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For many people with acute injury (or post-surgery) or a chronic pain condition pain-management simply means pharmaceutical medicine, e.g. analgesics such as codeine, paracetamol, tramadol, etc. However there can be side effects with any medication, e.g. codeine can cause constipation and drowsiness in older people. Asthmatics can be sensitive to anti-inflammatories (ibuprofen, diclofenac, aspirin, etc). It's always a good idea to check with your pharmacist and ask questions.

Over the counter combinations are: Neuromol (ibuprofen & paracetamol), Neurofen (ibuprofen & codeine).
The good news is that these days it is possible to look up all your medication on the internet and check the research and that it is ideally suited for your condition. This can sometimes be a bit scary reading the medical literature, so please remember that you do not have all these things, or all these symptoms. Nor will the medication you are taking necessarily have any side effects at all for you. There is a reason you have been prescribed this medicine and your doctor will have weighed things up very carefully before making his or her choice about what's best for you. It's also very helpful to have a good GP to discuss any concerns with, and talk about possible alternative medications if you would like to.

You might want to watch this short video (2:30) about a more modern, comprehensive approach to pain-management that does not emphasize medication alone, and looks at other factors that effect our pain perception and experience:

Show video: Understanding Pain: Brainman chooses

Research suggests that opioid medication is not a good way to manage chronic pain, and although this may work initially, soon these medications don't seem to work so well, as your body will develop a tolerance effect to them. You might want to see this short video (1.46):

Show video: Understanding Pain: Brainman stops his opioids

Non-steroid Anti-inflammatory Drugs. There is also another category of drugs which have an anti-inflammatory effect, e.g. ibuprofen, diclofenac, etc. This category of non-steroid anti-inflammatory drugs are prescribed for a variety of conditions where an inflammatory component may be present, e.g. arthritis. Ibuprofen may also be suggested for conditions such as period pain (dysmenorrhea). Sometimes a side-effect of this category of drugs is heartburn or reflux symptoms. You may also be given omeprazole (losec) to offset these side-effects.

It is, of course possible to buy anti-inflammatory medication over the counter without a prescription. Neurofen contains ibuprofen (together with codeine).

Amitriptyline is actually a tricyclic antidepressant, and is effective when used in this way — at least as effective as the newer SSRIs (according to one study, 2001, see amitryptyline link). However, Amitriptyline is often prescribed in a low does (10mg) for muscle and joint pain, and fibromyalgia. Amitriptyline may also be prescribed for other pain conditions, and conditions such as Carpal tunnel syndrome. Carpal tunnel syndrome, compression of the median nerve at the wrist with tingling in the fingers, can sometimes respond very well to both acupuncture, osteopathy and physical therapy. The causes of this condtion are various and not fully understood. Nerve compression at the wrist is Carpal tunnel syndrome, however there can be other nerve compression sites in the arm, and also in the chest, first rib, clavicle or neck. This is called Thoracic outlet syndrome.

So you may be prescribed Amitriptyline for pain, even if you have no symptoms of depression.
If you experience a significant amount of pain in the mornings on waking, which then seems to diminish as the day goes on, as you are moving about, then this suggests that 'inflammation' may be the cause of your pain. (By contrast, pain that increases towards the end of the day may be more due to muscle fatigue.) Early morning inflammation itself may be due to injury, muscle sprain, or tissue damage. You may find that anti-inflammatories take the edge of your pain.



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