Medications for Pain
Gordon Irving, M.D.
- Pain medications will not block all pain. Most medications even when they work will only lower pain by about a third.
- When you have a pain flare-up, taking more medication than prescribed may not help and you may run out of your prescription early. If you use more pills one day, use less over the next few days so you do not run out.
- Take short-acting painkillers before you do something you know will be painful — for example, gardening. This may stop the pain from becoming intense.
- Try to have a few pain pills left over at the end of the month so you always have at least a three-day supply. Having an extra supply decreases your anxiety when you get close to your refill date.
- Always get a refill before you need it so you are not waiting until the last minute.
- You are the only one who really understands your pain problem and your needs. It is up to you to create a pain-management plan with your doctor. Your provider may not always understand your pain, and it may sometimes be hard to reach them.
- Medications are only part of the solution and will not solve all your pain.
a. Using your other pain-management tips are just as important.
b. Learn to pace yourself during activities.
c. Avoid trying to get everything done when you are feeling good because it may make you feel bad later.
- You can have a life even with pain. Those with pain who do the best are those that accept their limitations but live life fully. Understand your fears. If the fear of more pain keeps you from doing anything, it can increase disability. When you are less active you have more time to dwell on your pain. You will have even more limitations over time.
- The cure is inside you.
• Pay attention to your body and feelings.
• Become an active part of your healthcare team.
o The STOMP project will give you the tools to improve your life.
o You are the only one who can work with your team.
• You have the most to gain.
- Remember to keep your pain medications safe!
Common Medication Concerns
1. Long-term Opioids, including hydrocodone, oxycodone, hydromorphone, fentanyl, morphine, methadone, oxymorphone, buprenorphine and tapentadal
- High doses taken for a long time may make your body more sensitive to pain [opioid-induced hyperalgesia]. The only fix is to stop taking the medication.
- These drugs may affect how your body fights germs and lower hormones such as testosterone, estrogen, and cortisol.
- High doses may increase falls. If testosterone has also been suppressed, broken bones are more likely.
- They may affect sleep [central sleep apnea].
- They should never be taken with alcohol.
- Other drugs that affect the brain like benzodiazepines (valium, Ativan, Xanax) increase the risk of overdose and seriously affect your ability to drive safely.
2. Benzodiazepines: Valium, Ativan, Xanax, and temazepam
- Chronic pain is usually linked to anxiety. However, long-term uses of benzodiazepines does not treat chronic pain well.
- They may pain worse.
- They are also very addictive and affect sleep.
- If short-acting ones (Xanax, Ativan) are stopped suddenly, seizures may occur.
3. Muscle relaxants: Flexeril, Soma, Robaxin, Zanaflex, Skelaxin, and baclofen
- Most of these drugs are very old and have never been tested to treat pain. They each affect the body in different ways and soma is addictive.
- Like many medications for chronic pain, these drugs should be used as little as possible.
4. Acetaminophen (Tylenol)
- Do not take more than 3 grams per day (for example, 6 extra-strength Tylenol). Take less if you have any liver problems or drink a lot of alcohol.
- This drug can cause liver and kidney failure when taken for a long time.
- Some medications, such as Vicodin and Percocet, contain acetaminophen. This should be added in your daily dose.
5. Anti-Inflammatories such as Advil, Aleve, ibuprofen, and Celebrex
- These drugs may cause stomach and intestinal bleeding, kidney damage and high blood pressure.
- They often do not help chronic pain except when there is a flare-up due to physical over-activity.
- If they are not helping, do not take them. They are dangerous. Over 14,000 Americans die from anti-inflammatory drugs every year.
Common Side Effects
All medications have side effects. Some are obvious, others are not.
- Constipation: Many pain medications, especially the opioids, cause the gut to slow down and absorb more water. Treatments include laxatives, eating fiber, drinking more water, and taking stool-softening medicine. The stool should be soft and you should not feel bloated after. If you still have problems, talk to your doctor.
- Dry mouth: Many medications may slow or stop your saliva (spit). Less saliva can cause stomachache, mouth burning, difficulty talking, and cavities. If you feel your mouth is dry because of your medications, go to your dentist, drink more water, use fluoride and mouthwash, and try other medications to increase saliva.
- Drowsiness (feeling tired): To decrease drowsiness; take less of the medication that is making you tired. Ask your doctor if you can take it before bed or change to a different medication if that does not help.
Gordon Irving, M.D.
Why should I protect my medications?
You are responsible for using your medication safely and keeping it from being abused or stolen. Doctors will rarely give you extra medication.
If you give someone your opioids, this could be a crime called “supplying”.
Steps to Get There
- Do not share your medications with anyone.
- Lock your medications in a cabinet or safe box and hide the key. You can buy these boxes from many stores.
- Do not use a bathroom cabinet. These rarely lock and are the first place any stranger or visitor in your house will look.
- Make sure your prescription has the right number of pills and count how many you have left every day. If you are missing pills, ask your family and anyone else in your home about it.
- If you are missing pills, move the locked container and change the lock.
- Remember, stealing narcotics a crime and it is taking medication that you need for your pain.
- If you do think someone has stolen your medicine, tell the police. This will help you and may help the person who stole your medicine.
Allen Hume, Ph.D.
Alcohol and drug use can affect pain management. Follow all directions with medications since it could cause problems if you do not. When using medications, be sure to be honest with your provider, who will likely have you sign a contract if you are on opioid (i.e. narcotic pain) or benzodiazepine (i.e. Valium, Xanax, etc.) medications. This contract is for your safety and should be followed. Using other drugs and/or alcohol can have very serious and even deadly effects if used with your medications. While it may seem that drugs or alcohol help with pain, anxiety, or depression, do not use them for managing pain. Alcohol, prescribed drugs, and other drugs can make pain feel worse and can lead to injury. Overuse can turn into addiction. If you have concerns about addiction (yours or a family member’s) see the links below. Remember, making healthy choices about your usage will make pain management much easier for you.
Steps to Get There
- Be honest with yourself and your provider about your alcohol and drug use. This includes prescriptions, over-the-counter, and illicit drugs, all of which can affect your treatment.
- Know your family history of drug and alcohol use Addiction often runs in families.
- Go online and take a test on your drug and alcohol use. Talk to your doctor or other provider and seek treatment if needed.
- There are many self-help groups, including Alcoholics Anonymous, NA, and Rational Recovery. Have others help you figure out if you have a drug or alcohol problem. If so, they can help you get better.
- Learn about drug and alcohol use, either on your own or with a provider’s help.
- There are many excellent providers who can help you with your alcohol, drug, and chronic pain issues.
- Seek individual and/or group counseling to address your usage and concerns.
- Stay hopeful and optimistic that you can change your behavior, recover, and improve your pain condition.
• Alcohol Screening, www.alcoholscreening.org
• National Institute on Alcoholism and Alcohol Abuse, www.niaaa.nih.gov
• National Institute on Drug Abuse, www.nida.nih.gov
• American Psychological Association, www.apa.org
• Alcoholics Anonymous, www.aa.org
• Narcotics Anonymous, www.na.org