I recently heard Cynthia Kuhn, PhD, professor of pharmacology at Duke University Medical School, speak about the best prescribing practices for pain management.
Some people don't like the idea of taking painkillers—but Dr. Kuhn points out that severe unresolved pain can decrease immunity and slow healing...lead to sleep disorders, depression and anxiety...and rewire the nervous system to cause chronic pain. It is very important to work with your physician to understand the source of the pain and to explore the best strategies to treat the pain effectively. Dr. Kuhn advises moving up the "analgesic ladder" only if pain persists.
Step 1: Use acetaminophen (Tylenol) or a nonsteroidal anti-inflammatory (NSAID), such as aspirin, ibuprofen (Advil or naproxen (Aleve). If the pain is not relieved by the highest recommended dose, your physician may suggest moving up the ladder to…
Step 2: A weak opioid, such as codeine, hydrocodone or tramadol (Ultram) or a Step 1/ Step 2 combination drug for a stronger effect.
Examples: Percocet (acetaminophen plus oxycodone).. Vicodin (acetaminophen plus hydrocodone). If the pain continues, your physician may go to…
Step 3: Stronger opioids, such as hydromorphone (Dilaudid), methadone, morphine or higher-dose oxycodone OxyContin).
To enhance pain relief, physicians may prescribe an adjuvant at any step on the ladder.
Examples: Certain antidepressants, such as amitriptyline (Elavil) and duloxetine Cymbalta), and antiepileptic drugs, such as gabapentin (Neurontin).
While narcotic drugs are effective, they are addictive and an overdose can be lethal. Precautions to take…
- Ask about side effects so that you will know what to expect.
- Tell your doctor if you have ever been addicted to drugs or alcohol. Such a history increases the risk for opioid addiction and may influence which drug is prescribed.
- Take the prescribed medication on a schedule to prevent over-or under-dosing.
- Never increase the dosage or frequency on your own. Overdose deaths have risen dramatically due to patients taking narcotic drugs more frequently than prescribed.
- Do not stop prescription painkillers abruptly. Discuss with your doctor a plan for tapering off to minimize withdrawal symptoms.
- Once the pain resolves, discard any unused prescription drugs so that no one is tempted to take them in situations for which they have not been prescribed.
Nondrug treatments, such as exercise and deep breathing, also are critical to pain management. Certain types of pain (especially back pain) are not well-controlled with medication alone. Discuss all options with your doctor.
Ginkgo for Pain?
Neuropathic pain in which nerves that are damaged send erroneous pain signals in response to harmless stimuli such as a light touch-is hard to treat. Common causes include diabetes and shingles. Among rats with neuropathic pain, those given a ginkgo biloba herbal extract showed significantly lower pain responses to cold and pressure than those given a placebo. Human studies are needed.
More Relief for Shingles Pain
A recent study followed 87 patients with shingles who took the painkiller oxycodone (Oxycontin)...the antiseizure drug gabapentin (Neurontin), also used to treat pain...or a placebo for 28 days. All patients also took the antiviral drug famciclovir (Famvir).
Result: The oxycodone group was more than twice as likely to experience at least a 30% decrease in pain, compared with the placebo group. The gabapentin group did not report a significant reduction in pain.
Caution: Oxycodone can be habit-forming and can cause such side effects as constipation, dizziness and nausea.
Are Pain Medications Sapping Your Sex Life?
Most men and women taking opioids, such as codeine, hydrocodone (Vicodin), morphine and oxycodone OxyContin, Percocet), show reductions in blood levels of estradiol, testosterone and related hormones.
Among the consequences: Patients may experience loss of libido, depression, decreased energy, mood disturbances, osteoporosis and/or premature menopause. Once the opioid is stopped, hormone levels rebound.