Medications
for treating pain come from varying classes. Most uses of pain medication are
off label, i.e. physicians have used medications approved for other types of
treatment, in order to treat pain. These off label medications include anti-inflammatories,
antidepressants, anxiolytics, anticonvulsants, cardiovascular agents, local
anesthetics, and general anestetics. Pain presents a complex picture of multiple
alterations to the peripheral and central nervous system, with loss of normal
symmetry between the spinal cord and the brain. The general rule of treating
acute pain with one or two agents is reasonable, but chronic pain must usually
be treated with an approach of rational polypharmacology. Coordinating this
with psychotherapy, social interventions, non-invasive approaches, interventional
invasive approaches and surgery may be necessary to control severe chronic pain
states.
