ME4TM: Explaining Medication-Based Pain Treatment for the Layman

Medications used in the treatment of pain vary widely, and many of these drugs are also used in treatment of other psychiatric/neurological conditions - Now here are some classes of drugs relevant to pain treatment:

Anticonvulsants, which slow down signal transmission through nerves by either blocking ion channels or by activating GABA receptors. These two actions are considered to "numb" our neurotransmission, therefore reducing the sensations of pain in our bodies. The GABA-encouraging drug gabapentin (US: NEURONTIN) is probably the most notorious anticonvulsant pain medication, and is approved by the US FDA for the treatment of post-herpetic (pain occurring during and after shingles disease) and neuropatic (nerve damage-related) pain. Ion channel blockers (such as carbamezapine/TEGRETOL) are also being studied in the management of pain.

Very common in the treatment of moderate-to-severe pain are the opiates, the archetypal members being morphine and codeine. Other related compounds include oxycodone (seen in OXYCONTIN), hydrocodone (seen in VICODIN), and the highly potent fentanyl, which is generally reserved for the most intractable types of cancer pain (and is such a knockout drug that it's used in general anesthesia!). (Sidenote: Interestingly, Adam Gontier, lead singer of Three Days' Grace (the band quoted above) recently faced and recovered from an addiction to OXYCONTIN. Probably was enjoying too much "Pain".)

Another important pain medication is duloxetine (US: CYMBALTA), which was (and still is) marketed and approved as an antidepressant. In terms of pain syndromes, duloxetine is approved for diabetic neuropathic pain (aka pain due to nerve damage due to diabetes). Also, some of the tricyclic antidepressants (TCAs; an older generation of antidepressants) are also extensively studied as pain medications. I suppose this comes as no surprise, given that TCAs share some chemical actions with CYMBALTA.

A major concern and liability in the treatment of pain, especially chronic pain treated with opiates, is addiction, which along with the similar phenomenon of tolerance, has a very strong biological component. In terms of how pain medications work, it's important to keep in mind what long-term treatment with these drugs can do.