Adjuvant Treatments for Pain Management
An adjuvant helps boost your immune system when you are taking medicine for pain treatment. Adjuvants are additional ingredients in some vaccines and medicines to help you better fight the disease. They may not directly help reduce pain but will help you manage the pain.
Any tissue damage in your body will lead to some pain, acute or low, depending on the gravity of the damage level. Acute pain is potential tissue damage, whereas chronic pain lasts beyond tissue-healing time.
We have listed different Adjuvant treatment methods and techniques to help you resolve your pain management. Adjuvant medication includes antidepressants, muscle relaxation, sedatives, electrical treatment methods, psychotropic, and even non-pharmacological types.
AntiDepressants
Antidepressants (ADs) boost the working levels of body chemicals like serotonin, norepinephrine, etc., that may help obstruct pain signals. It works well for people in depression due to chronic pain and improves their mood. Some ADs like nortriptyline, venlafaxine, and duloxetine may help lower your nerve pain or neuropathic pain.
Moreover, antidepressants may help control the coordination process between your brain and the spinal cord. It may help decrease your anxiety, which is a common factor in pain. This aspect will regulate your sleep order, and better sleep will help in lowering your pain intensity and its levels.
You may see a successful impact of antidepressant intake for treating chronic conditions like migraine, tension, and the usual headache. That said, unlike opioids, ADs may take weeks to show their effects. Several patients report they experience the results after three weeks.
Anti-seizure Medications
Medications such as gabapentin, lamotrigine, topiramate, pregabalin, and carbamazepine may also be helpful for nerve-related pain. The most common side effects of these medications are drowsiness, dizziness, and balance problems, but they usually improve with continued use.
Muscle Relaxants
You have multiple choices when it comes to using muscle relaxants to ease out your pain, including:
• methocarbamol
• baclofen
• diazepam
• cyclobenzaprine
These relaxants will respond in short periods due to stiff muscles. They directly interact with your central nervous system to make an impact.
As the name suggests, these relaxants help relax muscles by taking away stiffness and thus reducing pain level or other movement discomforts you may have. However, don’t consider them as substitutes for exercise or physical therapy.
Relaxation Therapy
It’s a methodical process to keep patients abreast of their physical response system and a physiological sense of calmness. Such therapy sessions may help with reducing chronic headaches, vascular headaches, and lower back pain.
Sedative and Anti-Anxiety Medications
Pain may keep you awake for long periods. Your doctor may prescribe zopiclone, lorazepam, or temazepam to help fight your sleeping disorder. You may take these medicines for the short term only; else, it can become a habit. The habitual use of these medicines can be ineffective for a chronic condition.
Anti-anxiety medications
Severe or acute anxiety can give you the worst form of pain. You may seek an anti-anxiety medicine or discuss with a doctor to come out of such a situation. Avoid alcohol consumption during such medication period, as it may cause shortness of breath and dizziness.
Benzodiazepines (BZs) are a common treatment to reduce anxiety and improve sleep disorders. Moreover, valium and BZ consist of antispasmodic, sedatives, and anticonvulsant effects. These will help relax your muscle.
There’s a wide range of non-BZ anti-anxiety agents that are equally good for relaxing your muscular pain, such as.
• buspirone (Buspar),
• hydroxyzine (Atarax),
• diphenhydramine (Benedryl)
• propranolol (Inderal) and
• atenolol (Tenormin).
All these agents give anxiolytic-like effects without any sedating and addictive potential of BZs.
Botulinum Toxin
Botulinum is not only a cosmetic product, aka Botox. It’s a type-A Botulinum toxin that is helpful in treating muscle spasticity (continuous constriction of muscles leading to its stiffness). This may lead to strokes.
It may help prevent migraine headaches. You may have it injected into your muscles around the neck area. Get the next dose after three months.
Muscle contraction happens when your body releases acetylcholine; this may cause temporary paralysis on affected muscles. Botulinum toxin typically blocks your nerves from releasing acetylcholine.
Traditional Adjuvant Analgesics
Traditional adjuvants analgesics majors are:
• NSAIDs and acetaminophen,
• COX2 inhibitors
• Tizanidine
All these help in managing your pain.
NSAIDs and Acetaminophen
NSAID is a Non-steroid Anti-Inflammatory Drug.
You may note Acetaminophen is not an anti-inflammatory medication. However, when used with mild NSAIDs, it will become more effective in treating mild-to-moderate pain. Both in combination are good to treat inflammatory processes like muscular pains, aches, sprains.
In addition, you will find that NSAIDs have analgesic, anti-inflammatory, and antipyretic effects. These qualify as non-steroid due to the absence of any steroid agent in them.
NSAIDs as an adjuvant can be more effective with opioids for treating pain that is not reacting to opioids alone. Patients with bone and incidental pain may have such a condition.
COX-2 Inhibitors
Celecoxib and Rofecoxib prevent enzyme cyclo-oxygenase-2 (COX-2) and consequentially give an anti-inflammatory effect. This is helpful for people with renal, gastric conditions. COX-2 will have no effect on your platelet aggregation.
Tizanidine (Zanaflex)
It has some analgesic characteristics, which is good in reducing lower back pain, spasm. It's an acting agent and also sits well in alpha2-adrenergic agonistic that talks about its more analgesic nature.
It has a good effect on acute musculoskeletal neck pain and chronic headache.
Psychotropic Medications
These drugs modulate the pain experience for treating certain symptoms, which intensify or compound the effect of pain. It deals with anxiety, sleep disorder, depression, neural excitation, and anger.
Classes of psychotropic medications include treating anti-anxiety agents, stimulants, and major tranquilizers in general.
Selective Serotonin-Reuptake Inhibitors (SSRI)
It has multiple results for different pain conditions.
SSRIs treat depression by raising serotonin levels in your brain; it’s a chemical that carries signals between brain nerve cells (neurons). SSRIs will block the reuptake of serotonin into neurons. They have excellent results in treating anxiety disorders besides depression.
Anti-epileptic Drugs (AEDs)
AEDs may get you excellent results like ADs in managing your pain. However, it offers little help for dealing with neuropathic pain. AEDs are safer and prevent the necessity of monitoring blood levels. These drugs will block your sodium channels in order to reduce your pain level.
Carbamazepine (Tegretol)
Carbamazepine is also an AED, and is excellent for treating neuropathic pain. It has other pharmacological action that helps it produce analgesia, hence making it a good treatment for curing chronic pain conditions.
Valproate
Valproate may help reduce your chronic mild migraine, albeit it has no effect on an acute migraine condition. It should be under regular monitoring due to hepatotoxicity.
Gabapentin (Neurontin)
It is widely in use to reduce neuropathic conditions like diabetic neuropathy, migraine, and multiple sclerosis. It may comfort your phantom limb pain. Its efficacy is good with other AEDs. Plus, it may help you with sedation.
Pregabalin
It binds to the alpha2-delta site in your central nervous system tissues. Pregabalin may reduce the calcium-dependent release of neurotransmitters by modulating calcium channel function.
It helps with lowering diabetic peripheral neuropathic pain besides neuralgia. Many people worldwide use it for other forms of neuropathic pain. It is effective for adults with partial seizures.
Other Adjuvant Analgesics
Antiarrhythmics
You may find that the use of Mexiletine has a beneficial effect on treating neuropathic pain. It may not only reduce the pain level but also impacts lowering dysesthesia and paresthesias. It helps in improving the sleeping cycle as well as reducing pain.
Ketamine
Ketamine is a model anesthetic agent that works well on N-methyl-D-aspartate (NMDA) receptors.
It has excellent results for treating cancer and non-cancer pain. Ketamine is good for high-opioid-dependent persons. It’s also available in topical form to assist and help reduce your pain.
Non-pharmacological Adjuvant Analgesics
Non-pharmacological Adjuvant Analgesics have strong properties for warding off stress, anger, anxiety, pain, etc.
Electrical Stimulation
Electrical stimulation may have a deep impact when it deals with the spinal cord and peripheral nerves.
Long electric-stimulation of the spinal cord may produce substantial analgesia in some patients with chronic pain. Analgesia may result from both stimulation of rising tracts and/or blockage of spinothalamic pathways. This method has good short-term efficacy.
Transcutaneous Electrical Nerve Stimulation (TENS)
TENS is widely in use for chronic pain. Spinal cord stimulation is a costly procedure, whereas TENS is cost-effective and involves only surface stimulation.
In TENS, they place the electrodes on the area with acute pain and then rub it around to optimize pain relief.
Cranial Electrical Stimulation (CES)
It’s another form of electrical stimulation, also known as cranial electrical stimulation (CES).
It has a different mechanism of action than TENS. This method has great success in treating diversifying nature of disorders ranging from anxiety, depression, insomnia, and psychosis.
This stimulation is good for enhancing nitrous oxides and decrease narcotics requirement during neuroleptic analgesia and surgery.
Biofeedback
It’s another procedure for managing and rehabilitating patients with chronic pain. It has shown excellent results for treating Raynaud disease. In contrast, in myofascial pain syndrome and surface, EMG triggers the points and regulates muscles.
Doctors use it for various pain-relevant disorders like back pain, vascular like diabetic neuropathy, and anxiety.
Conclusion
We have given you a gist of multiple uses of adjuvant treatment for pain management. Pain, whether acute or chronic, will make your life miserable. Persistent pain in any of your body parts may lead to some disability or may leave you handicapped. Don’t ignore them. Treat them.
There are various adjuvant medicine, treatment methods, and procedures for diagnosing and treating your pain level to live in the relative comfort zone.