Do I need to take drugs to help with pain?
Many patients who experience chronic pain need medications to help them. If you are experiencing pain that is interfering with your daily life then you will probably need to take medication on a regular or as needed basis. Some patients need two or three combined medications to relieve their pain. Analgesic (pain relieving) medications offer most people decreased pain and improved quality of life.
How should I take these medications? Pain relieving medications should generally be taken on a regular basis and not on an as needed basis unless specified by your doctor. They don’t necessarily have to be taken around meal time.
A word on adverse effects
Most people don’t like the idea of taking medications; they worry about the long term adverse effects. Every medication for strong pain has adverse effects. Individuals have different susceptibility to adverse effects and these are impossible to predict. Your doctor and you often have to balance the adverse effects with the benefit they provide.
All drugs used for moderate to severe pain enter the central nervous system (brain and spinal cord). They can be generally expected to cause lightheadedness, altered attention and concentration, nausea and change balance / equilibrium. These adverse effects occur with the commencement of medication, when doses are escalated or decreased. Once a steady dose is reached these symptoms usually subside.
If you want more information on any individual drug you are encouraged to obtain consumer information from the secretary or your pharmacist.
What are the different classes of pain relieving medications?
The most common medications used to treat moderate to severe pain are opioid analgesics, anticonvulsants and antidepressants.
These are morphine – like, they are the most powerful of all analgesics. They all have the potential adverse effects of tolerance (the longer you take it the more your body becomes used to them and the less effect they have), physical and psychological dependence (physical dependence means that you will experience withdrawl if you stop the drug abruptly), hormonal suppression, respiratory (breathing) depression, constipation and decreased cognitive (thinking) performance. They include MS Contin, Oxycontin, Endone, Methadone, Durogesic, Norspan, Digesic, Doloxene, Tramadol and Codiene preparations.
Patients with chronic non malignant (non cancer) pain should only be trialed briefly on these medications. If they improve pain and function then they can be used regularly. They should only be prescribed by one doctor, preferably your local doctor. They should be stored safely and kept out of reach of children, scripts should be kept secure and never lost. The dose should only be altered by a medical professional. They should never be stopped abruptly due to the risk of life threatening withdrawl.
If you are taking an opioid patch: norspan or durogesic, special care is required. They should be placed on the chest, back or outer arm. You can shower and swim with them on. The date and time of commencement should be marked (in texta) on them so you are reminded when to change them. Hot packs or bottles should not be placed on them. They should be kept in a secure cabinet out of the reach of children.
The two agents most commonly used are gabapentin (neurontin, nupentin, gantin) and pregabalin (lyrica). They both work by decreasing the activity of painful nerve fibres and are especially useful in neuropathic (nerve) pain. The most common side effects are drowsiness, decreased attention and concentration and nausea. Gabapentin can cause swelling of the ankles.
You can expect that all of the above medications will alter your attention, concentra-tion, memory and judgement. You should not drive if you feel your attention or judgement is affected at any time by these, the law emphasizes individual responsibil-ity in this regard. You should not drive or operate machinery (this included power tools and gardening implements) when these drugs are commenced, ceased or their dose changed. In addition you should not drive or operate machinery if any additional drug that acts on the central nervous system are added to your existing list of medications. These include any of the above medications, other antidepressants, anticonvulsants and antipsychotic medications. Alcohol or recreational drugs are not to be used with any of the above drugs. The above recommendations are for private licenses only, strict limitations are placed on commercial licensing, you will need to consult with your doctor or specialist concerning this.
None of the medications mentioned should be used if you are planning to have children or are pregnant.
Medications regimens for chronic pain can often be quite complex and are always individualised. If you have any questions do not hesitate to ask the attending pain medicine specialist.