricyclic antidepressants (TCAs) - These include amitriptyline and nortriptiline.
. Anticonvulsants - Also called neuroleptic medications, these drugs include valproic acid, carbamazepine, felbamate, clonazepam, and phenytoin.
. Local anesthetics - These include application of tocainide, lidocaine, and mexiletine.

The misuse, overuse, and/or abuse of opioid (narcotic) pain medications has now become a national issue. Deaths due to overdoses of prescription drugs has increased drastically over the last few decades, and the abuse of prescription opioid medications now ranks second behind marijuana as the nation’s top drug issue. Therefore, each person with chronic pain should be managed individually by a pain management specialist. Medication use must be determined by weighing the benefits compared to alternative options, as well as potential side effects, the patient’s medical problems, and the cost of treatment.

Nearly one-third of all prescribed medications are for individuals over the age of 65 years. However, 30% of hospital admissions among the elderly are linked to toxic effects from medications or an adverse drug-related event. Many of these reactions are often overlooked by healthcare personnel because they are assumed to be age-related changes, such as dizziness and general weakness. It is very important for you to tell the pain management specialist about everything you are taking, whether for pain or another medical problem.