By Ariel Majjhoo, MD
When doctors like myself have the freedom to prescribe effective, FDA-approved treatments to their patients, everyone wins. But deciding the right type, dose and duration of pain medications can be challenging.
There are many medications and complementary approaches for managing acute or chronic pain. For many patients, over-the-counter pain relievers such as acetaminophen or ibuprofen are sufficient. Patients may also find relieve from massage, acupuncture or physical therapy.
I always tell my patients not to give up when searching for relief. If over-the-counter remedies aren’t enough, prescription-strength pain relievers are also worth exploring, but there are pros and cons for each.
Prescription-strength NSAIDs, for example, can cause gastrointestinal bleeds if taken at high doses for an extended period of time. In fact, a quarter of patients using NSAIDs in this fashion will get a GI ulcer. But some people may not know that. And many of these patients will remain asymptomatic, only becoming aware of an issue when it becomes an emergency.
These GI complications can be reduced by taking an NSAID with a GI protectant, studies show. This is especially important for patients at a higher risk, such as people over the age of 65, people living with diabetes or those with a previous history of GI injury. Anyone taking blood thinners, including aspirin, or certain antidepressants should also be cautious.
Corticosteroids are another option to decrease inflammation and are particularly helpful for addressing chronic pain. They also can suppress nausea and alleviate fatigue, which makes them a valuable option for patients with arthritis or cancer. But long-term use can cause health risks. While corticosteroids can be life-changing, prolonged use can also lead to weight gain, high blood pressure and a range of psychological effects.
Finding the right approach to managing one’s pain is a deeply personal decision. That’s why it’s important for doctors to have the autonomy to work with their patients and find the path that’s right for them.
A multifaceted treatment approach can be beneficial. Combining therapies and pain management techniques can also help address comorbidities such as depression, anxiety or sleep disturbances. Dual-action antidepressants, for example, can address depression and physical pain. Adding talk therapy to a more traditional pain management regimen can help patients process anxieties, negative thoughts and emotions that can make pain worse.
Patients shouldn’t have to live in pain – or put themselves at risk trying to manage it. Ensuring access to balanced pain management and patient-centered care approaches can yield positive outcomes for patients.
Ariel Majjhoo, MD, is board certified neurologist and interventional pain medicine specialist in Michigan and is a member of the Alliance for Balanced Pain Management.
