Medication can provide some relief. Not all pain can be cured.
It is safer to use as little medication as possible and to avoid medication that has serious side effects. All medications have some sort of side effect. I remember a professor telling me that if a medication doesn’t have a side effect, it doesn’t have an effect.
Medication can provide relief. Unfortunately, when it comes to chronic pain, medication can provide little to no relief, and, at most, moderate relief.
There are many classes of pain medications. Some of them may improve the pain enough to allow a restful sleep, which is essential in the management of chronic pain.
Over the counter medications like:
Acetaminomphen
Never use more than 4000mg (4g) per day. Consult with your health care provider and pharmacist about use. It may work better to use it regularly as getting on top of severe pain is harder than managing moderate pain.
Non-steroidal Anti-inflammatories (NSAIDs):
Asprin, Naproxen, Ibuprofen, Celebrex and Meloxicam. Anti-inflammatories, on the other hand, can be dangerous even with small doses. It depends on your body and your luck. Up to 6% of people can develop heart complications from an NSAID and they are more likely to upset your stomach, even cause ulcers. it can also raise blood pressure and other side effects.
If you are taking a preventative dose of daily Asprin, it may be negated by NSAIDs.
Antidepressants
Anticonvulsants
There are multiple medications that can be used for chronic pain. I cannot mention all their uses and side effects, but will say that I have found Topiramate helpful for chronic severe headaches and migraine and Gabapentin helps improve sleep in some patients and has been suggested to help fibromyalgia.
Opioids
Not all pain can be managed with NSAID or over the counter drugs. Severe pain requires a multimodal approach which may include opioid treatment. The new opioid guidelines and restrictions have led to patients in severe pain suffering unnecessarily. This an article from The Washington Post.
Learn about harm reduction – 2018 Harm Reduction Client Survey.
There are tools that help patients and health care providers improve safety when it comes to prescribing opioids. DIRE Score. CAGE questionnaire.
Other Antiinflammatory Drugs
Hydroxychloroquine is a pill used for malaria that can be used for severe arthritis with an inflammatory component. Can be used for psoriasis arthritis.
Many treatments for inflammatory arthritis like rheumatoid arthritis can be tried: like Methotrexate plus hydroxychloroquine plus and Sulfasalazines before biologicals.
Always talk to your healthcare professional before taking medications.
Your pharmacist can be very helpful too.
Cannabis
Cannabis can seem like a harmless drug, but like any substance, it needs to be used with caution. I remember a professor telling me, if a drug doesn’t have a side effect, it doesn’t have an effect, and that is certainly true of cannabis. It has many side effects and the overall value of cannabis as a chronic pain management tool is still unproven by decent drug trials.
The risk of cannabis may outweigh the benefit. Adolescents in particular are at risk when they use cannabis. They are two to four times as likely to develop a substance use disorder and have an increased risk of mental health or neurological problems.
The elderly are also at risk. Is cannabis worth the risk of a lower IQ? Learning difficulties, earlier onset dementia, falls, psychosis, anxiety, and increased suicide risk are all side effects that occur with cannabis use.
Withdrawal symptoms after regular cannabis use include irritability, anger, aggression, anxiety, weight loss, restlessness, depressed mood, abdominal pain, tremors, fevers, chills, and headache.
Please speak to your healthcare provider about alternative management tools. I have had patients self-medicate their chronic pain with alcohol. Alcohol silently attacks muscles, including the heart, and the brain, kidneys, liver, and other organs. By the time alcohol damage shows itself, it is usually too late.
If you are using cannabis or alcohol to cope with your chronic pain, consider speaking to your doctor about other drugs. Opioids may be necessary in cases of overwhelming pain. They have significant side effects, especially in the elderly, and should be used to assist in the use of other chronic pain tools, like those in Step 2, Step 3, Step 5, Step 6, and Lower Inflammation.
It can be helpful to have someone with you to help you communicate your pain to your doctor/healthcare provider. Have the conversations necessary to make reasonable choices.
Unfortunately, there are too many patients without physicians. I believe healthcare needs to be changed. There are many patients who have incredible knowledge and resources – those who have learned to manage their pain. If only we could find a forum where these patients become the leaders helping others to heal. In the future, I see nurses and physician assistants working with patients in group settings for education and working individually with patients to tailor safe chronic pain management.
We are far from where we need to be to provide those in pain with relief. In BC, we are trying with Pain BC and Self Management BC to find help, but we have a long road ahead of us.
Different types of medications – Check with your healthcare provider: I can’t mention ALL THE DIFFERENT INDICATIONS AND SIDE EFFECTS.
Antidepressants
Antidepressant drugs that in low doses are used for pain, rather than depression (To treat depression you need high doses of these drugs) These medications are also used for cancer pain: Amitriptaline, Nortriptaline, Venlafaxine, Prisiq. Amitriptaline and Trazodone can help sleep and with good sleep you can have less pain.
Antidepressants can help chronic pain in some instances. Their sedating side effects can help you sleep and build restorative chemicals. Improved sleep helps you cope with the stress of chronic pain.
Many people with pain suffer from anxiety and depression either from the pain or maybe you have inherited depression from you parents, or have it because of stress.
How do antidepressants work?
Antidepressants can help pain: https://bit.ly/2FbtPrS
Sometimes anxiety is so over-powering that depression is not noticed. If you would like to try anti-depressants but are very anxious, ask your doctor to consider a two week course of benzodiazepines to help you through the worst. After two weeks the side-effect of increased anxiety goes down and in six weeks the effect is usually noticeable.
Some people feel numb or “dead” on anti-depressants. I wonder if that is not because chronic pain or chronic stress has led to PTSD. Our brains then only feel alive in a state of chaos. On anti-depressants, the calm feelings make you feel uncomfortable as your brain seeks the energy and excitement of chaos. Check out Stress Anxiety and PTSD
Antidepressants do not cause a physical addiction. They do have side effects. Speak to your health care provider.
Serotonin can be found in medications other than antidepressants. If you take too much, you may develop toxicity
Speak to your health care provider if you have: tremors, increased reflexes, muscle spasms, dilated pupils, sweating, fast heart rate, increased breathing rate, agitation, over-excitement, restlessness, or confusion.
Opioids
Opioids carry significant risk and should be reserved for people suffering from severe or moderate to severe pain. Consult your health-care provider and, if necessary, bring family members along to advocate for you if your pain is severe enough to warrant opioids.
Under-treatment of pain carries significant risks to individuals. Use forms to help communicate your pain. Forms relating to Pain
Buprenorphine and Methadone
Using the steps provided, it is possible to improve your quality of life, but if the pain is overwhelming, then medication may be needed to enable you to use the tools.
Activity helps – but remember pacing. Step 5 Pain and Pacing
Ideally find activities that you enjoy doing. When you are unable to manage activities due to pain, then your health-care provider should be your advocate. Use Forms relating to Pain to ensure good communication if you need stronger medication, like opioids. Browse through http://chronicpainmanagement.ca/?s=MD+tools
Using forms ensures easier, quicker and more effective communication with your health-care provider. Your local library may be able to help you print the forms to hand to your health-care provider.