Types of pain:

Nociceptor pain: Caused by injury to tissue.
- Usually will respond to conventional pain relief mechanisms.
Somatic pain: Sharp, localized sensations in the body.
Visceral pain: Generalized dull and internal throbbing or aching.
Neuropathic pain: Pain caused by direct injury to the nerve.
- Hard to treat.

Complementary and alternative treatments:

These can help improve patient's mood, reduce anxiety,and provide patient with a sense of control.
They often relax the muscles, strengthen coping abilities, and improve quality of life.
Intractable pain: Pain that isn't easy to relieve.
- Co-analgesics may be used for this.
Adjuvant analgesics: Drugs not typically classified as analgesics, but can provide relief for specific types of pain. Examples include carbamazepine (Tegretol) for trigeminal neuralgia; valproic aicid (Depakene) for migraine pain; gabapentin (Neuronin) for postheretic neuralgia; and pregabalin (Lyrica) for fibromyalgia, postherpetic neuralgia, and peripheral diabetic neuropathy.
- Anesthetic nerve blocking drugs are also used. Lidoderm is used to reduce pain and discomfort caused by skin irritations, and corticosteroids can be used for inflammatory pain.
- Meds are also used off label. Amitriptylline (Elavil), nortriptyline (Aventyl, Pamelor) and imipramine (Tofranil) are all used or chronic and neuropathic pain. Mexiletine (Mexitil) and flecainide (Tambocor) can help neuropathic pain.

Neural mechanisms for pain:

A neurotransmitter called substance P is thought to be responsible for continuing the pain message up the spinal cord.
Substance P is affected by things like endogenous opioids (endorphins, dysnorphins, and enkephalins).
Opioids act within the CNS, whereas NSAIDs act at the nociceptor level.

Chapter 18: Drugs for the Control of Pain