Everyday pain management ideas

I believe in living simply.  And when it comes to medications, it appears that this is a good philosophy. Apparently, the folks at drugwatch.com agree with me. This agency is an advocate for consumers--it provides informations about drugs, devices and the pros and cons of using these things. Getting back to why they agree with me (or vice versa): When a person takes a medication, it is important for them to know as much about it as possible What is the name of this medication? What is this medication used for? What are the directions for use? What are the possible side effects of this medication? and lastly, What are the potential drug interactions of this medication? This last point may not seem any different than the others at first glance, but it is in fact, a very important point.  Drug interactions can occur in several different ways, so let's take a look at some possibilities. Drugs can interact with other drugs. Most pharmacies will run a drug interac...

Most everyone will find the need to take some kind of medication some time in their lives. And whether that medication is a pain medication or not, there are some general rules that apply for the safe use of all medications. While this list is not all inclusive, here are some safety tips that apply to all. image source: wikimedia Store medications as per package directions. Some medications can be keep at room temperature, while others need to be refrigerated or perhaps frozen.  Every prescription or over-the-counter drug comes with information as to ideal storage temperature.  If you are unsure about a specific medication, ask your pharmacist. Keep all medications out of the reach of children. Take medications as per package directions.  Do not exceed recommended dosages. Do not share prescription medications with other individuals.  Medications should always be used only by the person it is prescribed to. Read package information or patient educat...

Have you ever considered trying "Australian Dream?" I have seen ad after ad for this product time and time again.  So I started to wonder about this product, and whether or not it really works. The first thing I did was to take a look at the " Australian Dream " website.  According to the site, the active ingredient in the product is a substance called histamine dihydrochloride .  I searched for this drug on some drug reference sites, and found that it is FDA approved as a topical analgesic, for temporary relief of minor aches and pains, arthritis, sprains, and strains. There was not too much information about side effects except that a rash could occur, in which case the product should be discontinued. So, for the most part it's pretty safe...but does it really work?  To answer that question, I decided to check out some reviews of the product--both by consumers and professionals. On the professional front, I saw one physician review on a chronic pain...

Are you a chronic pain patient who has been on opioids for a long time?  Or maybe a physician who has patients like this?  As you might know, there is no magic formula for "getting off" of an opioid regimen.  The risks of long term use of opioids is quite clear. In addition, after a period of use, the effectiveness of an opioid regimen seems to diminish. One thing is for certain.  If a patient has been on an opioid regimen for an extended period of time, an abrupt discontinuation can lead to withdrawal symptoms. That is certainly not a good plan of action! So, how can a patient find their way off of one of these treatment regimens in a healthy way? Here are some suggestions based on a lecture at the World Congress of the World Institute of Pain in May 2016: 1) For patients on multiple opioid regimens, decrease long acting opioids first . This way the patient still has the shorter acting opioids available if necessary. 2) Go slowly .  Reduce dos...

You may (or may not) realize it--but there are antacid products on the US pharmaceutical market that contain "salicylates"--which are a form of aspirin.  One example it Pepto-Bismol®: just look at the active ingredients and you'll see the term "bismuth subsalicylate". Herein lies the problem..as salicylates are a form of aspirin, they carry all the risks of aspirin and all the other NSAID drugs.  Recently the FDA has been monitoring reports of increased bleed risk with use of these drugs.  Many people take a daily dose of aspirin to reduce the risk of stroke or heart attack. Who would think that taking a product for an upset stomach on top of this could be such a serious problem? My advice to you...ALWAYS read labels carefully when you purchase over the counter products. Just because a product is available over-the-counter does not mean it's risk free.  Make sure you understand exactly what you are taking and why you are taking it!  Check with you...

On this day 4 of fibromyalgia week, I am going to focus my writing on treatments for this mysterious condition.  As discussed in earlier posts, this condition tends to be chronic --and while it is debilitating, it is not life threatening.  There is no inflammatory process involved either. Pharmacotherapy for fibromyalgia  Drug treatment for fibromyalgia is still sort of in the trial and error phase.  There has been good response to some of the SSRI and tricyclic antidepressants to date.  Other drugs that have some use in fibromyalgia are NSAIDs (ibuprofen for example), COX 2 inhibitors (a specific category of NSAID such as celecoxib) and antiepileptics (eg Gabapentin). There have been some trials of naltrexone and also Immune Globulin . To date, these last two studies look promising but at this point they are not conventional therapy.  At one time, guaifenesin was thought to be promising but there is no clinical or scientific data to support its...

Researchers at Tulane University School of Medicine are working on a genetically engineered version of endorphin.  For those of you who don't know, endorphins are the feel-good, pain killing substance that the human body produces as a way of relieving pain. Endomorphin The genetically engineered version, known as endomorphin, seems to work at least as well as morphine in preliminary studies.  The best part is, the risks of morphine usage--such as respiratory depression and impaired motor skills--do not seem to occur when endomorphin is used.  In addition, endomorphin does not appear to be addictive in nature. According to lead researcher James Zadina,  it's unprecedented to that a peptide such as endomorphin can fight pain so well without the side effects of the opioid drugs currently in use.  Clinical trials are expected to begin within a couple of years. Source: PainWeek; Wikimedia

Whether you are a chronic pain patient, or anyone else for that matter, here is some food for thought. Every medication known to us has the potential to present us with at least three types of problems-- 1) Medications can interact with other medications in a person's system. 2) Medication can interact with foods that people eat. 3) All medications have side effects . Let me elaborate a bit: Medications can interact  with other medications  in a person's system. Many drugs have the potential to interact with other drugs; it's probably a lot more common than one might believe.  A common reason for this type of problem occurs when both drugs in question are metabolized in the liver, commonly through the cytochrome P-450 system.  In this scenario, both drugs are competing for the same enzyme, and usually one drug will predominate.  This results in a change of effectiveness and/or drug toxicity for one or all of the drugs involved.  The opioid d...

When children have fibromyalgia, it hurts.  It really hurts.  And from what research on this topic suggests, the pain continues for years, sometimes lasting into adulthood. Traditional thinking would suggest that there must be some kind of medication to help these kids get their life back.  But in reality, that's not the case! Research at the Children's Hospital of Philadelphia (known affectionately as CHOP) have come to realize a different approach to this problem.  Their treatment protocol consists of a combination of physical and occupational therapy.  They also discontinue all pain and sleeping medications that the patient may have been prescribed prior to coming to CHOP. The researchers followed 64 children in this program.  All of the subjects suffered from fibromyalgia for about 2 years prior to beginning treatment at CHOP. At the start of the study, the average pain rating for the group was 7.1 on the 1 to 10 scale.  A few weeks into th...

Source: Washington Post You've probably seen some news articles about this topic lately...I thought it was relevant to share in this forum.  The use of opioid pain medications for chronic pain is/was a standard practice for decades.  At this point, there are still many folks out there with chronic pain syndromes who are still being prescribed these medications.  They are, in fact. at increased risk of addiction due to that fact alone.  Now that medical practitioners are starting to think differently about this prescribing practice, some patients are left addicted to these medications but no longer have access to them.  Some of these are actual patients, others may be someone who abused/borrowed Oxycontin and other narcotic analgesics by obtaining them via less than legitimate means.  It's a lot easier to obtain heroin in the present day, so it has become an attractive alternative.   Statistics show that deaths due to heroin overdose have...

I saw a story from last year about former professional football players who took the NFL to court . The players argued that the NFL used poor decision making and mishandled prescription pain killers for during the course of their medical treatments. Over 500 players took part in the suit. According to the article, the DEA raided at least three NFL training rooms to investigate the situation. In light of these issues, many NFL teams have adopted different strategies for pain management issues of professional players.  One such strategy is the use of Rapid Release Technology, or RRT. As per the manufacturer's website, Rapid Release Therapy (TM) is a revolutionary breakthrough in therapeutic technology focused on relief of soft tissue problems affecting nerves, muscles, tendons, and ligaments.  RRT was designed from the ground up to target scar tissue adhesions with a specific frequency.  In addition, this frequency is in a range that is known to relax muscle ...

If you follow the world of pain management as I do, you are always looking for new material... For instance, recently the DEA tightened restrictions on some of the drugs already in the pain management arena.  Hydrocodone (a component of Vicodin® and the new long-acting product Zohydro®) and many other products is now a Schedule II drug.  That makes for a lot of  new restrictions/problems for those who use these products in their pain management regimen. Tramadol, which previously was  not a scheduled drug , was recently placed in Schedule IV. This means that all products that contain tramadol are more tightly regulated than they used to be. Now for some good news.. With this tightening of regulation...regarding all opioid drugs, and more recently the addition of the two above...there is research going on to find pain management applications for drugs currently in the marketplace that possess no abuse potential.  The tricyclic antidepres...

Opioid drugs have been on the marketplace for decades. But it wasn't until the 1980s that the idea of using long acting opioid products for chronic pain became reality.Before that time, opiates were mostly used short term; long term use of these products was pretty much limited to terminal illnesses, including cancer.  At that time, I was a newly licensed pharmacist; we were taught that, if someone had a terminal illness, quality of life was more important. If a terminally ill person became addicted to pain medication, so be it. Dr. Russell Portenoy was one of the early proponents using opioid medications for patients with chronic pain conditions.  In the late 1980s, he co-authored a paper about a study using these products in this way.  The study was based on a relatively small sample: only 38 patients were involved. The authors contended that the benefits of long term opiate therapy experienced by the study subjects could be of potential benefit to many people wit...

This blog post is truly more my opinion than anything.  I was looking to write a post on fibromyalgia because I try to post something about it every week for my readers.  This week, I came across some articles about Intravenous Vitamin Drips for various conditions, and the latest one is fibromyalgia. This form treatment has been around for some time, largely a Hollywood fad.  The celebrities are all about it, claiming it helps to rejuvenate.  Apparently these infusions are customized to the individual and they are said to provide immediate relief because the nutrients can reach their targets instantly. Some websites are beginning to promote this idea as a treatment for fibromyalgia...and that is why I am writing about it today. A recent story in the Huffington Post tells one such story. Actor Ryan Phillipe and his girlfriend Paulina Slagter apparently use this treatment.  Apparently this treatment makes up for the fact that they don't eat right...

Gouty tophus of the knee. In all likelihood, the diagnosis of gout means treatment with medication will be involved.  In this post, we'll look at some of the medications used to treat gout and how they work.  Part III of this series will focus on non-drug measures to help relieve the pain of gout and prevent recurrent attacks. Pharmaceutical treatment of gout falls into two basic categories: the first category consists of medications that would be used for a gouty attack, while the second category of drugs are utilized to help prevent future attacks. Drugs for treatment of gout attacks are agents that help to reduce the pain and inflammation associated with the condition.  Many years ago, the primary agents for gout attack were butazolidin (one of the first NSAIDs on the market) and colchicine.  Butazolidin was removed from the US market many years ago over safety concerns, and has largely been replaced by more modern day agents such as ibuprofen or...

Have you ever heard of oxytocin?  It is a naturally occurring hormone/neurotransmitter.  If you have heard of it, you probably know that it has a role in pregnancy, childbirth, and lactation. It is also a powerful neurotransmitter, and has a role in pair bonding.  Human chorionic gonadotropin is another hormone produced in pregnancy; its usual role is in the production of progesterone in the first trimester. These two substances have recently been under investigation for a possible role in pain management. Although studies are very early on, there is some excitement about the possibilities! A recent small scale study by PAINWeek faculty member Forest Tennant, MD, DrPH, indicated that  administration of oxytocin and human chorionic gonadotropin (HCG) to 9 patients resulted in a 30-40% decrease in pain in 7 of the 9 patients studied. In addition, these patients reported longer pain free periods between flares, and the need for pain medication was ...

In all the months I have been writing posts for this blog, I have observed that people with fibromyalgia are eager for relief.  The current recommendation for fibromyalgia treatment is multi modal--that is to say, it includes approaching the condition from multiple angles--medication, exercise, improvements in sleep duration and quality, etc.   For today's post, I am sharing recent article from National Pain Report that discusses the medication aspect of fibromyalgia treatment.  After reading it, you will see why medications alone won't help most people.   Drugs for Fibromyalgia: How Good Are They? March 5th, 2014 by Dr. John Quintner Most fibromyalgia sufferers will at some stage be offered a prescription for one or more the  officially approved drugs – Lyrica, Cymbalta, and Savella. Many will ask their doctors two important questions: How good are these drugs and what harm can they cause me? Many would be surprised by th...

Yesterday's post gave some idea of how to prevent back injury--but I did not feel that words alone could describe what good lifting technique is all about. So, for today's post I am sharing a short YouTube video that gives you a visual example of this important technique!

I have decided to devote a few posts to my thoughts about why non-drug pain management ideas are important.  Up until the present, I have focused on over 60 different ideas ( see recap #1 and recap #2 for a quick overview) . Not every intervention is appropriate for every situation-for example, inversion tables are primarily used for people with back problems, but would probably not be of much use for someone with fibromyalgia. In any event, for this first post I would like to point out that medications have a role in the treatment of chronic pain, but there ARE limitations.  Some thoughts:  Dosage ranges need to be observed to reduce the risk of side effects/toxicity/drug interactions.  The more medications a person takes, and the higher the dosages they take, the more likely they are to encounter problems at some point. Of particular danger is the use of opioid medications because of the risks associated with the nature of the drug: addiction, dependency, and ...

Even though I am a pharmacist, I do not write or share much information about medication in this blog, because I do not feel it is appropriate to promote the use of medication as if it's some kind of nirvana.  But occasionally I find things I think worth sharing, and this is one that I got from one of the pain management websites that I frequent.  So, for your reading pleasure-  I present "A Patient Guide to Topical Analgesics." Sources: http://www.acpa.org               http://www.ampainsoc.org