Medical treatments

Non-opioid medications:

1) Acetaminophen (Tylenol): Discovered in 1877 it was first marketed in US in 1953. Since then it has become a widely used over the counter pain killer. It is useful to control pain of mild intensity by inhibiting COX and acting on cannabinoid endogenous receptors. Its efficacy as pain killer is comparable to aspirin or other NSAID but it does not have anti-inflammatory effects. When given in recommended doses its side effects are nearly non-existent. It is usually prescribed in combination with other pain killers to achieve better pain relief without increasing side effects. 

2) Non-steroidal antiínflammatory drugs (NSAID): The most common NSAIDs are aspirin, ibuprofen or naproxen. They reduce synthesis of prostaglandins that cause fever and inflammation, hence their beneficial effects. The balance between their benefits (pain relief) and secondary effects (kidney impairment, gastro-intestinal bleeding or cardiovascular events) must be carefully assessed before starting a chronic treatment with NSAIDs. For otherwise healthy pain patients, short courses with NSAIDs treatments can be of some help.

3) Antidepressant drugs for pain management: Depression occurs as an imbalance between chemical compounds within your brain. When substances like serotonin or noradrenaline are found low in targeted areas of your brain, symptoms of depression may occur. Initially antidepressants were given as a help for patients suffering with chronic pain and concurrent depression but since 1970 it is known that , independently on the emotional impact of chronic pain, the use of antidepressants for treating chronic pain has benefits. Their exact mechanisms are yet to be clarified but they are thought to provide pain relief for certain pain syndromes by increasing the levels of serotonin and or noradrenaline in targeted nervous cells along the pain pathways. Tricyclic antidepressants (amitriptyline-like drugs) are the most useful antidepressants to treat certain types of chronic pain conditions such as neuropathic pain or fibromyalgia. Newer antidepressants with higher potency and less side effects are available for pain management.

4) Anticonvulsants drugs for pain management: The central nervous system operates in a state of balance between excitation and inhibition. Shifts in this equilibrium can lead to excessive neuronal activity. Epilepsy (convulsive disorder) appears to result from an inability of the brain to regulate this activity, rather than from abnormal neurons. Thus, anticonvulsants act to either increase inhibitions or decrease excitations. These principles can be applied to pain management in special that of nerve origin (also known as neuropathic pain). Clearly, neuropathic pain is also due to excessive neuronal activity and the use of anticonvulsants has been undoubtedly advocated as a useful treatment for neuropathic pain conditions (and others such as migraine or fibromyalgia).

Opioid medications

Nerve blocks

Joint injections

Radiofrequency procedures

Cryoablation procedures

Cement augmentation procedures

TENS

Intramuscular stimulation

Dietary modifications

Medical marijuana program: 

A brief history of cannabis use in humans: Cannabis is a type of plant (hemp) whose use by humans dates from >6000 BC in China. It was the first plan ever grown for non-alimentary purposes (paper, threads, oils). Benjamin Franklin grew cannabis to make the 1st paper plant in America. Its use as medical remedy dates from Chine 3000 BC. It was brought to the west from the India (1815) where it was used to treat tetanus, rabies and cholera. A liquid mixture was made with analgesic effects but also with muscle relaxant and anticonvulsive properties. Between 1840 and 1900 more that 100 articles demonstrated its efficacy as muscle relaxant, analgesic, hypnotic, sedative and stimulant of appetite.
To a certain degree, cannabinoids and opioids share similarities:
  Both activate an specific human “endogenous” system
  Their use for chronic pain management are known since ancient times
  Their effect is mediated mainly through the nervous system
  Due to their profile of side effects their therapeutic use requires strict medical control
  They possess a role for potential abuse