Medical Management

The use of medications, diet, supplements, and lifestyle interventions constitute medical management. PalliPain takes a comprehensive approach towards medical management, and all medications are prescribed within this philosophy of care.

Medication Options

Our team will thoughtfully include medication management, when indicated, in your overall symptom management program. We use various classes of medications that include mechanisms for reducing inflammation, analgesics that target symptoms directly, and other medications drawn from other classes. Opioid medications may be prescribed when necessary. Other classes of medications which assist with symptom control include:

Anti-depressants
Anti-seizure medications
Muscle relaxants
Anti-inflammatories
Acetaminophen (Tylenol)
Other medication classes that can be used to manage pain as well as manage associated symptoms.

Other associated symptoms may include insomnia, depression, or anxiety, among others. The presence or absence of these symptoms will influence which class or classes of medication to choose from. For example, if sleep is a problem, we will choose a medication that will assist with pain management as well as sleep. Some antidepressant medications are excellent for treating pain and may be chosen for treating pain alone or to serve both purposes, treating depression and pain. Some of the muscle relaxants can be used to help with sleep, and the anti-inflammatory medicines are good for treating pain and can be combined with Tylenol or other medications to boost their effect. These medication decisions are also made in the context of developing a multimodal approach which may include physical therapy, massage, behavioral therapy, and lifestyle changes.

Inflammation

When our tissues or nerves are injured, it not only sets up a local inflammatory response at the site of injury, but also within the brain and spinal cord. This reactive brain inflammation is known as neuroinflammation. Normally it only lasts a short period of time and resolves when the tissue injury heals. In some cases, however, this inflammation does not resolve normally and a chronic problem results. Changes occur at nerve endings and tissue at the site of injury, which can lead to a hypersensitivity of the local nerves and tissue. When this does not resolve normally, a peripheral neuroinflammation can develop, and an abnormal signaling from the nerves (neuropathic pain) can develop. The same cycles of inflammation can occur in the brain and spinal cord. Normally, there are chemical signals within nerves and the brain, largely effecting nerve cells called glial cells. Glial cells signal a return of the normal status of the brain, or homeostasis. If the inflammation continues, this can also cause persistent hypersensitivity to nerve signals from the site of injury, which also contributes to neuropathic pain. One of the goals of medical management is to help suppress this inflammation, both at the site of injury and the spinal cord/brain, to help resolve the neuroinflammation, restore homeostasis, and reduce or eliminate pain. This can sometimes be accomplished early on after an injury with the use of oral anti-inflammatory medications, oral corticosteroids, or topical applications. Other tools we utilize include: Diet Supplements Restoring or improving sleep Regular exercise Psychological treatments These components, alone or in combination, can be very effective at bringing down the bodies’ inflammatory level, helping to restore the nerve cells in the brain/spinal cord and periphery towards their normal state. This in turn will reduce pain.

Opioid Management

The team at PalliPain can assist with the adjustments of your opioid medications. These decisions are made mutually between you and your team and are based on discussions of your history, current treatments you're undergoing, goals of treatments, and effects of your medication regimen on your daily living.

Our philosophy is that opioids should be the last medication we start, and the first we remove in managing severe symptoms.

In addition to medication management, we may also refer you to other specialties at our discretion to help manage your symptoms most appropriately.

We may suggest reducing or tapering your opioid medications very gradually, over weeks or months if appropriate.

Or we may rapidly or immediately switch to other, safer options if we're seeing significant side effects.

These options can also include a transition to buprenorphine, which is considered an atypical opioid that has a generally safer profile, and one that can be tapered or used for lengthy periods of time as a safer chronic pain management option. It can also be used to help prevent withdrawal symptoms or opioid cravings when this is an issue.