Medications

All physicians know how to treat pain, but the management of chronic pain and pain medications is far more complex than most physicians realize or want to deal with. Many patients sent to the pain clinic are either on whopping high doses of opioids or can't tolerate the side effects. Coming up with an appropriate regimen, tapering someone off, or escalating to treat cancer pain are all routine clinic visits. Luckily, pain signaling in the body is a complex dance involving molecules, neurons, and interneuron communication. Our armamentarium of non-opioid pain medications includes calcium channel modulators, sodium channel blockers, serotonin and norepinephrine reuptake inhibitors, NMDA receptor antagonists, and alpha-2 adrenergic receptor drugs. We target peripheral neurons, the spinal cord, and the brain. Despite all these options, our understanding of pain states is still quite limited. Sometimes I feel like I'm banging a hammer at tiny targets. Occasionally, the drug we select is the miracle pill, but more often than not, we spend months finessing the drug, balancing it with its side effects, tempering it to the circumstance. This is the art of pain management.

Image of harvesting the opium plant is in the public domain, from Wikipedia.