Drugs used in injections
One of the treatments used for some types of pain is the use of injections either to nerves or to painful joints or other areas. In the past Pain Medicine made heavy use of injection treatments, either to temporarily numb areas or to destroy nerves. We now do this far less often (and for the most part reserve destructive techniques for pain control in advanced cancer) but injections of various types can still be useful for some pains.
The maintenance of some chronic pain states involves “vicious cycles” both of muscle spasm and sensitisation of pathways in the nervous system. Sometimes, temporarily reducing the level of pain with local anaesthetics or other drugs may allow these to reset to a lower level with long-term reduction in pain.
In addition, the addition of locally acting steroid drugs can reduce inflammation and swelling in painful areas, as well as potentially having an action in reducing the irritability and reactivity of abnormal membranes in nerve compression.
The drugs most often used are long- or short-acting local anaesthetics such as Lidocaine or Bupivacaine, and locally acting depôt preparations of steroids such as Methylprednisolone or Triamcinolone. These steroids are injected in a form which works locally, being very slowly absorbed from the site of injection. With single use they have little effect on the rest of the body, and are not usually associated with any of the side-effects usually associated with the use of steroid medicines by mouth over longer periods.
Very occasionally, particularly in advanced cancer pains, drugs such as Phenol or Alcohol can be used to permanently kill nerves, but these are very rarely used for other pains since in the longer term they can give rise to nerve pain or irritation in their own right.
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Pain Service Website, Gloucestershire Hospitals NHS Foundation Trust
Webmaster Dr J G de Courcy, Consultant in Pain Medicine and Anaesthesia
Page updated 19/02/2016