Steroidal Drugs (Corticosteroids)
Steroidal medications such as cortisone and prednisone are available by prescription and injection. These drugs reduce inflammation and can relieve pain. They often are used to treat the following conditions:
- Carpal tunnel syndrome
- Crohn's disease
- Tendonitis (e.g., trigger finger, tennis elbow)
- Ulcerative colitis
Steroids can reduce the immune system's ability to fight infection. Oral corticosteroids can cause side effects such as weight gain, headache, mood changes (e.g., irritability), and difficulty sleeping.
Opioid Analgesics (Narcotics)
Opioid analgesics (e.g., morphine) may be prescribed to treat severe pain that does not respond to other medications. These drugs, which relieve pain through an effect on the central nervous system, have addictive (narcotic) properties. They may cause physical and/or psychological dependency when used over a long period of time, so they are reserved for treatment of acute pain (e.g., cancer pain, labor and delivery). Opioids also may be used during surgery (e.g. dental surgery) to relieve pain and to facilitate anesthesia.
Opioid analgesics may cause serious side effects, including the following:
- Constipation (may require fiber supplements, laxatives, or naloxegol [Movantik]an oral treatment approved by the FDA in September 2014)
- Dry mouth
- Excessive sleepiness (somnolence)
- Excessive sweating
- High blood pressure (hypertension) or low blood pressure (hypotension)
Unlike non-opioid analgesics, most opioids do not have an upper limit of effectiveness. As doses increase, pain relief increases. In high doses, these medications can cause unconsciousness and affect breathing.
Commonly prescribed narcotic medications include morphine (MS Contin), hydromorphone (Dilaudid), and fentanyl (Sublimaze, Duragesic). Morphine and hydromorphone are usually administered in tablet form or through an injection or IV.
Duragesic (fentanyl transdermal system) delivers fentanyl through a patch that is worn on the skin and provides continuous pain relief for 72 hours. Dosages of this medication should be individualized to each patient and evaluated at regular intervals.
Supplemental opioids (also called "rescue medicines") can be administered orally (e.g., pill, capsule), as lozenges that dissolve under the tongue (sublingual administration) or are absorbed through the inner lining of the cheeks and mouth (oral transmucosal administration), and as rectal suppositories.
Oral opioids usually are the most convenient and the least expensive; however, they result in a slower onset of action. Pills and capsules also remain in the bloodstream longer than necessary, and may cause intolerable side effects such as dizziness, sedation, and vomiting.
Adjuvant drugs are used to hasten or improve the primary mode of treatment, to treat certain types of pain (e.g., neuropathic pain, bone pain), and to reduce side effects of other pain relievers.
Neuropathic pain is less responsive than other types to both non-opioid and opioid analgesics. Adjuvant drugs that may be used to relieve neuropathic pain include antidepressants, anticonvulsants (antiseizure medications), oral local anesthetics, cutaneous local anesthetics, and corticosteroids.
In most cases, antidepressants are used first in adjuvant drug therapy. These medications can reduce pain and help patients sleep. Doses of these drugs are less than what are required to produce a mood-altering effect. Side effects include dizziness, nausea, dry mouth, and sleepiness. To avoid serious "rebound" side effects, antidepressants should not be discontinued abruptly.
Antiseizure medicines can relieve pain caused by damaged nerves, which often is described as "shooting" pain. Side effects of antiseizure medications include drowsiness, nausea, and lethargy.