Narcotic pain medications

Opiate drugs have been the most effective  pain treatment drugs known to man for over 2000 years. Such pain relievers, when used as prescribed, play a critical role in improving patient health. However, when misused or abused, they can be dangerous and even deadly. In November of 2011, the Centers for Disease Control and Prevention reported that "more people die in America every year from prescription drug abuse than die from heroin and cocaine combined."

How do Opiates Work?
Opiates such as morphine are like keys. Nerves in the spinal cord are like locks. The morphine key fits into the nerve lock, and tells the nerve to block pain. There are many opiate medications. Some fit the locks very well. These tend to be very addictive. Others don't fit the lock well.  They tend to be less addictive, but are not as strong pain relievers. Using opiates for a short time, such as in shingles treatment is usually not a problem. Long term use of opioids for non cancer pain such as neuropathy is controversial.  Fortunately, pain management doctors are experts at determining if opioids are right for your pain treatment.

What is tolerance?
One of the biggest problems with opiates for pain treatment is that a tolerance to the effect builds fairly rapidly. Thus at first they seem to provide excellent pain relief, but over time they don't seem to last as long, then typically don't seem to be as strong. So you have to take more and more over time to get the same effect. The more you take the more side effects you get, and the harder it is to get off of them when they don't work well. Many people experience withdrawal side effects such as nausea, sweatiness, jitteriness, diarrhea, and headache when they miss a dose. Pain management doctors can help you manage your pain without opioids.

Getting over tolerance
Pain management doctors have several ways to combat tolerance other than simply upping the dose. One is called a drug holiday. You will go completely off of the opioid for a fixed time, let your body detox, and then when you restart the opioid, it will work well again. Another strategy used in pain management is opioid rotation. You will switch periodically from one opioid to another, and because each opioid is slightly different, you have some pain relief.

What are some side effects?
For pain patients, constipation and sleepiness are common. At very high doses, such as given in cancer pain, hallucinations can occur. In people who haven't taken opioids very long or who are just starting them, breathing can be reduced, and is the most common cause of death with overdose.

Will I become an addict?
Opiates can be addicting. It is estimated that 10% of the population has addictive tendencies. While statistics show only a small fractions of pain patients become addicts-that is using the pain drug for reasons other than pain, pain clinics will monitor your use as do insurance companies, pharmacies, and many states including California.

What is a pain contract?
Typically when taking opiates for non cancer pain, you will need to sign a pain contract, which will limit you to one pharmacy, not allow you to get pain medications from more than one physician, have you submit to random urine drug screens, and not allow early refills for lost prescriptions or taking more than you are prescribed. It is unfortunate that many people who use opioids for pain treatment feel almost like criminals when they go to pharmacies or clinics for pain medicines.  However, because abuse in all age groups is increasing, and because of the serious nature of abuse, a check and balance system is necessary for chronic pain patients.

Exercises for pain

Exercise therapy is the cornerstone of pain relief.  But exercise is a 'Catch 22' for many pain sufferers, especially those seeking sciatic nerve pain releif.  They know they need to exercise to relieve pain, but the exercise itself causes more pain.



Our pain management doctors have found that exercise pain can be reduced if a few pain treatment guidelines are followed. First is to select the right exercise for the right pain.  This may mean seeing a physical therapist with expertise in selecting exercises for neuropathy, lower back pain or other pain conditions.  Second is to spread the exercises out over a day. It is better to do a few minutes many times a day, then 30 minutes once and then hurt more.  Third is to only start exercise when pain treatment medications are optimized. It can take time for a pain specialist to get your medications adjusted well.  Fourth, we find that a nerve block or epidural block before initiating an exercise program can be very helpful.  Last, it is important to have goals. We recommend keeping a daily pain treatment exercise/activity log and a pain log at the same time.  Over time, with consistent pain therapy, you will see your activity levels increase, and your pain score go down.




Walking for exercise
Whether for lower back pain treatment, fibromyalgia or neuropathy treatment, walking is a good pain treatment activity for many chronic pain patients to start. For those with lower back pain, start off slowly and gradually build up. Taking bid strides can stretch the back. An inexpensive pedometer can be helpful to track your activity levels.

Swimming
For those with lower back pain, or are looking for sciatic nerve pain relief,  swimming can be an ideal pain treatment. In the pool, you are nearly weightless, and that takes pressure off of the back.  If you are not a swimmer, your can do water aerobics in the shallow end, stretches on the steps or in the Jacuzzi, or use body boards or pool noodles to help you. Check with a local gym, the YMCA, community center, or arthritis foundation for pool access near you.

Stretching
One of the most useful exercises for back pain, neck or shoulder pain is stretching. After surgery, stretching is needed to break up scar tissue. Pain management doctors will usually refer you to an expert to teach you stretching techniques. Many of these pain treatment activities can be done in bed.

Yoga and Tai Chi
Yoga and Tai Chi are great pain treatment exercises, as they help with the chronic deconditioning seen in low back pain and neuropathy. Yoga and Pilates can build core strength with minimal pressure on the discs. Clinical studies have shown both effective at low back pain treatment in the elderly.  Classes are often available at a local community center. Videos of techniques are on the web, or available at your library.

Weight loss
Weight adds to the force the low back must carry. Getting to a normal weight is critical for low back pain treatment, as well as for hip, and knee pain. Because exercise levels are so low in chronic pain sufferers, they do not burn many calories. thus to lose weight, calorie levels must be very low.  Counting calories is a good way to start.

Consistency is important
Whatever exercises your pain management doctors have recommended, the key is to do them consistently, on good days and on bad.  Keeping a daily log of your activity to show your pain management doctors is helpful.

Non drug pain relief options

There are many ways other than pain pills to reduce chronic pain.
One of the simplest and best ways to reduce pain is with hot packs and ice.

Which is better-heat or ice?
The answer is whatever works best for you. Heat brings blood into the area, and can be relaxing for tight muscles. A hot bath, a Jacuzzi or a steam room all can help when pain peaks.  Ice can reduce inflammation, and provide a temporary nerve blocking effect if placed in the right areas. Ice cubes in a ziplock bag held to the skin with a wrap is simple and effective.  Heat and ice combined with simple massage is even more effective.

Braces and Supports
Belts, braces and supports are effective for lower back pain treatment if fitted properly and used part time. They help you get around, but overuse can lead to muscle atrophy and more pain.  Some braces even have hot packs and electrical stimulation built in.

Electrical Stimulation
TENS is a small box that sends mild electrical zaps to EKG like decals placed over painful areas such as the lower back. The idea is that you body feels the non painful electrical tingling, and not the pain. In 2012, medicare indicated it will no longer pay for TENS devices for lower back pain treatment.

Massage therapy for pain
Almost everyone likes a good massage. Unfortunately, the pain treatment effects seem all too temporary. For neck pain, lower back pain and fibromyalgia, myofascial release stretching has many proponents. You will hear the terms rolfing, strain/counterstrain and spray and stretch techniques used. We can teach your spouse how to use these techniques to help reduce your pain flares.

Acupuncture
Acupuncture has been used for pain treatment for over 5000 years. Modern pain management doctors believe that acupuncture works by stimulating the release of natural pain killers in the body called endorphins. Thus like any drug, the effect is usually short acting. Acupuncture seems to be a good pain treatment for people with headaches.

Biofeedback
Biofeedback is a relaxation technique that uses modern technology help a pain sufferer relax the muscles, slow the heart beat, or reduce stress. It is actually very easy to do, and an effective pain treatment for symptoms aggravated by stress, such as headaches, neck and low back pain.

Low Level Laser Therapy
Also known as photobiomodulation includes use of light emitting diodes. It is thought that certain wavelengths of light stimulate mitochondria (the energy factory of cells) to produce energy, and induce changes in the cell. Controlled human pain treatment studies have not shown significant benefit for neck pain, and it was not endorsed as effective treatment for diabetic neuropathy by the American Academy of Neurology or the American Academy of Physical Medicine and Rehabilitation in 2011. It does not appear to be harmful, but did stimulate oral cancer cells to be more aggressive. Thus, more time is needed to find where this therapy will work best in pain treatment.

As seen on TV
Your friends may use Copper wrist bands, Holographic wrist bands, magnets, balance bands, etc. for pain treatment. None of these devices has been shown in large controlled studies to be effective pain treatment methods.

Non narcotic pain relievers

Non narcotic pain medications are the most common drugs used for pain relief. Chances are, you have two or three such pain medications in your cabinet right now.

Acetaminophen
Acetaminophen was discovered in the 1800's, but pain doctors still don't know exactly how it works to relieve pain. Acetaminophen acts as a booster to many other pain treatment medications, and you will find it in many pain medications.  This can be a cause of concern, as a person can easily overdose on acetaminophen and not realize they are doing it. The FDA has moved to limit the amount of acetaminophen in pain medications.

NSAID's
Non Steroidal Anti Inflammatory Drugs or NSAID,s are drugs like ibuprofen, naproxen, meloxicam, and celecoxib.  Even though many of these are over the counter, they can cause serious side effects such as kidney failure, stomach ulcers, rebound headaches, and heart attacks.  They are very effective for arthritis type pain, and when used with acetaminophen can even stop migraines when taken in the early stages. 

Capsaicin
Capsaicin is an over the counter form of the hot ingredient in chile peppers. It has been shown to block pain transmitters.  It is effective for neuropathy treatment, but must be applied 4 times a day, and takes several weeks to build up. It is hot on the skin, and will make your eyes burn it you touch your eyes with some cream still on your hands.

Muscle Relaxants
Carisoprodol (Soma), Cyclobenzaprine (Flexeril) and methocarbamol (Robaxin) are commonly prescribed as 'muscle relaxants' although they actually have little to do with muscles. Soma can be a drug of abuse. Most pain doctors prefer baclofen and tizanidine.

Adjuvant Pain Medicines
These are medicines that started out as drugs for one thing, but have been found to be effective for chronic pain. 
    Antidepressants are effective pain medications.  The most studied one is amitriptyline and its cousins called tricyclic antidepressants. As a class, they have an advantage of helping you sleep if pain keeps you up. They also block stomach acid, and give you a dry mouth. Some people do not have enough of the proper liver enzyme to remove it quickly from the body, and in them, a little goes a long way. Newer antidepressants such as duloxetine (Cymbalta) and others can also be effective without the drowsiness of amitriptyline.

Anticonvulsants for pain treatment
The cornerstone of shingles treatment, neuropathy treatment, and for sciatic nerve pain relief are the anticonvulsant (epilepsy) medications.  Anticonvulsant medicines give best results in treating sharp, neuropathic pain.  When used for pain treatment, anticonvulsants must start out at low doses, and build up over time to get to a dose that works. Pain management doctors often have patients who say they tried these and they did not work, only to find that the dose given was too low to be effective pain treatment. An effective pain treatment dose for gabapentin usually starts at a total of 1800mg a day.  Pregabalin (Lyrica) was selected as first line medication for diabetic neuropathy pain treatment by the American Academy of Neurology in 2011.