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“Doctor Kozmary and his whole crew are the best pain management crew in Cleveland. I have gone to a lot of doctors trying to find a good Doctor that cares about the patients’ pain relief instead of just handing out pain pills. They try injections and other procedures to try to get rid of the pain. I like the fact that they drug test to make sure they know people are not trying to just get pills that don’t need them.”

- Chris A

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Pain Medication

There are a host of medications that are often prescribed for patients with chronic pain. The classes of drugs include: non-steroidal anti-inflammatory medications (NSAIDs), anticonvulsive medications, antidepressants, muscle relaxants, and opiates. The NSAIDS are both over-the-counter and by prescription. Common over-the-counter medications include Ibuprofen (Motrin) and Advil. Prescription non-steroidal anti-inflammatory medications include Celebrex, Meloxicam, and Naproxen. The major side-effect is gastritis, peptic ulcer disease, or gastrointestinal upset. Please note whether you have these conditions before your physician prescribes these medications.

Anti-convulsive medications

pain medication

These include Lyrica (pregabalin) and Neurontin (gabapentin). These anti-convulsive medications are commonly prescribed for patients with neuropathic pain. They increase the threshold for nerve firing and are thought to put a damper on overactive or hypersensitive nerves. They can be quite effective at treating pain, but oftentimes have side-effects of sedation, dizziness, drowsiness, or loss of mental acuity.

Antidepressant drug therapy

There are two classes of antidepressants that are commonly prescribed: selective serotonin reuptake inhibitors (SSRI’s) and serotonin-norepinephrine reuptake inhibitors (SNRI’s). These help to raise the levels of norepinephrine and serotonin in the brain. These medications include Effexor, Venlafaxine, Cymbalta, and Duloxetine. The SNRI’s seem to have fewer side-effects than the SSRI’s.

Anxiolytic medications

These are often prescribed for the anxiety that frequently accompanies chronic pain. Anxiolytics include Xanax (alprazolam) and Valium (diazepam.) They can be addictive.

Muscle relaxants

Muscle relaxants are also prescribed in chronic pain management for people who experience muscle spasm as a component of their pain. These include Skelaxin, Robaxin, Flexeril, Soma, and Valium. Baclofen and Zanaflex are also used for continued muscle spasm.

Opiates

Opiates are pain relieving medications. There are two types: short-acting and long-acting.Short-acting medications, as their name implies, last for a relatively short time period, about two to four hours, and have a short onset of action. The long-acting opiates include Morphine sulfate extended release, Oxycontin, methadone, Opana, Exalgo, and Duragesic. These medications have a much longer duration of action, typically from eight to twenty-four hours, and have a longer onset of action. It is common to utilize both short-acting and long-acting opiates in patients with severe and intractable pain. Long-acting pain medications serve as the base for relief of pain. They are typically taken on a regular schedule, regardless of the patient’s pain level. Short-acting pain medications are then utilized for breakthrough pain. Breakthrough pain medication is utilized on an as needed basis for pain that occurs despite the long-acting pain medication.