Pain Medication Management

It may be necessary to take a particular pain medication in order to manage your condition. Often this will be given in conjunction with another type of therapy, such as chiropractic care or physical therapy.

It is of paramount importance that medications for pain management are prescribed safely and appropriately to meet your individual pain management needs.

While pain medication can be highly effective, when used improperly it can cause serious illness or death. In fact, in 2014, there were over 5000 deaths in the USA from opioid prescriptions alone. This is why we take care in the way we treat pain, with medication being prescribed only when completely necessary.

Opioid Medication

Opioid medication is a narcotic and can be used to treat a wide range of pain sources. It works by binding the opioid receptors in the brain and spinal cord. Pain signals are not received properly by the brain and therefore a patient can function in a more normal way.

Types of opioid medication are:

• Codeine
• Fentanyl
• Hydrocodone
• Methadone
• Morphine
• Oxycodone
• Hydromorphone

Opioids can react with other medications, so it is essential you give your practitioner a full medical history and disclose any medications you are taking.

Ordinarily you will start on a lower dose, in order to ascertain the effectiveness of the medication. It might be increased if you’re still experiencing a lot of pain.

Our practitioners are dedicated to providing medication in an ethical way. They ensure that the specific goals set prior to treatment are being effectively managed by the opioids and that you are benefiting from the medication.

Like with all drugs, opioids have a list of possible side effects. Some of the most common side effects are:

• Constipation
• Drowsiness
• Itching
• Nausea
• Irritability
• Dependency

To avoid dependency, your practitioner will make sure that you are taking an appropriate level of pain medication. When you no longer need the medication, you will be given a schedule to reduce safely. You should never stop taking opioids suddenly or without prior medical advice.

Typically, studies have shown that opioids can reduce pain by approximately 65% and that opioids are likely to work for chronic pain if positive results are reported within the first two week.

Gabapentin / Lyrica

Gabapentin is a anticonvulsant that is primarily prescribed for neuropathic pain. It was originally developed to treat epilepsy, and is still used for that purpose, but is now widely understood to be beneficial for conditions such as fibromyalgia. A recent study has shown that Gabapentin can reduce pain caused by fibromyalgia by 50%. There is also evidence to support Gabapentin in its use for reducing migraine pain.

Similarly, Lyrica (also known as Pregabalin) is also an anticonvulsant and is prescribed to treat conditions such as chronic back pain. It has a very low potential for addiction, making it a good option for long term use in chronic cases. Studies have shown that Lyrica can reduce back pain by up to 50% in over half of patients, as well as significantly helping to stabalize sleeping patterns.

Side effects in both Lyrica and Gabapanten typically include

• Drowsiness
• Constipation
• Headache
• Dry mouth
• Nausea

Anticonvulsant medication may not be suitable if you are pregnant or breastfeeding, or if you have diabetes or mental health conditions.

NSAIDS

NSAIDS (nonsteroidal anti-inflammatory drugs) are the most commonly used pain medication in the country. More than 30 million Americans used NSAIDS to help with headaches, migraines and general aches and pains. NSAIDS also reduce inflammation by blocking the effects of particular enzymes (specifically Cox-1 and Cox-2). This is what causes the reduction in swelling and pain, which is especially beneficial for arthritis patients. Other conditions such as headaches, joint pain or muscle pain can also be treated.

It is possible to purchase NSAIDS over the counter in the form of aspirin, ibuprofen and naproxin.

NSAIDs that are available on prescription include:

• Daypro
• Indocin
• Lodine
• Naprosyn
• Relafen
• Vimovo
• Voltaren

In general, the pain reduction felt by patients who take NSAIDS is thought to be approximately 50%. Studies also show a 60% improvement in mobility in osteoarthritis patients.

There can be some side effects to taking this form of pain medication. Most commonly these are:

• Gastric problems
• Nausea
• High blood pressure
• Ulcers
• Kidney problems

NSAIDs are not recommended in long term, chronic pain conditions due to the increased risk of stomach ulcers and other complications.

Triptans

Triptans are a class of medications that treat migraine pain. Typically, triptans are prescribed when over the counter medications are not working. They are taken when the patient feels the onset of a migraine emerging, and reduce the severity of the migraine pain by acting as selective serotonin receptor. This means that they work by producing serotonin to reduce inflammation, thereby stopping the migraine before it can fully develop.

The following drugs are triptans:

• Almotriptan
• Eletriptan
• Frovatriptan
• Naratriptan
• Rizatriptan
• Sumatriptan
• Zolmitriptan

Side effects from taking this medication can vary, and it should be noted that if it’s taken too early before the onset of a migraine (eg as a preventative) it reduces its overall effectiveness.

It is recommended that you try a triptan for three individual migraine attacks before opting to swap if it is not effective. Each triptan works slightly differently, so if one medication doesn’t work, another can be trialled.

It is not recommended that you take triptans if you have had a stroke or have hypertension, cardiovascular disease or if you are pregnant.

Common side effects can include:

• Nausea
• Dry mouth
• Dizziness
• Tingling sensations
• Flushing

Triptans are an effective medication for over 60% of migraine sufferers which can drastically improve the overall quality of life.

Topical Pain Medication

We offer a range of topical pain medication which is applied directly onto the skin. Topical pain creams can be used to relieve the pain from a variety of conditions, such as arthritis, back pain and whiplash.

Common ingredients found in this form of medication includes counterirritants (which gives certain gels and creams their cooling sensation), salicylates (the same ingredient as found in aspirin) and capsaicin, a property found in red hot chilli’s which also contributes to reduced pain.

The FDA has approved the use of NSAID as a topical treatment for osteoarthritis of the joints. This can be found in products such as Volteren and Solaraze and has shown to work just as well as the tablet form. This makes creams a good option for people who cannot tolerate oral NSAIDs and want an effective alternative.

Some pain relief topical creams are not suitable for people with blood thinning disorders or kidney problems.