Matching the pill to the pain, part I

Welcome to matching the pill to the pain, part I, a
brief review of medications used in the treatment of
chronic pain. I’m Dr. Kent, your narrator from Chronic pain and suffering is what we’re talking
about. Chronic pain and suffering requires a holistic
approach and there are many aspects of care.
Medications are only one aspect.
There are lots of opportunities to improve pain,
suffering and function. If you’re interested in a
more comprehensive review of medications, you might
consider joining one of our webinars like matching
the program to the pain. This blog is brief and is not intended to replace the
ideas of your healthcare team. It is offered as
information to enhance your interaction with your
pain medicine providers. Discuss what you learn with
your team of providers, your therapist, your
pharmacist, your nurse, your chiropractor, your
physicians. Informed communication with experienced
providers will help you explore all of the pain
management opportunities for improved quality of
life, better days.
If you get the work done, you’ll get relief.
So we’re here to review the best pill for the pain.
That means medicines. Medicines, what are they?
Well, they are synthetic chemicals shown in clinical
trials to work better than placebo or other medicines
used for the same problem or disease. They work
differently in different people. It takes trials of
different medicines to find out the best regiment for
you. An experienced clinician is needed. They
certainly help quite a bit.
Medicine is not a science. It is a scientifically
based clinical art requiring an experienced team of
providers that will work together, communicate and
reach the best outcomes for you. It requires
communication from you. And I believe, keeping that
in mind, that a good pain diary while you are
changing your medicines will help communicate the
change in therapies and how they are helping or
hurting you. I advocate online diaries. If you are
not very internet savvy, you might try something
simple like or if you want
more data collection and direct access to your
doctor, you might try relief in sight.
First, let’s go over some of the basics of just using
pain medicines. First, what are rescue medicines and
maintentance medicines? A maintenance medication is a
daily medicine used to suppress pain, suppress the
disease process, preventing severe pain and improving
disability. It might suppress pain, or it might
suppress the disease process, therefore, suppressing
pain. Some examples: Gabapentin, Lyrica, they
suppress nerve pain like in diseases like diabetes or
You have immunomodulators like Enbrell, that treat
Rheumatoid arthritis.
You also have chronic long acting narcotics. Now,
these drugs may work all day, or a patch may work
several days and they just suppress the pain that is
experienced. Those are all examples of maintenance
Rescue medicines. Rescue medicines are short acting
drugs that stop break through pain that your
maintenance regiment just isn’t handling or while
you’re changing your medication regiment.
It’s pain that you need to be rescued from to help
you keep functioning, debilitating pain.
Non-steroidal anti-inflamatory drugs or short-acting
narcotics are commonly used.
Now, some general rules.
Close monitoring is very important when you are
changing medicines. You need to know what the side-
effects are and what’s helping and what’s hurting.
Pain diaries help a lot. Go slow. Pay attention. Pay
attention to those side effects, pay attention to if
the therapy is working. Go one medicine at a time;
That includes taking a pill away or adding a pill. If
you don’t what’s working, if you’ve got multiple
medicines going on at the same time being changed.
Avoid too many medicines. More medicines cause more
side-effects. Subtract meds that aren’t working. Ask
your doctor when you subtract a medicine, what can
you replace it with? Get your pharmacist to help you.
Remember, it’s not just suppressing the pain, but
it’s also paying attention to the side effects. It’s
the best regiment for your function. The least side-
effects with the best control you can get.
All right, we’re going to go over adjunctive
medicines real quick. They increase the treatment’s
efficacy or enhance it. It may be something like
anti-depressants that are commonly used. We use this
term a lot, so that’s why I want to go over it. Also
lets go over symptomatic relief medicines.
Symptomatic relief medicines are medicines that help
the symptoms and triggers that make your pain cycle
worse. For example: insomnia. Insomnia can really
make the pain cycle bad. By treating the symptom,
this key trigger, you can reduce pain and suffering a
great deal. You can improve mood, you can improve a
lot of things. Melatonin or tryptophan are some other
ones that are used, or maybe a tricyclic anti-
depressant that’ll help raise your pain threshold and
help with your sleep and also help your type of pain.
I’ve gone over a lot of things with you. In the next
section, we’re going to go over broad categories of
medicines. Medications are approved by the FDA for
specific diseases, but we’re going to go over broad
categories: symptomatic relief medicines, opiates,
non-steroidal anti-inflammatory drugs and
acetaminophen, rheumatological drugs, anti-
depressants, anti-seisure drugs, topicals and
miscellaneous medications.
That’s it for part one. I hope it helped. I hope
today is a better day for you. This is Dr. Kent
signing off from Hope to see you
at part two.



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