Family Issues #5

On Fridays, I’ve been having a series of posts about family issues and your pain. Pain conditions affect not only you, but also your family… your husband or wife… your children… your Mom and Dad… even your friends.

These posts are excerpts from a handout for family members (and friends) of patients with pain that I’ve written with a colleague, Dr. David Kannerstein, who is the lead author.  These excerpts are reprinted with permission from Practical Pain Management, 2007, Vol 7, 48-52.  We’ve written this handout to provide information for family members and to help them with what they’re going through.

You’re invited to copy these posts and discuss them with your loved ones.  If you’d like a copy of the complete handout, information is available at the end of today’s post.

Today’s excerpt: What Medications are Available for Chronic Pain?

There are numerous medical and other treatments which can help patients with pain live happier and more productive lives.  Sometimes complete pain relief can’t be reached, but reducing suffering and increasing a patient’s functioning can almost always be accomplished.  As a loved one of a patient with pain, you need to be aware of these to help your loved one get the appropriate treatment.  As every patient is different, this information is not meant as medical advice, but to give you a sense of the range of treatments.

Let’s start with medications.  There are many medications that can be helpful in making your loved one’s pain more tolerable.  You and your loved one should be aware of both common and serious side effects from any medication being taken.

1. NSAIDS: For mild to moderate pain and inflammation, a Non-Steroidal Anti-Inflammatory Drug (NSAID) may be recommended. This includes over-the-counter medicines like aspirin, Advil and Motrin (forms of ibuprofen) and prescription drugs like Rufen (ibuprofen), Toradol (ketorolac), Naprosyn (naproxen), and Inderol (indomethacin) as well as many others.  Tylenol (acetaminophen) operates on pain like a non-steroidal anti-inflammatory, but does not reduce inflammation.
2. Narcotics:  For more severe pain, narcotics (opioids) are often prescribed.  These include drugs such as hydrocodone (Vicodin), morphine, hydromorphone (Dilaudid), and oxycodone (as in OxyContin).  Narcotics may be short acting (taken every 4-6 hours) or longer acting (12-24 hours).  They may be in the form of a patch put on the skin, such as Fentanyl in the Duragesic patch.  A non-opiate which works much like narcotics is tramadol (Ultram) which is also available combined with acetaminophen (Ultracet).
3. Antidepressants:  Some medications used to treat depression are useful to help with pain, and 2 types of antidepressants are most effective.  These are the tricyclic antidepressants, including Elavil (amitriptyline) and Pamelor (nortriptyline); and the dual-action antidepressants, including Effexor (venlaxafine) and Cymbalta (duloxetine).  Another class of commonly prescribed antidepressants, the SSRI’s (Selective Serotonin Reuptake Inhibitors) are generally less effective in treating pain, but they may work for some people.  Examples include Prozac, Zoloft, Paxil, Celexa, and Lexapro.  Antidepressants are helpful in treating the depression that patients with pain may develop, but they treat pain even without accompanying depression.
4. Anticonvulsants:  Medications used to treat seizure disorders may be used in treating pain, especially nerve pain.  They include Neurontin (gabapentin), Tegretol (carbamazepine), and Topamax (topirimate).
5. Others:  Other drugs used to treat pain include muscle relaxants like Soma (carisoprodol) and Flexeril (cyclobenzaprine).  Medication to help improve sleep is often used, as patients with pain often have difficulty sleeping.  These include Ambien and Lunesta.

In addition to oral medication, patients may use medicated creams on the skin.  Medication can also be delivered by procedural interventions.  For example, patients may receive injections, including trigger point injections, or spinal injections such as nerve root blocks and facet blocks.  Anesthetic and/or steroidal medication may be used in injections.

We encourage you to talk with the pain management physician to better understand your loved one’s condition and treatment.

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Next Friday… Family Issues #6:  Are You Worried about Narcotic Addiction?

You’re welcome to copy this handout from this site, with a notation that it’s from www.howtocopewithpain.org.  For a copy of the complete handout, you can contact my co-author Dr. David Kannerstein at dkanner@comcast.net.  David Kannerstein is a psychologist in private practice with Margolis Berman Byrne Health Psychology in Philadelphia and SRI Psychological Services in Jenkintown, PA.  He specializes in helping individuals and their families manage chronic pain.

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