4) Other meds cover neuropathic pain (pain cause by the pinching of, inflammation of, and degeneration of, nerves.) There is a whole list these but the two that I am aware of are: carbamazepine and gabapentin. Neither will do a hole lot for pain that isn't related to nerve damage, degeneration, or inflammation, however like all these meds, there can be crossover in coverage. Each has its advantages and its drawbacks.

I am hearing more and more about Gabapentin being very popular among those seeking mood altering effects through pain medication, and thus, I understand that it is currently being considered for "controlled substance" status. Personally, I prefer carbamazepine, but, there again, I am able take relatively low doses of almost everything, in spite of my advanced state of disease.

5) Further, added to this extensive list of meds there is yet another category that aims to counteract pain. These are what are known as Skeletal Muscle Relaxants (SMR) and include, a whole host of meds which target muscle spasms and other muscle-related pain. Some of these can be mood altering, and also slow down the system through Central Nervous System (CNS) depression. A number of the are considered controlled substances, because they can be sedating, interact with other meds and or alcohol, and often age, because messing with the muscles, (potentially) means changing the body's ability to maintain its balance. These are the meds that often take very small amounts to do a lot of "heavy lifting" towards pain management, if there is muscle involvement.

At my stage of Ankylosing Spondylitis, I have inconsistent but very painful muscle spasms. I DO take a maintenance medication for this, but because I am a relative lightweight in this department, I pair it down to the bare minimum and only up it when I know I have done something physical enough to bring on the spasms. As I am OLD (LOL) I am not a candidate for any of the "Benzos" that are classified as SMR, but my doc has found me something that I can get in a small does and easily break in half. Its been working well for several years.

6) In the end, both the causes of pain and the meds that target each kind, are multiple. A medical professional with empathy and knowledge, is needed along with extensive "testing" (imaging, blood tests, to name a couple) to determine just the right strategy for each chronic pain patient. Unfortunately, we who are in chronic pain, don't always have the words, or access to the languaging we need to describe our emotional response to being chained to so much pain all the time.

I hope this helps a little.... I know its long... but I wanted to cover the ground.. without sound like I was a know-it all LOLOLOL

2) -- Certain meds target certain types of pain, and often in conjunction with other meds that also do so, but for different reasons. For instance: most analgesics, including opioid analgesics, will cover (their share of) general pain (from joints, tendons, bone, migraine, wounds, etc.) but won't do much for neuropathic pain which involves nerve pain. There are (other) specific meds which are aimed at targeting migraines. All meds in this category are potentially mood altering and should be taken under the direction of a medical professional. Even OTC meds such as Tylenol, if taken in sufficient dosages, and/or over time, can affect the liver to the point of doing serious damage.

In this category, I take regular acetaminophen (NOT extra strength) along with two versions of low-dose opioid analgesics. I am very fortunate that my Physician is an Internist who really "gets" it that I have a chronic condition which involves a great deal of pain. He also trusts that I will be responsible about my meds. So, short of changes in the actual law, he makes sure my meds stay consistent and stable. When I need more coverage, I let him know in advance that I am thinking my current level pain may not be just a (passing) flare, but a new level of "normal" and that next time we meet, I might ask for a small increase.

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Hi John. I take hydrocodone 7.5 2x a day, mobic 10mg x2 a day and baclofen 10 mg 2x a day. It helps most of the time

You said it all John. We all respond so differently to medication that the standard of what we should take should be tossed out the window for cases like ours. I was put on Flexiril 20 years ago, when I was finally diagnosed, and I had to stop taking it after two days because one dose had me sleep all day and I needed to be awake to take care of my then toddler. The doctor convinced me to try again, all these years later, to help with muscles and sleep but now it does nothing. No muscle relief and certainly no trace of sleep. I was up to 10 mg but still nothing. My doctor kept trying different ways for me to take it and it just wouldn't work. She is finally convinced that this medicine is not for me and now I am on my second night of Baclofen. Twenty years ago I was taking 2400 mg of Skelaxin and that did nothing either. I have run the gammut as well and I'm still stuck in the bed with pain.
I told my doctor, this week, that I can deal with stiffness. I can deal with swelling, but severe pain is crippling and no matter how tough you are pain will break you. With that being said, I really hope this Baclofen takes more than just the edge off.

3) Other meds target Inflammation mostly of areas that involve joints, tendons, etc, but also to a smaller degree, neuropathic (nerve) pain. The most common of these meds are called NSAID (S) (Non Steroidal Anti inflammatory Drugs) - they are an analgesic in that they reduce pain, but they target areas that are inflamed. These meds come in over the counter (OTC) versions that are reduced in strength compared to their prescription counter parts. Some of the drugs in this category are NOT available over the counter (OTC) and can only be obtained through prescription. All of these meds are typically not mood altering. However they have other effects on the body and must be taken in moderation and under the direction of a medical professional. Often, they are taken in conjunction with analgesic medication mentioned in the above description, and/or in conjunction with medication that targets neuropathic pain (see paragraph below.)

I take a prescription NSAID that is considered one of the safer ones. I have tired several over the years, and this one (Meloxicam) seems to cover the ground the best, for me.

NOTE: there are Disease Modifying Drugs called biologics (or, in some cases, bio-similars) -- they are not really in this category, but they are not in any other on this list, either. They are chemical cocktails (not unlike cancer drugs but formulated to target different aspects of disease) which have various ways they can be introduced to the body (by pill, injection, infusion etc.) They are very expensive and in some cases are not as affective in their modification of AS as the marketers would have you believe. There's a new one that the FDA just a approved for AS (starts with an "I" -- but can't recall the rest.)

I was offered "Embrel" just before I left the HMO to go on a different Medicare plan (as soon as I turned of age -- about 8 years ago,) but I knew that by the time I dealt with the red-tape, I'd no longer be there. Seemed like a waste of everyone's time and resources, so I declined. I have been skeptical, but as I find myself less and less able to function it gets more tempting. Not sure if anything that would work for AS would be covered by medicare LOL... but at least there is more info out there about what potentially with be a more successful target for AS.
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