These medications serve as useful tools to control pain in the chronic pain patient. Usually, they are used in a combination, which often includes a high-dose nonsteroidal anti-inflammatory drug, muscle relaxant, as well as a narcotic. An anticonvulsant and an antidepressant are usually added with neuropathic pain control is desired. The guidelines that govern the use and prescription of narcotics in this pain management center are the ASIPP guidelines for controlled substances (Controlled Substance Guideline, Pain Physician, Volume 6, Number 3, 2003, by Atluri et al). This pain management center observes compliance with the state board of medicine regulations and guidelines regarding the use of narcotic prescription for patients. The use of a narcotic contract, when a narcotic is in use, is common practice. The objective is to educate as well as encourage the patient regarding the benefits and responsibilities during the period these controlled substances are being prescribed for them. The primary object is to avoid diversion as well as avoid abuse. The practice also incorporates random urine drug screen as well as blood screen as indicated as part of the requirements in the narcotic contract. Most patients go through their needed short-term use of narcotics successfully without any problems. However, solely narcotic-based treatment may sometimes be necessary in rare instances; otherwise, most patients receive narcotics while efforts are being made to alter their pain generators and to lower the amount of narcotics they requiring or completely wean them off of the narcotics as soon as pain control is achieved.

Anti-Migraine:
Axert®
Esgic-plus®
Fioricet®
Fiorinal®
Frova®
Imitrex®
Midrin®
Relpax®
Zomig®

Depo Steroids:
Aristocort® (triamcinolone acetate)
Celestone®
Depo-Medrol ® (methylprednisolone acetate)

Local anesthetics:
Bupivacaine®
Lidocaine ®
Ropivacaine®
Tetracaine®