HEALTHCARE
"I'm in pain. What can you give me for it?"
Most physicians have heard this request from patients time and time again. Relief from pain is a major reason people seek medical attention, and often their assumption is that a pill is the answer. It is true that in many cases, medication may play a role in easing pain and discomfort from a variety of ailments. However, the same drug that might help one patient function and feel better may harm another. Being aware of the types of medicines used for pain, as well as their side effects and risks, can help patients protect themselves and their families.
Acetaminophen (Tylenol TM) is a common over-the-counter (OTC) pain reliever. Although it doesn’t have the gastrointestinal side effects of other medications, it can cause liver damage at high doses. The recommended maximum dose is 3,000 mg a day (6 extra-strength tablets). People with liver disease or those who drink significant amounts of alcohol are at increased risk and should check with their primary physician about recommended dosages.
NSAIDs (non steroidal anti-inflammatory drugs) are a large group of prescription and OTC pain relievers. Popular brand names include Motrin TM and Aleve TM, as well as the prescription-only Mobic TM. Serious gastrointestinal side effects, including bleeding, can be associated with these medications, along with kidney damage. One common mistake is to take an OTC version of these medications at the same time as a prescribed one, not realizing that this increases the risks of side effects. Also, NSAIDs are often not safe to take with many prescription blood-thinners, or in some patients with kidney disease.
Opioids are powerful drugs used to treat severe pain that work on certain targets, or receptors, in the body's cells. Some, like morphine and codeine, are derived from the poppy plant, the same source that provides heroin and opium. Others are synthetic, such as methadone and fentanyl. Although opioids are effective in many cases of acute pain (such as for a fracture, or after major surgery), they may not be helpful in many cases of chronic pain, and in some cases can actually cause an unusual pain syndrome. The US is currently in the midst of an epidemic of overdose deaths related to opioids, both legal and illegal. Opioids, including prescription drugs and heroin, killed 33,000 people in 2015. Remember, these drugs have a significant risk of dependency and addiction, and should be used with caution.
What you can do to stay safe with narcotic medications:
Tell your provider about all of your significant medical issues, including a history of addiction or alcoholism. Patients with a history of addictive issues in the past are at particular risk. If you are in treatment for opioid dependency and are taking maintenance medications (such as methadone or suboxone) let all your providers know. This is especially important if you are undergoing a surgical procedure.
Don’t take the medication more often than prescribed, and use it for severe pain only. Ask if other medications, such as acetaminophen, NSAIDs, or non-narcotic pain medicines like gabapentin, can be used with it.
Never mix narcotics with alcohol, and use caution with other medications that can cause drowsiness. Some medicines for anxiety, such as lorazepam (Ativan TM) and related drugs, are particular risky in combination with narcotics. Do not, however, suddenly stop another prescription medication without discussing it with your provider.
NEVER sell or trade narcotics, or give them to family members. Store them in a secure location, preferably a lock box. Dispose of extra pills safely by mixing them in coffee grounds or kitty litter and throwing them in the garbage.
Other options include medications initially approved for seizures and psychiatric conditions, such as gabapentin, Lyrica TM, and Cymbalta TM. They may be helpful for nerve-related pain, which often doesn't respond well to other medications. Topical creams, both prescription and OTC, may also give relief. Again, all of these have some associated risks and side effects, and don't work for everyone.
Keep in mind that many types of pain are best managed without medication at all. Musculoskeletal options such as physical therapy, massage or manipulation treatments can be particular helpful. Heat or ice applications are often useful, and many patients have found relief with alternative treatments ranging from acupuncture to meditation. Sometimes and injection can be an option too.
To sum up, make sure you know what you're putting in your body before you swallow that pill, and have open and honest discussions with your provider about all of your medications for pain, both prescribed and not.
Maria A. Guglielmo, MD
