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Best medical options for pain management

A

AlexxRed

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Joined
Apr 2, 2002
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293
Location
melbourne, Australia
Hi

Just wondering if anyone can suggest what drugs might be best to deal with a pain syndrome.

It appears to have a bruxism type (face/jaw pain) origin but without teeth grinding. I guess it would be possible to tense the muscle in your jaw and build up a habit over time.

Can an SSRI's be a helpful short term solution if it has been something that has grown out of a habit?

What about some of the more modern tranquilizers? Pre Gabalin etc

Could a neutropic like Aniracetam help?

Cheers

Alex
 
Well a NSAID such as ibuprofen along with a muscle relaxant would probley be the best choice here. Theres tons of muscle relaxants and some work much better then others so take your pick.

If that combo doesent get the trick done then you might want to add a opiate to it. Even something like codeine might be enough.

I dont think a ssri would be of much help in this type of pain. They havent been proven to work that good on pain. You might want to try a tricyclic anti-depressant as they do work on some types of chronic pain.
 
Voltarol suppository, stick it up yer bum and you'll be cured! Nah but it would probably do the trick. If you are under stress, that could be the problem i suppose. If that is the case a valium might help.
 
There's a lot of options. Discuss them with your doctor. Benzodiazepines and other anxyiolitics/muscle relaxants. SSRIs and antipsychotics are on the table, but I'd hold off on them. The GABA modulators tiagabine, vigabatrin might be worth a go... I don't know about pregabalin, it's a calcium channel antagonist, I'd leave it out.
 
AlexxRed said:
What about some of the more modern tranquilizers? Pre Gabalin etc
Click to expand...

BilZ0r said:
The GABA modulators tiagabine, vigabatrin might be worth a go... I don't know about pregabalin, it's a calcium channel antagonist, I'd leave it out.
Click to expand...

Tiagabine, Vigabatrin and Pregabalin all raise GABA levels, but Pregabalin is the only one among them that is indicated for pain (neuropathic pain, but also when other 'traditionnal' pain killers fail to relieve pain).
Gabapentin (close to Pregabalin) is also good for that.

So I don't understand why you would leave it out? (pregabalin)

AlexxRed said:
Just wondering if anyone can suggest what drugs might be best to deal with a pain syndrome.

It appears to have a bruxism type (face/jaw pain) origin but without teeth grinding. I guess it would be possible to tense the muscle in your jaw and build up a habit over time.
Click to expand...

Your options are:
-NSAIDs
-muscle-relaxants (try to avoid benzos, as they are so addictive, try Methocarbamol, Dantrolene, etc... before)
-opiates pain killers (if Opiates are the only thing that can help you, try to stick to the weakest ones: Propoxyphene, Tramadol, Codeine, maybe Dihydrocodeine. The addiction will still be a problem, but not as strong as a Hydrocodone, Oxycodone or Morphine addiction.)
-'atypical' pain killers: Pregabalin/Gabapentin (Neurontin) help a lot with pain; and some antidepressants like Amitriptyline can also help a lot with pain, when they are associated with another pain-killer.
 
Pregabalin helps with pain, but it doesn't raise GABA levels (well AFAIK there are no studies looking at it, it's a Calcium channel antagonists). But the problem here isn't neuropathic pain, it's muscle spasms...
 
BilZ0r said:
Pregabalin helps with pain, but it doesn't raise GABA levels
Click to expand...

All the studies concerning Pregablin that I can understand are in French laguage. I can read english papers, but not english scientific papers...
And what I read from a very trustable site is that Pregabalin raise the GABA synthesis by stimulating the activity of the glutamic acid decarboxylase...
(if this doesn't mean anything, it's because I translated it wrong, I'll try to find an english source saying the same thing)


EDIT: BilZor, I think you're (as often/always?) right... While there are some serious studies saying that Pregabalin makes more GABA available in the brain/ or raise GABA levels by stimulating the activity of the glutamic acid decarboxylase...(I know nothing about neuro-chemistry); I also find many studies, that say that we are not sure of the effects of Pregabalin on GABA...
 
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They're might be enzymatic studies, I don't know, I can't find them, but there is no electrophysiological or neurochemical data to support the fact that pregabalin increases GABA release in the brain.
 
Thanks for the suggestions,

Guess it's just going to have to take some trial and error...as well as lots more exercise rest which seem to help. I know the the dexamphetamine for my ADD make it worse, so its no more of that.

I've got a pretty good doctor now and I'm pretty sure she will let me try different things.

Just on the SSRI's I know that in long term they can be awful, sure seem to be plenty of horror stories but can they in theory correct a chemical imbalance and increase serotonin production?
 
Just on the SSRI's I know that in long term they can be awful, sure seem to be plenty of horror stories but can they in theory correct a chemical imbalance and increase serotonin production?
Click to expand...

Not everyone finds them horrible, a lot of people view them as life savers.

The "chemcal imbalance" theory is pretty rubbish. No one has really ever found evidence that it exists in depressed humans.
 
How do you know it is not bruxism? Have you checked with your dentist? If it is night grinding there is a very effective bite guard that can help. It is expensive, but so are drugs.
 
^^^^

Girlfriend says I don't grind my teeth in my sleep, also as I understand with Bruxism you usually feel the tension/pain soon after waking. Mine tends to occur later in the day.

But good point i'll check with my dentist.
 
do you think the jaw clenching is anxiety related? if so an SSRI or another anti anxiety medication might be better than a pain killer (though a pain killer would be more fun, heh.) american doctors are obsessed with prescribing SSRIs for anxiety even though the argument can be made that benzodiazepines are equally effective. some of the "atypical" pain medications that have been mentioned (gabapentin, pregabalin) are prescribed off label for anxiety as well.
 
^^^^^^^^

It could be stress related. I don't think that I'm grinding my teeth or clenching my jaw. As I have said in another post, I actually hope that is the problem.

The dentist I see is very good and picked up on my step sisters teeth grinding without her even asking.

Pain killers or benzo's could be fun, but I'm not looking for that.
 
A muscle relaxant might work well. Perhaps Soma? It metabolizes to meprobamate, an old-school GABAergic anxiolytic. At low doses, it is not particularly zonking--however, at really high doses, it is similar to a barbiturate in toxicity and effect. Other compounds that might be interesting are the GABA-B agonists known as beta-phenyl-GABA (phenibut) and beta-hydroxy-GABA (GABOB). These compounds are usually considered very mild muscle relaxants and calmatives.
 
Actually, slightly off topic, I've found gabapentin to be a wonderful pain reliever for neuropathic pain (phantom limb pain in my case) that comes in very useful when I don't want to take (or don't have) cannabis. Up until that point, the only relief I've ever achived was with cannabis or ketamine (but the latter in 'pin you to the floor' doses, which aren't practible for everyday use), which is unfortunate considering I need to obtain them illicitly.

Up until then I'd had various antiepileptic drugs eg carbamazepine, NSAID's and even heavy duty opiates (Diconal) prescribed & they did fuck all for the pain
 
Riemann Zeta said:
A muscle relaxant might work well. Perhaps Soma? It metabolizes to meprobamate, an old-school GABAergic anxiolytic. At low doses, it is not particularly zonking--however, at really high doses, it is similar to a barbiturate in toxicity and effect.
Click to expand...

Carisoprodol is active by itself before it is converted to Meprobamate.
I've tried both (I have been on Meprobamate for months, and I have taken hundreds of Somas-Carisoprodol),

And I can tell you that Carisoprodol is a much stronger muscle-relaxant than Meprobamate, and it is much better for pain.
Meprobamate, on the other hand is a stronger sedative and anxiolytic.
 
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