Medication Management

Having a pain specialist who is an expert at managing medications is essential. At Sereno Pain Management, we have this expertise, and will work with you to determine which, if any, medication, would be helpful and safe for you to use to treat your painful condition.

Pain medication, non-prescription and prescription, is among the most commonly used medication in this country. Most people take pain medication for brief periods of time, usually associated with temporary conditions. Headaches, acute back pain, toothaches, minor injuries, and minor surgeries are the most common reasons that people take pain medication. When pain becomes chronic, it has usually started as something expected to be short-lived. When the pain doesn’t resolve as expected, we must consider the fact that treatments for acute, short-lived pain problems may not be the best treatment for a chronically painful condition. We must look further into the reason the pain has not improved. Curing the pain would be the optimal outcome. If this is not possible, or not successful, we must look at ways of reducing the pain so that it is manageable and tolerable. Sometimes this involves using a variety of medications, often combined with interventional procedures. Knowing the type of pain that we are treating will often guide which medication is going to have the best chance of success.

There are different types of pain, which we often sort into classifications. This is only one method of classification, and is used for illustration purposes only:

  1. Musculoskeletal pain (muscles, joints, bones, connective tissue): examples would be arthritis, muscle strain, rotator cuff tears, ACL tears, sprained ankles, and possibly fibromyalgia
  2. Neuropathic pain (pain originating in an injured or diseased nerve); examples of this time of pain are carpal tunnel syndrome, shingles pain, trigeminal neuralgia (facial pain), sciatica, CRPS, and possibly fibromyalgia
  3. Mixed pain, meaning a combination of musculoskeletal and neuropathic pain.
  4. Central pain, related to brain disease or injury, such as after a stroke
  5. Visceral pain, related to organ pain, such as from interstitial cystitis of the bladder, chronic heart pain (angina)
  6. Headaches

We then may use our pain classification to guide which type of drug would be most effective.
Commonly used medications for pain:

  1. Nonsteroidal anti-inflammatory drugs (NSAIDs): ibuprofen, naproxen, celecoxib, diclofenac, ketorolac, and acetaminophen. This class is commonly the first line of pain management, and is most effective for musculoskeletal pain.
  2. Opioids: morphine, hydrocodone, hydromorphone, oxycodone, oxymorphone, tramadol, tapentadol, buprenorphine, methadone, levorphanol, codeine, fentanyl. This class of drug often treats multiple classes of pain, but often has side effects, and can result in tolerance, physical dependence, and addiction. Prescribing and dispensing of this class of medication is highly controlled and monitored by the state and federal governments.
  3. Muscle relaxants: baclofen, tizanidine, cyclobenzaprine, carisoprodol. This class is primarily used for muscle-related pains. Some of the drugs in this class are habit- forming.
  4. Antidepressants: amitritpyline, nortriptyline, duloxetine, venlafaxine, milnacipran. This class of drug is effective for neuropathic pain, fibromyalgia and musculoskeletal pain.
  5. Anti-epilepsy drugs: gabapentin, pregabalin, carbemazepine, topiramate. This class of drug is primarily prescribed for headaches, neuropathic pain, and fibromyalgia.
  6. Triptans: sumatriptan, rizatriptan, naratriptan, frovatriptan, eletriptan, zolmitriptan, almotriptan. These drugs are used to treat migraine headaches.