ANGALGESICS (PAIN MEDICATIONS)
Pain is a symptom of endometriosis and there are various pain relief and pain management options available. Pain medication does not prevent the growth of endometriosis; however, the management of pain is an important part of managing the condition. It is important to understand how different medications work and should be taken, to improve their effectiveness.
The World Health Organisation recommends starting with simple analgesics for pain and if the pain is not controlled to add a NSAID and if the pain is still not controlled add the mildest possible opioid (Codeine is the most common opioid that is prescribed). It is important to add pain medications and not swap them and that while the elimination of pain may not be possible, control of pain is generally attainable.
Simple analgesics
Paracetamols is a simple analgesic that can be used to treat mild pain and is the most-used pain relief in New Zealand.
Paracetamol acts mainly in the brain and has an effect on the way pain is felt. For some types of chronic or long-term pain, taking paracetamol at regular times may be helpful.
Combining paracetamol with an NSAID will improve the effectiveness of both.
Nonsteroidal anti-inflammatories (NSAIDs)
NSAIDs work by blocking and reducing enzymes, hormones and prostaglandins that cause swelling and inflammatory pain.
It is best to start taking NSAIDs the day before - or several days before - a period or pain is expected: a symptom diary can be helpful. Common side effects of NSAIDs include nausea, vomiting, diarrhoea, stomach upsets and stomach ulcers - which can be reduced by taking the medication with food or milk.
Many NSAIDs can be bought from your pharmacy without a prescription in lower doses. Common NSAID’s are listed below.
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Aspirn (Disprin, Solprin)
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Ibuprofen (Nurofen, Panagen, Brufen)
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Naproxen (Naprogesic, Naprosin, Sunflex)
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Diclofenac (Voltaren)
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Mefenamic Acid (Ponstan)
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Tenoxicam (Tilcotil)
Opioids
Opioids work by binding to certain receptors in the brain and spinal cord. This decreases pain and the reaction to pain, as well as increases the tolerance for pain.
Opioids are used to relieve moderate to severe acute or short-term pain and are prescribed when weaker pain medications alone do not work well enough. Common side effects of opiates include feeling sleepy, dizzy, or tired, reduced concentration, nausea or vomiting, and constipation, along with a risk of addiction.
Opioids are divided into two groups – weak and strong. Weak opioids available in New Zealand are Codeine, Dihydrocodeine, and Tramadol while Strong opioids include Morphine, Oxycodone, Methadone, Fentanyl, and Pethidine.
Common opiates include:
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Codeine
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Tramadol (Tramal)
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Pethidine
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Morphine (oral)
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Oxycodone
Neuropathic Medications
Nerve (neuralgia) pain is a common cause of chronic pain. Tri-cyclic antidepressants, anti-epileptic and anticonvulsants can be treatment options.
Low doses of antidepressants can be effective with neuralgia pain, as well as improving sleep and helping with relaxation. Antidepressants influence the nervous system and the way the body manages pain. These medications can help stop pain messages from the central nervous system from reaching the brain.
Anti-epileptic and anticonvulsants also treat neuralgia pain by blocking certain kinds of nerve activity or changing the way that nerves send messages to the brain.
Examples of medication for neuropathic pain are
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Tri-cyclic antidepressant (for example Amitriptyline and Nortrioptyline)
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Anti-epileptic (for exaple Gabapentin)
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Anticonvulsant (for example Carbamazepine, commonly known as Tegretol)