More than one hundred different medications and over a dozen different classes of medications are used to treat pain. There is very little research to tell us which medication best treats a particular condition.

Take headaches for example. Nobody knows the best medication to treat a headache. There are classes of medications that are frequently used, but no one medication works equally well for everyone. The problem is compounded because headaches have many different causes that respond to different treatments and people are different. What works well for one person won’t necessarily work well for another.

Little is being done to figure out which medication is best for particular problems. Rarely are medications compared to one another to determine which is best. With so few available comparisons between medications, it is impossible to know which one will work best without considerable experience treating patients.

Some people believe all that is required is something called a head-to-head trial. This type of medication trial directly compares one medication to another to determine which is the most effective, much like playoffs in sports. The problem with this approach is that physiology differs from person to person. It is also very hard to compare specific disease states in chronic pain because a number of different conditions can produce the same symptoms.

In the example of a headache, there are probably as many as twenty medical conditions that can result in headache. They can’t all be treated in the same way. While one individual may respond well to a particular drug, another may not. Chronic pain can be caused by so many different events that it is not possible to name them all on this page. When the cause cannot be definitively identified, treatment is even more difficult.

It is important to understand that pain and effective treatment are extremely individualized. Most of the pain medications that we currently have in our toolbox are aimed at treating symptoms rather than the underlying cause of the condition.

The underlying cause for many conditions is a runaway inflammatory reaction in the body leading to the changes in the endocrine system, the nervous system, and the immune system. At this point, science has not yet developed a drug that will alter the underlying problem in the neuroendocrine immune system.

It is possible to treat the base cause with dietary changes, psychological techniques, and exercise but, so far, not with a pill. I’m not implying that pills don’t do any good. Medications have their place. I think that place is rather low on the treatment continuum. They should not be the first thing we do to treat pain, but often they aren’t just the first, they are the only thing.

Most of the time when someone takes medications to treat chronic pain, they don’t use only one drug. Usually they are on several medications at a time. I rarely see patients cured by these treatments.