Tuesday, September 22, 2009

Arthritis Pain Medication

There are various medications or a combination of them that can be used to provide relief from the pain which one experiences during arthritis. One such type of drug will naturally be an analgesic which is essentially a painkiller. These will provide relief from pain but will not do much about the inflammation; these are helpful if you are allergic to aspirin or have an ulcer. Acetaminophen is one such analgesic which can give temporary relief from the pain which at times can be excruciating during arthritis. This however does not reduce the swelling. This can be bought over the counter (without the need for a doctors prescription). Tramadol is another such drug. Sometimes, narcotic pain relievers are used for patients with severe arthritis when all other medications have not provided relief.

Arthritis medications like Nonsteroidal anti-inflammatory drugs which are commonly known as NSAIDs do help in reducing pain of joints, stiffness and the swelling which occurs. They also cut down on the production of prostaglandins which are substances found in the human body which send messages of pain to the brain. Examples of NSAIDs will include the common aspirin, ibuprofen and naproxen sodium. Other NSAIDs are available only through a doctors prescription. One side effect of using such drugs is that they can cause a stomach upset. There is a serious possibility of cardiovascular side effects also.

Glucocorticoids are drugs which are connected to the natural hormone which is already present in the human body which is called cortisol. Scientists have developed synthetic forms of cortisone which can be consumed either by way of oils or in injection form which will go directly into joints or other tissues where the pain is occurring. These medications do assist in relieving or reducing arthritis pain by reducing the swelling and inflammation in that area. Glucocorticoid injections need to be carefully taken and monitored. Side effects can occur if one takes such injections on a regular basis and too frequently.

Disease modifying anti-rheumatic drugs (DMARDs) are often used to control inflammatory conditions such as rheumatoid arthritis. While their main purpose will be to lessen inflammation, slow down and suppress the body immune system, these medications can also lessen the pain which is what arthritis patients having. These drugs could take a fair amount of time (several weeks or months) before the effects begin to show. Examples of DMARDs would be: methotreaxate, hydroxychloroquine, azathioprine, azulfidine and lefunomide.

Phantom Pain

All the information which comes into our sensory system such as feelings like touch and pain is transmitted up to the sensory cortex of the brain, where the parts of the body have specific parts of the cortex dedicated to them. The diagram which results when the body parts are illustrated against the sensory cortex is called the homunculus, in which certain parts such as the lips and hands have much larger areas of brain devoted to them than average. This is because the importance for daily life of those areas is greater and more information is required from them to figure out what's going on.

In an acute injury the injured part goes through an inflammatory process, with the soup of irritating chemicals waking up normally silent pain nerves and a stream of nerves impulses making their way upwards. These enter the spinal cord and pass the messages on to the next stage nerves, which become highly stimulated by the incoming impulse streams as they start to amplify the incoming pain levels. This increases and passes on higher pain intensities up to the brain, forcing us to take corrective actions.

Pain needs to get through up to the brain and force its way into our conscious minds until we feel it, as our pains are always in our minds strictly speaking. Pain is never imaginary but our brains construct a virtual sensory reality so we can make sense of the world which includes touch, pain and visual realities. It is important to realise that the brain builds the pain experience that we endure and that this is not made up by our injured neck, disc prolapse or torn ligament.

When we have an amputation our Nervous system is divided as well as our limb. The bone, muscle and ligaments which are cut through are easy to envisage, but we do not think about the nerves which have to be cut, the consequences of which can be very important. The nervous system does not like parts of it to be removed, it does not like it when an area which normally sends in loads of information suddenly stops doing so. When this occurs odd things start happening in the nervous system, things which can have unpleasant results.

When incoming impulses are completely prevented from reaching the second stage nerves, these nerves react by rapidly increasing their excitability. With no incoming messages due to the amputation or nerve transection, the second stage nerves start to fire off spontaneously, that is for no particular reason but just because they are over-excited. The leg nerves may be missing but all the central nervous system transmission nerves for the leg still exist. The areas of the brain looking after the missing part are still present and still capable of creating pain in that missing part.

When someone has an amputation the pain problem which is often generated afterwards in known as phantom pain, a pain syndrome which appears gradually over a period of months or weeks and which can be very difficult to manage. An example of a very unpleasant type of pain called neuropathic pain, phantom pain can be very deep or stabbing and is very hard to cope with as a sufferer. These neuropathic pains are being generated inside the nervous system and are not related to normal, tissue injury pain.

Morphine related drugs such as codeine, Tramadol, fentanyl and morphine may not be very effective against neuropathic pain so pain clinics more commonly prescribe drugs which affect nerve transmission of pain. These include gabapentin, pregabalin and amitriptyline, which are typically used for depression and epilepsy but have been found to have activity against pain. TENS (transcutaneous electrical nerve stimulation) can be useful, sending electrical stimulation in through electrodes on the skin. Coping with a long term pain problem can be addressed by cognitive therapy.

Phantom pain can be an intractable, serious problem for anyone with an amputation, and having significant pain before the amputation may make the likelihood of phantom pain greater. A multidisciplinary approach involving a pain clinic is most likely to be helpful.