Medication management

First your doctor will determine what is the mechanism of your pain. In general. there are a few classes of medications commonly used to treat pain:

• NSAIDS (non steroidal anti inflammatory medications) - includes: ibuprofen, naproxen, meloxicam, nabumetone, etodolac, celecoxib(celebrex). Tylenol (acetaminophen) is somewhat part of this class too.

• Antidepressant medication: commonly used are duloxetine (FDA approved for many conditions including fibromylagia, back pain, knee pain), amitriptyline/nortriptyline, milnacipran (savella)

• Anticonvulsant medication:  commonly used are gabapentin, pregabalin (lyrica), topiramate (topamax)

• Muscle relaxants: used for muscle pain. Examples: cyclobenzaprine (flexeril), tizanidine (zanaflex), baclofen

• Opioids: rarely indicated for chronic pain. Centers for disease control and prevention (CDC) came up with recommendations in March 2016 (long version and short version). Basically the recommendation is to be very cautious when prescribing more than 50 mg Morphine equivalents daily and have a very good reason to prescribe more than 90 mg Morphine equivalents daily. To see how much is is that for your medication use opioid conversion table here. Be aware that our pain clinic does not provide opioid prescription on the first visit.

• Others: ketamine, low dose naltrexone for certain types of pain
  

One important thing to remember is that most medications just help with pain. It is important to combine medication with lifestyle changes, physical therapy and psychology. Let's say that you get 20-30% benefit from pain medications, 20-30% benefit from physical therapy and another 20-30% benefit from psychology, then combining all of the them you get more than 50% pain benefit.