Each drug has a medical name (for instance, ibuprofen), but may be sold under many different brand names. As an example, the drug diclofenac is available under 75 different brand names. I have given the accepted medical name for drugs below. You may have to search on the packet to find out just what is the medical name for the drugs you have been given.
"Normal" pain is the kind of pain that you get from an injury, and stops when the injury is healed. It is relieved using the normal painkillers such as aspirin, paracetamol/acetaminophen (used in Tylenol), codeine and morphine.
Neuropathic pain is different - it comes from the nervous system itself. It can arise when nerves are damaged, or when normal pain carries on for a long time, and the nervous system becomes changed by the continuous stimulation. It may lead to a normal touch on the skin becoming painful, and can also cause odd sensations like tingling, burning, etc. Neuropathic pain is not stopped by normal painkillers. So if your pain is not stopped even by strong painkillers, then it may neuropathic.
TENS (Transcutaneous Electrical Nerve Stimulation) can relieve neuropathic pain. It is not a drug, and for that reason is worth trying before drugs.
A large number of papers have shown that cannabinoids (smoked cannabis or preparations of medical marijuana) can relieve neuropathic pain. A review of these papers is given by Rahn and Hohmann. Note that this treatment is illegal in many countries.
Cymbalta is used to treat nerve pain in the feet, legs or hands that is due to nerve damage caused by poorly controlled diabetes. It is not a general painkiller, but seems to be able to control pain caused by nerve damage. Several people on this website have reported Cymbalta to be helpful for coccyx pain.
A paper on gabapentin says that it was effective in combating neuropathic pain - that is, pain caused by damage to the nerves. It was not effective in general low back pain. Several people have reported Neurontin to be helpful for coccyx pain, though it may have unpleasant side-effects.
Lyrica is an anti-epileptic drug which can reduce neuropathic pain in some cases. It may have unpleasant side-effects, and sometimes causes thoughts about suicide.
This group of drugs, which includes amitryptyline and clomipramine, have the effect of reducing certain types of pain. When prescribed as pain-killers the dose is lower than when given as an antidepressant. Side effects include feeling groggy in the morning and dry mouth. Unfortunately you get the side effects immediately, but you may have to take them for more than a month before they reduce the pain. There is a large number of different tri-cyclic antidepressants, and they have different side effects and different pain-reducing properties, so a doctor may try more than one on you.
Doctors prescribing tri-cyclic antidepressants often start with amytriptyline, as it has been around for a long time and many medical trials have shown that it can reduce pain. Unfortunately it also has the worst side-effects of any of them - being on amitriptyline has been compared with having your head filled with glue. One doctor wrote (about prescribing these for pain control): 'Desipramine, nortriptyline and trazodone, rather than amytriptyline, are preferred because of their superior side-effect profile'. So, if possible, get your doctor to start with one of the other tri-cyclics instead. I (Jon) found that dothiepin reduced my pain (but did not stop it).
Susan, who was put on amitryptyline wrote to me: "I increased from 10mg to 100mg gradually, when a reaction put me in hospital - I had a massive dizziness and irregular rapid heartbeat. I've been out of hospital for a week now and recovering slowly. I wasn't aware tri-cyclics can interfere with the heart rhythm."
It has been proved that in patients with arthritis, an extract of fish oil (the omega-3 fatty acids EPA and DHA) has an anti-inflammatory effect, and allows some arthritics to reduce their drug doses. This is not the same as cod-liver oil, which contains large amounts of vitamin A. If you tried to take enough cod-liver oil to get a high dose of omega-3, you would get an overdose of vitamin A. If you want to try this, buy fish oil enriched in omega 3. A typical dose might be 3000-6000 mg per day of EPA and DHA (you need to read the label to find out how much EPA and DHA the capsules contain). Anonymous and Sally reported that fish oil helped their pains.
Another sufferer told me that flax oil (which is supposed to have similar anti-inflammatory effects as fish oil) gave her relief, without the side-effects of NSAIDS.
One sufferer has told me that his pain was relieved using cherry juice. Cherries contain anthocyanins which help to reduce tissue inflammation, and have been used by some arthritis sufferers.
Lesley reported that curcumin (derived from turmeric) helped her pain.
Non Steroidal Anti Inflammatory Drugs, or NSAIDs, include aspirin, ibuprofen, naproxen, diclofenac and many other drugs, some available only on prescription. They can reduce both inflammation and pain. The dose necessary to reduce inflammation may be greater than that to reduce pain. They are widely used for headaches and other pains, and for diseases like arthritis where inflammation of tissue is a large part of the problem.
NSAIDs, as well as reducing inflammation and pain, affect the mucus layer which protects the gut. They can therefore cause bleeding and peptic ulcers in some people (though this is not a problem for everyone). A pain clinic doctor told me that long term use of NSAIDs can cause kidney problems as you get older. These may be serious - you may not notice symptoms until 80% of kidney function is gone.
For coccydynia NSAIDs may be given as tablets to swallow, as creams or gels to be applied to the skin, or as suppositories. Although NSAIDs can be effective within half an hour for pains like headaches, a longer course is needed to reduce the pain of coccydynia, and results may not be felt for a week or two.
Several people (including me) have reported that suppositories of diclofenac, an anti-inflammatory, help with the pain. The anesthetist who attended my operation told me that diclofenac was a good painkiller to take after this particular operation.
Note that paracetamol is not an NSAID and though it reduces pain, it does not reduce inflammation. It is also known as acetaminophen, and an ingredient of Tylenol. It is important not to exceed the prescribed dose of paracetamol.
Opiates or opioids are drugs which are either derived from opium, like morphine and codeine, or have a similar action, like methadone. There is disagreement about which ones are the best to use for chronic pain, and little research work has been carried out on this subject. One doctor, writing in the British Medical Journal, suggested methadone should be tried first because it has been shown to be safe and is cheap. He then suggests: "If methadone is found to be unsatisfactory, buprenorphine, oxycodone, morphine (long or short acting), and fentanyl are all viable alternatives. Despite the best science, the use of such opioids is still often based on trial and error."
But doctors are often very reluctant to prescribe opiates for chronic pain fearing that patients may become addicted to them. However, in 'The Tragedy of Needless Pain' (Scientific American, see links page), Ronald Melzack shows that chronic pain which cannot be prevented by other means may be kept at bay indefinitely in most people by using morphine, with a low risk of addiction. But some chronic pain patients have become addicted, and have had to be weaned off the drugs. Opiates can have unpleasant side-effects such as nausea and constipation.