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Medication Management

Pain Medication Management

At MAPS, a comprehensive pain management center in Minneapolis, interventional pain management physicians have a number of pain management tools they can use to help patients manage, and sometimes eliminate, pain. These pain management tools include a number of specialized, minimally invasive procedures: exercise, physical therapy, occupational therapy and pain management medications.

Medications used for pain management have various purposes. As part of a comprehensive pain management plan, a MAPS physician (a pain medication specialist) may prescribe one or more of the pain management medications described here.

Opioids, pain management medications which alter the perception of pain by reducing the intensity of pain signals sent to the brain. They are usually prescribed at MAPS comprehensive pain management center in Minneapolis by a pain medication specialist for severe acute (short-term) pain.

Long-term use of opioids as a pain management medication may cause complications, such as tolerance to the effects of the drug or addiction. Because of this, opioid use requires pain medication management. It is carefully planned and closely monitored by a pain medication specialist as a part of an integrated approach to controlling pain.

Opioids may not interact well when taken along with other pain management medications. Opioids prescribed in the pain management clinic may include:

  • Fentanyl
  • Hydromorphone
  • Hydrocodone
  • Morphine
  • Oxycodone
  • Methadone

MAPS has developed pain medication management guidelines for using opioids as treatment for pain management. The major features of these guidelines are:

  • Comprehensive evaluation of the pain management patient
  • Written treatment plan by a pain medication specialist
  • Informed consent and agreement for pain management treatment
  • Controlled substances agreement
  • Periodic review
  • Consultation as necessary
  • Maintenance of medical records
  • Compliance with controlled substance loss and regulation
  • Random urine drug testing

Working in conjunction with the pain management patient, MAPS physicians can make sure that the opioids prescribed are safe and effective.

Nonsteroidal anti-inflammatories (NSAIDs) are pain management medications that are often the first line of medicinal defense used to treat pain, since they treat inflammation.

In their mildest form, these pain management medications are available over the counter (such as aspirin and ibuprofen, both of which can relieve pain and reduce fevers). NSAIDs taken daily often carry significant risks. While powerful and effective, these pain medications must be evaluated for potential complications or side effects prior to patient use.

Anticonvulsants are a type of pain management medication used to treat pain by decreasing nerve sensitivity. These pain management medications are referred to as "anticonvulsants” because they are also used in other practices to treat seizure disorders.

Both nerve pain and seizure disorders are characterized by overactive nerve signals. Calming the transmission of a pain signal created by a nerve can reduce pain, which can be more effective than simply "covering up” the pain with an opioid.

Examples of nerve pain include shooting pain down an arm or leg from the neck or back, pain in the hands or feet (peripheral neuropathy, which is sometimes associated with diabetes) and post-shingles pain. Several other conditions, such as migraine headaches and fibromyalgia, may also respond to anticonvulsant treatment.

Antidepressants are pain management medications that are often prescribed for patients in pain. This is not only to combat a depressed mood, but also to increase substances in the brain that can increase pain tolerance. (They are sometimes prescribed to pain patients who are not depressed.) Some pain management patients feel that if they are prescribed an antidepressant to treat their pain, their healthcare provider must feel that the pain is "all in their head.” However, this is not the case. Some patients simply find antidepressants more effective for pain management than opioid medications.

Muscle Relaxants
Several painful disorders are accompanied by muscle tightness or muscle spasms, which can be treated with muscle relaxants. For chronic daily pain, muscle relaxants may be most beneficial when combined with other forms of treatment, such as physical therapy and biofeedback. Some muscle relaxants (Soma/carisoprodol, Valium/diazepam) may be habit-forming and requires pain medication management, while others are safer to use in the long term (Zanaflex/tizanadine, Liorsel/baclofen).

Other Pain Management Medications
Tylenol (acetaminophen) is a very effective pain management medication that can be combined with other pain medications to increase their effectiveness. We review the daily total of acetaminophen in combination drugs to make sure that the daily acetaminophen dose does not exceed 4,000 mg.

Lidocaine patches and ointment are effective topical pain management medications. Lidocaine numbs the area of pain and doesn't cause many side effects. This pain management medication is particularly useful for areas of localized pain, but may be used for many conditions, including spine, muscle, nerve pain and pelvic pain.

Finally, Ultram/tramadol is an opioid-like pain management medication that has proven successful for some patients. However, since it is similar to an opioid, it has many of the same side effects and risks for addiction, and pain medication management guidelines should be used.

Learn how to manage your back pain with our Back Pain Risk Scale