Follow @painconsultant1

HPC | Hertfordshire Pain Consultants

CALL US NOW! 07803 559 091

  • I wanted to write a letter to you because I'm so grateful to you and your team at the pain management clinc. After spending over 15 years with the most horrendous headaches and seeing dozens of different doctors and therapists finally you have managed to get them under control. Thanks you for taking the time to genuinely listen to me and my problems. Much appreciated.

    K. R
    Hertfordshire
NEED TO
SPEAK TO OUR CONSULTANT?

CALL US NOW!

07803 559 091

Content

Conventional pain medication

These are the pain medications that we commonly rely on when in pain. They are usually graded by the strength with paracetamol the weakest and morphine related compound the strongest. Anti-inflammatories and codeine preparations are in the middle.

  • Paracetomol - weak
  • Codeine - moderate
  • Anti-inflammatories (ibuprofen, nurofen, meloxicam, naproxen) - moderate
  • Opiates (morphine, fentanyl, oxycontin) - strong

Anti-neuropathic medication (Nerve Pain Killers)

Nerve related pain is usually resistant to normal pain medication and we rely on specific anti-nerve medications. Many of these medications were developed from depression and epilepsy medications in the past as common to nerve related pain as they calm down excitable nerves.

These medications are used in lower doses than in depression treatment and are prescribed now more for pain treatment than for depression or epilepsy.

  • Amitriptylline – Usually the first line medication tried. Prescribed at night. Helps sleep.
  • Nortryptylline – Closely related to amitriptyline but causes less sedation. Prescribed at night
  • Gabapentin - originally developed as anti-epilepsy medication.  Useful in a wide range of nerve pain conditions. Does not interact with other medications. Slightly difficult dosing regime
  • Pregablin - Sister drug to gabapentin. Easier dosing regime. Taken twice daily.
  • Tramadol - Unique medication that has both conventional pain medication effect and anti-nerve effects.  Can be taken regularly or as required.  Should not be taken with amitriptylline/ nortryptylline or duloxetine
  • Duloxetine - Developed as anti-depressant but useful especially with diabetic nerve pain. Simple dosing scheme of 1-2 tablets taken in the evening with food

The basis of any trial of medication is that it provides you with good benefit with minimal side effects. The doctor may recommend a combination of the above medications to deal with your pain symptoms.

NEED TO SPEAK TO OUR CONSULTANT?

CALL US NOW! 07803 559 091

GABAPENTIN and PREGABLIN DOSING SCHEMES

SCHEME A -Gabapentin Dosing

Time interval
Am (tablets)
Lunch (tablets)
Evening (tablets)

Day 1-3

0

0

1

Day 4-6

1

0

1

Day 7-9

1

1

1

Day 10-12

1

1

2

Day 13-15

2

1

2

Day 16-18

2

2

2

Day 19-21

2

2

3

Day 22 -24

3

2

3

Day 25- 27

3

3

3

Day 28 -30

3

3

4

Day 31 -33

4

3

4

Day 34 - 36

4

4

4

SCHEME B Gabapentin night time only schedulae

Time interval
Evening (tablets)

Day 1-3

1

Day 4-6

2

Day 7-9

3

Day 10-12

4

Tablets will either be 300mg (aged <60) or 100mg (aged >60).

Continue increasing dose until

a) max dose achieved ( 12 tablets a day )

b) Max pain relief obtained (ie increasing dose does not improve pain relief)

c) Side effects troublesome. If side effects troublesome but pain relief good ( reduce dose by 1 tablet)

Common side effects: Drowsiness Apetite increase/ weight gain Nausea Dizziness.

Pregablin dosing schedule. ( tablets 75 mg or 25mg – to be decided by consultant)

Time interval
Am
Pm

Day 1-3

0

1

Day 4-6

1

1

Day 7-9

1

2

Day 10-12

2

2

Day 13-15

2

3

Day 16-18

3

3

Day 19-21

3

4

Day 22 -24

4

4

NEED TO SPEAK TO OUR CONSULTANT?

CALL US NOW! 07803 559 091

Twitter Feed