Learn the 5 important rules for becoming pain free.
Today’s article focuses on something we all try to avoid: pain. Pain sends many people to the doctor, but doctors often do a poor job of managing their patients’ pain. It’s a very difficult issue, and this article will only scratch the surface--discussing the proper use of pain medications.
What’s the Best Way to Treat Pain?
One of the biggest problems with pain is that it can’t be measured. I don’t have a “painometer” that tells me how much pain my patients have. I wish I did. To any entrepreneurial reader out there: you can make millions if you come up with a “painometer.” I won’t be greedy; I’ll only ask for a 25% cut. No, I have only one means of determining how much pain my patient is experiencing: by asking the question, “how much does it hurt?”
Why Is Treating Pain Difficult?
Being their own “painometer” creates a lot of problems for my patients, because:
They don’t want to exaggerate their pain and “act like a baby.”
They don’t want to ignore real pain.
They often don’t know how to express how bad the pain actually is.
This is a constant struggle for both me and my patients. I generally take their word for it, realizing that these difficulties exist.
4 Rules for Treating Pain
So how is pain treated? Let me give four rules for treating pain:
Rule 1: Treat the Cause
Pain exists for a reason: to tell us that something is wrong and needs attention. So the first step in dealing with pain is to fix whatever is causing the pain itself. Treating a heart attack or appendicitis with pain medications is a bad idea if you don’t first treat the heart or remove the appendix. Though most doctors wouldn’t do that, many will treat headaches or back pain without asking the simple question: why is this pain happening? For any pain you have, make sure you understand what is causing it.
Rule 2: Treat the Pain
This may seem obvious, but many doctors get so fixated figuring out a cause of the pain, they forget to treat the pain as well. Both sides of the coin must be addressed when at all possible. The problem is that many pain medications carry the risk of addiction, which both patient and doctor want to avoid. The good news is that patients who have acute pain, which is pain that has only happened for a short time, such as a broken bone or a kidney stone, are highly unlikely to become addicted to pain medication. Treating the pain is not limited to pain medications; there is a whole subspecialty of physicians who specialize in pain management and who use all sorts of means to minimize or eliminate pain.
Rule 3: Get Rid of the Pain
So what sort of pain medication should be used? One that is strong enough to get rid of the pain, if at all possible. This may also seem obvious, but one of the main mistakes people make in treating pain is using medication that isn’t strong enough. Studies show that inadequate treatment of pain often results in the use of more medication than if strong medications were used in the first place.
Which brings me to the final rule:
Rule 4: Don’t Use Quick-Acting Narcotics for Chronic Pain
People with chronic pain, or people who are always dealing with pain, often end up using a large amount of what are known as short-acting opiad pain medications, or narcotics. Narcotics are very good for pain relief, but carry a price. First, they are potentially addictive, as they cause what doctors call a “euphoric effect” and what regular humans call “giving you a buzz.” Second, they are highly abused, recently becoming one of the top drugs abused by teenagers. Using these meds to treat chronic pain is not only a sure way to cause addiction, it is also not as effective as using other medications.
Instead, chronic pain sufferers should take long-acting opioids, such as oxycontin, MS contin, and the Fentanyl patch, which are excellent for the management of long-term, or chronic, pain. They don’t have as much of a euphoric effect as the short-acting ones, and so they aren’t nearly as addictive given regularly.
A long-acting narcotic (I prefer the fentanyl patch) should be used at a dose to get rid of the pain and keep it away. Short-acting medications for breakthrough pain are fine, but a frequent need for them indicates the need for a higher dose of long-acting medication. This pain-control approach results in less addiction, better pain control, and actually less medication use overall.
Rule 5: It’s Not Nice to Share
Your mother may have taught you it is nice to share, and many people let others use their pain medications, not knowing that they are breaking the law. Why? Controlled substances such as Percocet may be dispensed by people with a license only. Giving your Percocet to your friend with a toothache breaks that rule, and actually legally constitutes drug trafficking! I am not saying it’s the moral equivalent to drug trafficking, but legally that’s what it is. That means that you must keep very close watch over any narcotic prescriptions you have. There is a huge number of teenagers taking their parents’ pain medications and sharing them with friends or selling them, and a huge number of teens ending up with a felony on their record for doing it. Don’t be careless with narcotics.
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Let me once again remind you that this podcast is for informational purposes only. My goal is to add to your medical knowledge and translate some of the weird medical stuff you hear, so when you do go to your doctor, your visits will be more fruitful. I don’t intend to replace your doctor; he or she is the one you should always consult about your own medical condition.
Catch you next time! Stay Healthy!
List of Pain Medications available:
Acetaminophen, or Tylenol
- Benefit: useful to treat mild pain and is probably the safest to use long-term.
- Risk: I’ve covered the pros and cons in a previous article/podcast, as well as warned about the serious
Non-steroidal anti-inflammatory medications, or NSAID’s
- Examples: Ibuprofen (Motrin, Advil), Naproxen (Naprosyn, Aleve), Diclofenac (Voltaren), Indomethacin (Indocin), Meloxicam (Mobic), and Celocoxib (Celebrex)
- Benefits: These medications are stronger than acetaminophen. They have the added benefit of helping inflammation, which occurs with musculoskeletal injuries.
- Risks: These medications are generally safe in the short-term, but long-term use can cause bleeding ulcers and kidney damage. For long-term they should be used with a stomach-protecting medication, although the medication Celebrex is much safer to use than the others as a long-term treatment (although more expensive).
Weak opioid pain medications
- Examples: Ultram (tramadol) and Darvon (propoxyphen)
- Benefits: These medications have a very low addiction potential.
- Risk: Many contain acetaminophen, and so can cause toxicity of that drug if care is not taken to account for that. Side effects are not great, but they can cause fatigue, constipation, and some alteration of mental status.
Strong short-acting opioids
- Examples: Hydrocodone (Vicodin, Lorcet, Lortab), Oxycodone (Percocet, Roxicet), Morphine, Dilaudid, Meperidine (Demerol), Codeine (Tylenol #3)
- Benefits: Very good at treating acute pain.
- Risks: Like weaker opioids, these medications are often combined with acetaminophen, so care should be taken. These medications are much more addictive, especially if used longer-term. They also have more side effects, with significant sedation, fatigue, and constipation being on the top of the list.
- Examples: Oxycontin (oxycodone), MS Contin (morphine), Duragesic (fentanyl) patch
- Benefits: Much better for long-term pain control. Much less addictive than shorter-acting medication.
- Risk: Side effects (aside from constipation) are generally less. There is significant risk of withdrawal if stopped suddenly (true for all opioids), so this should be done with great caution. These drugs have a history of being abused, but that was only because the active ingredient was distilled out of them and used for injection. This is no longer easily done.
Pain Relief sign image from Shutterstock