Different Drugs for Different Varieties of Pain

Pain-control options vary based on the type of pain and the severity of symptoms. Health-care professionals are trained to rate pain intensity on a simple “zero to 10” scale, zero being no pain, and 10 being the worst pain imaginable.

Pain falls into three general categories: muscle pain, bone pain and neuropathy. Muscle pain, the most common, is characterized by an achiness all over the body.

Pain in the bones is usually sharp and throbbing. This type of pain is normally seen in someone with bone cancer or in arthritis sufferers.

Neuropathy occurs when nerves are damaged. Symptoms include numbness, tingling or a burning sensation in the hands, feet or lower legs. People with diabetes, who often sustain nerve damage, may experience this type of pain, as well as cancer patients who have a tumor pressing against a nerve. Neuropathy also can be a side effect of certain AIDS medications and of chemotherapies used to treat cancer patients.

Pain specialists typically use a three-step approach to treat pain:

* Step one deals with mild pain. It is treated with mild pain relievers, including acetaminophen or over-the-counter non-steroidal anti-inflammatory drugs (NSAIDS), such as Motrin and Advil.

* Step two addresses mild to moderate pain. Treatment entails the use of prescription strength NSAIDS, Cox-2 inhibitors, such as Vioxx, and opiate-based drugs, including Vicodin and Lortab.

* Step three involves severe pain. Treatment usually requires long-acting pain killers such as OxyContin, Fentanyl, morphine and codeine.

In addition, specialists will treat bone pain with corticosteroids, which can reduce swelling and pressure. Neuropathy, however, doesn’t respond to NSAIDS. Anticonvulsants such as Neurontin, which are normally used to control seizures, can relieve tingling, and low doses of tricyclic antidepressants, such as Elavil and Norpramin, can also provide some relief.

Doctors may employ different methods of dispensing drugs, depending on the location and severity of the pain. These include pills, by far the most popular method of taking pain medication; fast-acting lozenges that contain opiates; rectal suppositories for those who have difficulty swallowing medicines; injections; skin patches containing opiates; continuous pumps that dispense morphine and enable patients to control dosage; and epidurals, which are injections into the space around the nerves in the spine.

A number of promising new medications are on the horizon, including treatment methods that more effectively control pain without the unpleasant side effects or potential for addiction.

Two drugs that are said to be many times more potent than morphine are in the pipeline. Ziconotide, a substance derived from sea snail venom, is said to work by blocking the transmission of pain signals to the brain; the FDA is considering approval.

Another drug, ABT-594, which is made from frog venom, is in the final stages of clinical tests. It is said to be 50 times as potent as morphine in blocking pain.

Also in the research pipeline are delivery systems that dispatch drugs directly to the affected nerve tissue, which would dramatically reduce the amount of painkiller needed.

Other scientists are devising electrodes that can be implanted in the brain to short-circuit pain messages.