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Anti-inflammatory agents
In addition to anti-inflammatory analgesics there are several non-steroidal medication that are mainly for their anti-inflammatory effect they are mild analgesic and antipyretic acts by inhibition of prostaglandin biosynthesis. They do not alter disease but suppress symptoms of inflammation. Corticosteroids exert potent anti-inflammatory effect by inhibiting prostaglandin biosynthesis; their suppressive effect on inflammation may mask infection. These are contraindicated in systemic fungal infection Herpes simplex infection.
Muscle relaxants
These are used to control myogenous pain. The muscle relaxants are the anticholinergic the examples are succinyl choline and methocarbamol. The disadvantage is that patient cannot remain ambulatory or safety to continue his usual activity, can be used for hospitalized patients under supervision .
Antidepressants
Tricyclic anti depressant agents increases the availability of serotonin and non-epinephrine in the CSF. The dimethylated tricyclic drugs make serotonin proportionally more available and induce some sedative effect. The mono methylated tricyclics makes non-epinephrine proportionally more available and induces some CNS stimulation. It has been demonstrated that low dose of amitriptyline 10 mg. just before sleep can have analgesic effects on chronic pain after several weeks of use. MAO inhibitor increases the available serotonin, dopamine, non-epinephrine in CSF by inhibiting their breakdown and may induce hypertension crisis. Therefore use of all anti depressant should be under adequate medical supervision. Many sedatives and tranquilizing agents are available some, of which are having the muscle relaxants action. Major tranquilizers like phenothizines are use full in pain controlle by decreasing modulating effect on anxiety and apprehension. Major tranquilizers such as mep-robromate and diazepam have advantage of fewer side effects. There muscle relaxation is useful but drug tolerance, dependence and addiction are common side effects occurring. If these are used it should be prescribed for limited period or different drugs should be used periodically.