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Medication for Pain Series: NSAIDS (Anti-inflammatories)

April 21st, 2014 · No Comments

This article is in our series on Medications for Pain…  What are your choices?  How do various medications work?  Pros and cons?  Side effects?

Today we’ll discuss a class of medication called NSAIDS (Non-Steroidal Anti-Inflammatory Drugs).  The 3 types of medication in this class are:

  • Aspirin
  • “Non-selective” cox inhibitors, e.g. Motrin (Ibuprophen).  (The “cox” simply relates to an enzyme in our bodies involved in inflammation.)
  • Selective” cox-2 inhibitors, e.g. Celebrex

Effect of NSAIDS:  NSAIDS block inflammation from occurring, and thus stop the pain that’s caused by inflammation.

Uses of NSAIDS:  Because NSAIDS block inflammation, they’re helpful in disorders that have inflammation, such as arthritis and some types of back pain.  They don’t help in pain disorders that don’t have inflammation, such as fibromyalgia.

Potential Side Effects:

  • Bleeding
  • Stomach upset
  • Asthma (in 10% of people)
  • Kidney problems
  • Cox-2 medications increase clotting, which can cause heart attacks and stroke.  This is why some of these medications have been taken off the market.
  • Liver toxicity above recommended doses

While these medications can be helpful, don’t eat them like candy.  They’re not benign!  Many people don’t recognize this, as they’re sold over the counter, and so are assumed to be perfectly safe.  Some stronger dosages have even been discontinued because of the risk of patients taking too much medication.

Interesting fact:  In studies, there is no difference in effectiveness between 1 medication in a class and another.  Therefore generic aspirin is just as good as Bayer.

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Medication for Pain Series

April 14th, 2014 · 1 Comment

Today starts a new series about medications for pain.  For each medication class, we’ll cover:

  • what are your choices?
  • how do various medications work?
  • what are the pros and cons of different types of medication?
  • how about side effects?

I hope this information will be helpful to you, both to better understand the current medications you’re on, as well as learning about options to consider with your pain management physician.  As always when I discuss medication, or any treatment, discuss these ideas with your doctor.  Don’t make any changes to your treatment by yourself.  These articles are intended as information only, and not as medical advice (see my disclaimer).

These are the medications and topics we’ll cover during this series:

  1. NSAIDS (Non-steroidal anti-inflammatory drugs)
  2. Anticonvulsants
  3. Antidepressants
  4. Anesthetics
  5. NMDA receptor antagonists (e.g. Ketamine)
  6. Muscle relaxants
  7. Blood Pressure Medication
  8. Anti-Psychotics
  9. Opiates (Narcotics)
  10. Medication Advances Coming Soon
  11. Research Advances

Today we’ll cover some general points about medication, and each successive Monday we’ll look at 1 category of medication for pain.

1.  Medication is part of comprehensive treatment

When I work with patients with pain, I talk about the many aspects of pain treatment.  These include:

  • treating the underlying medical problem
  • decreasing pain sensations
  • coping with remaining pain
  • living life despite pain

Medication can treat the underlying medical problem, decrease pain sensations, or both.

2.  A comprehensive treatment plan may include:

  • other medical treatments like injections, infusions, and spinal cord stimulators
  • psychological treatment including relaxation, guided imagery, and visualization
  • physical therapy, including treatments, TENS, and pacing of activities
  • family support
  • evaluation and treatment of psychiatric problems that pain may cause, for example, depression or anxiety
  • work to increase functioning, in whatever ways are meaningful and possible

Most often to get a good result, you have to focus on all parts of comprehensive treatment, not just hope medication does it all.

3.  What is your goal?

For many people, medication isn’t curative, nor does it reduce pain to zero.  But that doesn’t mean it’s not helpful.  The goal of pain treatment is to reduce pain as much as possible AND to function as fully as possible.  Don’t lose sight of the second because of only focusing on getting rid of pain.  And don’t wait for pain to get to zero before figuring out how to live life despite pain.

4. Medication treatment is an art as well as a science

We know some things about medications, but there’s a lot we don’t know!  For many of the medications we use, or use in combination with others, we don’t know enough about what types of pain they’re best for, what combinations work best for what types of pain, etc.

FDA approval of a medication for a certain disease is the best level of assurance that a medication might work well for you.  Unfortunately, many of the medications we use aren’t FDA approved – we’re just not there yet in our research.  That doesn’t mean they’re not good – we just don’t know for sure.

The second best level is when there’s some research and a lot of clinical experience, but just not FDA approval.  After that comes medication that a physician has some experience with, but a lot is still unknown.  Obviously the farther you get away from FDA approval, the more you have to weigh the possible risks with benefits.

Combination treatment – using multiple medications at one time – also has varying degrees of research backing it up.  Unfortunately again, it’s mostly on the “little research” end.  But that’s beginning to change – there are more and more studies looking at combination treatment.  So we’re getting somewhere!

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Pain Pathways magazine, March 2014

April 7th, 2014 · No Comments

Here’s the Pain Pathways magazine March issue.

Current Issue

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Pain Management Class: Stress Management, Part 2

March 31st, 2014 · 1 Comment

Today is the last in our series of articles featuring pain management techniques to help you decrease and cope with pain.  It’s your at-home pain management class!

Last week we looked at stress management in general.  As you remember, most people report that stress increases their pain levels.  So it’s important to both prevent and decrease stress.  Today you’re invited to pick 1 stress management technique you’ll focus on this week.

Why pick one?  You’ll have more success if you change 1 thing at a time.  As well, if you choose one, you’ll be moving from just considering ideas to actually committing to try something.

Pick a specific way to decrease your stress.

Your assignment:  Pick 1 stress management skill you’d like to work on.  Fill in the worksheet and practice this skill this week (click the above link to get to the worksheet).

Today is the last pain management 2010 class.  Please let me know any questions or comments!

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Pain Management Class: Stress Management

March 24th, 2014 · 1 Comment

Each Monday this series of articles will feature pain management techniques to help you decrease and cope with pain.  It’s your at-home pain management class!

So far, we’ve looked at relaxation skills and guided imagery as ways to decrease pain.  For most people, stress increases their pain levels.  So it’s important to both prevent and decrease stress.

Here’s a stress management exercise for you to review.  It lists many ways to decrease stress!

Your assignment:  Pick ONE stress management skill you’d like to try out this week.  Write it down where you’ll see it every day.

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Pain Management Class: Guided Imagery, Part 2

March 17th, 2014 · No Comments

Each Monday this series of articles will feature pain management techniques to help you decrease and cope with pain.  It’s your at-home pain management class!

Last week we looked at guided imagery which helps reduce pain through suggestion and images.  An image is paired with your pain, and by decreasing or changing the image in some way, your pain may also decrease.  Today’s guided imagery uses a sunset as the image.

Guided imagery with a sunset image

There are several ways to use this exercise:

  • listen to the exercise in the audio on the website
  • read through the exercise and then do it from memory (it doesn’t have to be done exactly as I’ve written it)
  • tape record the exercise yourself, then play it back for yourself to do (you can even record it into your cellphone)
  • have someone else read or record the exercise for you

As you try this guided imagery, see if you begin to benefit even more than with the plain relaxation exercises you’ve tried.

Your assignment:  Do a guided imagery exercise at least once a day.

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Book Review: Stop the Orchestra From Playing

March 12th, 2014 · No Comments

I wish author Gary Weinkauf could come to my Coping with Pain support groups.  He would be a great role model for patients coping with chronic pain!

Gary writes about his experience with acute and chronic pain in this memoir, Stop the Orchestra From Playing: One Man’s Odyssey With Pain.  Stricken with acute back pain, he endures a medical saga which will be familiar to others.  Evals, tests, tests, tests, procedures, surgery, and more surgery.  Today he lives with chronic pain and is on disability from his job as a computer programming.

Stop the Orchestra from Playing: One Man's Odyssey with Pain by Gary Weinkauf

What’s notable and very helpful about his book is that Gary also shares with us how he has coped with pain and the severe consequences of having chronic pain.  He highlights skills such as:

Gary’s sense of humor comes through in the book and makes for enjoyable reading.  His description of some of the challenges chronic pain brings to your sex life made me laugh (“Put on your sexiest back brace, grab your cane and say, ‘honey, I’m ready’ “).  He also shares very honestly the challenges of not working, depression and anxiety, and pain’s effect on his family.

I enjoyed this book.  Gary has done a real service to others in sharing his story!

(For information about purchasing:  Stop the Orchestra From Playing)

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Pain Management Class: Guided Imagery

March 10th, 2014 · No Comments

Each Monday this series of articles will feature pain management techniques to help you decrease and cope with pain.  It’s your at-home pain management class!

So far we’ve looked at relaxation skills – breathing, relaxation and visualization – that work to decrease pain indirectly through relaxation.  Guided imagery – while also a relaxation skill – is a bit different.

Guided imagery helps reduce pain more directly through the use of suggestion.  An image is paired with your pain, and by imagining decreasing or changing the picture in some way, your pain may also decrease.   Today we’ll use the image of special water.

Guided imagery of water

There are several ways to use this exercise:

  • listen to the audio on our website
  • read through the exercise and then do it from memory (it doesn’t have to be done exactly as I’ve written it)
  • tape record the exercise yourself, then play it back and listen (record it in your cellphone!)
  • have someone else read or record the exercise for you

As you try guided imagery, notice if you benefit even more than from using relaxation exercises.

Your assignment:  Do a guided imagery exercise at least once a day.

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Pain Management Class: Visualization

March 3rd, 2014 · No Comments

Each Monday this series of articles will feature pain management techniques to help you decrease and cope with pain.  It’s your at-home pain management class!

Today’s exercise is visualization.  Visualization is simply using a picture or image to help you relax.  Both relaxation and visualization reduce pain by helping you relax.  An image that may people enjoy is the beach, but you can use any place or thing that you love.

(And as you’re reading this post today, click here for sounds of the ocean to accompany your reading!)

Visualization exercise

There are several ways to use this exercise:

  • play the audio of the exercise on our website
  • read through the exercise and then do it from memory (it doesn’t have to be done exactly as I’ve written it)
  • tape record the exercise yourself, then play it back and listen (try recording it in your cellphone!)
  • have someone else read or record the exercise for you

When you picture your image, use as many of your senses as possible with visualization – what you hear, smell, see, feel, etc.  Some people find one favorite relaxation exercise and do just that one, while others like to vary the ones they use.  Either way is fine.

Your assignment:  Do a visualization exercise at least once a day.

Thanks to Adwriter for the photo from Flickr.

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Pain Pathways January 2014

February 26th, 2014 · No Comments

Here’s the link to the January issue of Pain Pathways.

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