Analgesic therapy by the use of analgesic medication in chronic pain

Is there a difference in the use of analgesic medications in acute and chronic pain? What is the significance of analgesic drugs? In which conditions should we use it? How can we choose the right drug respectively drug combination?

Acute pain has a signal character that points to a certain disturbance in our body - this could be an acute headache after having stayed too long in the hot sun, or if we sprain our ancle. After having excluded any serious cause of this acute pain, it is common to support the healing e.g. with a nonsteroidal antiinflammatoy drug (= NSAID) for some days. within some days or <2 weeks usually this kind of pain gets better, as our body could heal the acute disturbations or trauma.

But in chronic pain there is no more need for a signal character as by establishing a pain memory it could be that the cause of the pain has already heald, but the pain is still present! In these cases the chronic pain changed from a symptom to an own entity: the chronic paindisease! This maintenance of pain leads to a lot of different negative consequences for our body: by avoiding the pain we perform relieving positions and movements, which leads to highly significant muscular weakenings followed by further overload of joints, ligaments or fascia. And this is the source of additional pain - we call it the vicious circle of pain!

Under these circumstances the supportive use of analgesic medication can be crucial to break this vicious circle - but: in the last 25 years I never prescribed a NSAID just as a singular analgesic tool - just to enable the necessary movement therapy to get effective, because it is impossible to restrengthen muscles effectively as long as the pain is still strong!

in 1996 the WHO (=world health organisation) worked out a state-of-the-art plan for the best combination of analgesic medications for different kinds and intensities of pain! the basic and first step is the use of a NSAID (mainly peripheral antiinflammatory effect) in combination e.g. with a stomache protection and a muscle relaxing drug. if this is not effective within a given time to at least 50%, the painspecialist should shift to the second step. This is the combination of the medication from the first step together with a weak opioid (e.g. Tramadol), which has an additional central painkilling effect! If this, again, is not effective sufficiently, one has to shift to the third step, which is the combination from the first step together with a strong opioid medication (e.g. oxycodon, hydromorphon,...).
Additionally to the WHO-step-plan the international painspecialist community has worked out a more cause-specific medication! That means that e.g. head ache a needs total different chemical approach than e.g. a nervepain, caused by a discprolaps.

Therefore it makes sense to contact a experienced painspecialist quite early in the couse of your chronic pain (> than 12 weeks of pain)! I can work out together with you, if and which analgesic drugs will be helpful and which combination of these medications has the best effect-sideeffect-relation!