Posted in Uncategorized

ARE YOU Ready to CHANGE?

Photo by Glen Carrie on Unsplash

Day 40 of the world’s New Normal. I’m not even sure if that is the correct number. It may be lower. It may be higher. Regardless of the length of time since COVID-19 we can agree our lives have changed significantly since COVID-19.

Some of us have adapted well to this change. Some of us have died. And some of us believe this is hoax. I shake my head in disbelief.

In my job (I’m fortunate to work from home) I talk to people daily – regular folks like you and me. Some tell me bluntly their loved one died last week due to COVID-19. Others tell me quietly that their loved on passed this morning. Some walked into the ER and never walked out. Others contracted the disease from other people socially. And still others contracted the disease because they didn’t believe it was ‘real,’ and they didn’t wear a mask.

Healthcare professionals including doctors, nurses, physical therapists, and more have seen the horror up close and personal. They’ve worked non-stop helping people with this disease – subjecting themselves to the very real possiblity of contracting the disease themselves. But they put their health needs aside, to help others.And still people believe this is a hoax.

Photo by Mick Haupt on Unsplash

But, whether you believe it’s a hoax or not, the real truth is that our lives have changed due to COVID-19. Remember when we shopped the grocery store with everything at our fingertips? And when one item was not available? We complained to the manager. Now? We are happy to find any brand of our favorite foods and humbly ask when the next shipment of toilet paper is expected to arrive.

Lunch dates with friends, night dates with partners, play dates with neightborhood children are obsolete. Now? We come together as a family and cook at home, discover new recipes, and pull out old board/card games to teach our children.

Some are very creative in helping others. When they heard elderly neighbors were unable to go to the store, one couple began a neighborhood pantry. Food/paper products are placed on the wooden shelving unit made by the husband and using the same concept similar to neighborhood Book Lenders – Take what you need and give what you can. Landlords are waiving the monthly rent for their tenants in an effort to lighten the bills of those who are unemployed. Many people are still sewing masks for friends, family, healthcare professionals, and patients.

There is an abundance of ‘goodness’ in the world today…

Need proof?

Just Google “positive news during the pandemic.” There are pages and pages of articles, posts, and stories reflecting postive acts of kindness and GOOD NEWS! Take a moment and check out those sites. Sign up for daily positivity. Share the good news with others. And know in your heart, change is a comin … is here, and we are ready for it.

Remember: Wear your masks, Wash your hands, Cover your mouth when you cough, Practice Social Distancing!

Bless you and yours,

Carolyn

Posted in Uncategorized

CoronaVirus (COVID-19)

Photo courtesy cdc.gov

Thank you for stopping in! Grab your coffee and relax a bit. Today’s post serves as a public service announcement for everyone concerning the Coronavirus (COVID-19). I know. I know. By now you are sick and tired of reading about the Coronavirus or (COVID-19). This will be my first and last post (I hope) on the topic. It’s a short read, I promise!

Per my primary care physician’s suggestion, I signed up for updates from the Center for Disease Control on their website – CDC.gov. (Click underlined words on this post to go directly to the website.) My doctor checks this site along with government officials nationwide and locally. The CDC’s information updates daily with tips, guidelines, and information about COVID-19. Also, information is available on the worldwide, national, state and local venues. Signing up is easy or bookmark the page on your favorite device.

In addition to the website, the CDC’s toll-free number is 800-CDC-INFO (800-232-4636), TTY: 888-232-6348 and is open 24/7 for COVID-19 questions. Be sure to check the website FIRST for answers to your questions about the virus before calling the helpline. This courtesy allows callers who may be experiencing symptoms get information without delay.

The about CoronaVirus page of the cdc.gov website provides information on the virus, how it spreads, symptoms, and more. The Fact Sheets at the bottom of the page are informative, simply written, and available in English, Simplified Chinese, and Spanish.

For information about protecting your family and yourself from the COVID-19 click on this link. Detailed information can be found under the following tabs:

PREPARE YOUR FAMILY

PROTECT YOUR HEALTH

WHAT TO DO IF YOU ARE SICK

However, my PCP told me there will be cases of the virus in YOUR area. The key is DO NOT PANIC!

Remember these three tips:

1- WASH WASH WASH your hands throughout the day and especially when shopping at stores, visiting the doctor or hospital and restaurants.(Many fast-food restaurants offer drive-thru service only as a precaution and protective measure for their customers and employees.) Follow the 20-second rule for washing your hands and share it with every family member. (Video and detailed information can be found at cdc.gov.)

2- PREPARE your home and family for the virus.

3- CHECK OUT the cdc.gov for daily updates. This is a great source of information! Sign up for daily updates with your email.

As most of you know, empty shelves are growing in the grocery stores and pharmacies. The homes of hand sanitizer, disinfectant sprays, toilet paper, bottled water, and medicines have vacated. Preparing for enough supplies for at least one or two months makes sense. However, pictures of stockpiled supplies for 3-6 months is just plain selfish.

Would you consider providing this one simple act of kindness? When purchasing items for your family grab one or two extras for your elderly neighbor, the person who is homebound, or a family without the means to purchase these items. This simple action will go a long way during this virus crisis and the future.

Since it looks like staying home is a definite I should be able to crank out more posts about chronic pain and all that entails! Again, be safe, take care of each other, and thanks for stopping by!

Writing my next post!

All my best,

Carolyn

03/16/2020

Posted in Uncategorized

PAIN ISSUES IN THE 2020s

Happy New Year!!! It’s a brand-new decade (the 20’s), a brand-new year, a brand-new opportunity to commit to change (your lifestyle, your job, your body)… again.

I hope you celebrated with a BANG! or enjoyed a nice quiet celebration with your honey! Either way, I hope you had fun!

So……What are YOU DOING different this year?

Better question…WHAT AM I DOING different this year?

So far, nothing. I made resolutions still waiting to be carried out, kept pushing the start day later in the month and changed the resolutions repeatedly.

For this first post in 2020, I thought about tradition. Every country, race, nationality, family, and even individual celebrate at least one tradition during the Holiday season. One of my favorite traditions is BAKING cookies over the holidays. Lots of cookies and sweets! In past years special cookie packages for the postman, UPS driver, neighbors, friends, and favorite retail workers were delivered with smiles and excitement. That warm, fuzzy feeling fills your heart when sharing your favorite recipes with others!

However, Rick and I haven’t met many people since moving to Savannah and our gifts of sweetness were few this year – one to our postal carrier and one to our family. But, it’s ‘tradition’ and I baked sugary goodies regardless of my shortage of friends, shortage of time or my ever-present chronic pain.

Before we get into sugar vs chronic pain here is a mini-history paragraph about the tradition of baking cookies for the Holidays.

Christmas cookie recipes trace back to Medieval Europe. The introduction and hefty price of special ingredients: dried fruits, cinnamon, nutmeg, almonds, and ginger were added to favorite recipes by all families, regardless of social status. During Christmas celebrations the addition of sugary treats matched the excitement of the Holiday. By the 16th century cookies were baked into the different sizes and shapes of Christmas. The most famous of Christmas cookies, gingerbread, came from Germany. Although it has changed into a cake-like texture, gingerbread dates as far back as the crusades when soldiers brought spices home to Europe.

Now that we have an idea of its origin, the tradition of baking cookies seems to be more important than ever! However, not to burst the holiday bubble, sugary sweets bring their own problems to those of us suffering from chronic pain.

  • SUGAR ESCALATES PAIN AND INFLAMMATION

After baking comes eating and I did my share of eating! I noticed that my RA and chronic back pain increased lasted longer and traveled to other joints including my hands, elbows, knees, and ankles. The pic below shows how I feel inside when those flares occur.

Image by Camila Quintero Franco
  • MOOD CHANGES

Instead of being jolly, happy and almost giddy while baking, I became irritated with the amount of time it took to bake the simplest of recipes. This led to depression. Once again my ‘new normal’ interfered with those activities I loved to do before chronic pain became my middle name.

  • LEFTOVERS CAN WARP YOUR GOOD SENSE

I planned to start the Keto Diet on January 1st but instead pushed it out to the end of January. Why? Because there were still tins of cookies and candy in the house…and freaking sugar is expensive!

  • WAKE UP!

Now the goodies are gone, and I’m left with an indescribable craving for sugar and I’ve finally awakened to the fact that those ‘goodies’ increased my pain along with my weight. So, today, January 29, 2020, I’m beginning my low-carb, a whole lot less sugar, high-protein, high-fat diet!

  • UNNECESSARY TRADITIONS??

Junk food traditions do not equal a happy, family-oriented holiday. Food is an important part of the holidays, but it isn’t the central point of the festivities except for the weekend before Christmas, Christmas Eve and Christmas Day – okay it IS a central point of focus. But so is enjoying time and sharing traditions with family and friends. Food definitely has a part and I need to focus on the part food plays.

For next Christmas, my baking will be limited to decorated Sugar Cookies – exactly what Rick urged me to do this past Christmas. Our new tradition of decorating sugar cookies with our grandkids fills our hearts with joy, laughter, and love. Watching their imaginations come through with their designs and color combination were priceless! And they did most of the work themselves! THIS is our new tradition—combining holiday baking with special family time.

Realizing something hurts you more than helps you is a difficult pill to swallow, especially when you think that something is harmless. Experiment and see if you feel a difference in your pain levels when you add more sugar into your diet than normal. And share your findings! We are in this pain journey together!

Thank you for taking the time to read and I’d love to hear your family traditions! Until next time,

Take care of you!

Carolyn

Posted in Chronic lower back pain, chronic pain, Fibromyalgia

Part 5A – Injections Injections, Surgery Implants, and More…Oh my!

Good Monday!  And thank you for stopping by to read the latest post in the Relief Options for Chronic Pain series! This week’s information is familiar to me because I have had most of the injections discussed here, along with a Spinal Cord Stimulator implant. So, as I write I’ll be inputting my experience with each option of pain relief in italics.

Let’s start with the injections recommended by doctors as being an option to opioid use. These are the injections most prescribed for chronic lower back pain as well as other chronic pain:

Epidural Steroid Injections                                  

(Selective) Nerve Root Blocks (SNRB)

Nerve Block

Facet Joint Block 

Facet Rhizotomy                                           

RFA (Radiofrequency Ablation)

Sacroiliac Joint Block

Sacroiliac Joint Fusion (SI Fusion)

Trigger Point Injection                                      

Extensions of these injections are listed, but these injections appear to be the ‘primary’ injections selected.

Epidural Steroid Injections (ESI):

These injections are prescribed as relief for chronic lower back pain and are injected into the lumbar section of the spine. However, Epidural Steroid Injections injected into the cervical (neck) and thoracic (mid-spine) areas of the spine are common. The consensus from most pain physicians is ESIs offer temporary relief spanning from one week to one year. And those patients reporting long-term relief are less credible.

(I was given this injection while living in Mt. Pleasant, SC thirteen years ago. Due to the extreme lower back chronic pain I agreed to the injection with the hope it would alleviate the pain, and it did – for one year. Coupled with the injection I saw a physical therapist for six months but eventually, the pain returned.)

The use of fluoroscopy or X-ray assists the physician with placing the medication in the pain and inflamed area. This helps the physician to inject the medicine in the area the patient feels the most pain.  (A word of warning – be sure to seek a professional with considerable experience directing injections with fluoroscopy for careful placement.)  This act makes an ESI a more desirable injection compared to oral pain medications which have a less-focused contact. An ESI helps control inflammation (it has been determined chemical inflammation produces pain) and flushes out chemicals and inflammatory proteins from the area. ESIs are performed up to three times per year and usually given in sets of three. More detailed information regarding ESIs can be found here.

Selective Nerve Root Block (SNRB):

Used to diagnose the source of Nerve Root Pain and provide relief of low back or leg pain, a Selective Nerve Root Block (SNRB) is a good choice for the patient. A compressed or inflamed nerve root will produce back or leg pain. Because an MRI doesn’t show which nerve causes the pain, an SNRB assists in isolating the pain source. This may be used a treatment for pain management of a far lateral disc herniation (when a disc ruptures outside the spinal canal)

The nerve is approached where it exits the foramen (the hole between the vertebral bodies) with an injection of steroid (relieves inflammation) and lidocaine (numbing agent.) Fluoroscopy, which is a live x-ray, assists the physician in finding the specific area of pain. If the patient reports no pain, then it is surmised the injected nerve root was the source of pain.

Success depends upon whether the injection was administered to alleviate pain from a primary diagnosis or if the injection’s purpose is to confirm a diagnosis. SNRBs are limited to three times a year. (Again, because of the difficulty of administering SNRBs, seek an experienced professional.)

Facet Joint Block (FJB):

Paired joints, or facet joints, have side by side surfaces of cartilage (the tissue that cushions between the bones) and a surrounding capsule: an illustration from Google search

Degeneration of cartilage with aging and injuries of twisting (dancing?) may cause damage to either one or both facet joints. A Facet Joint Block can alleviate the pain and/or confirm the specific source of back pain for patients. FJBs are like SNRBs and should be administered by an experienced physician.

Nerve Block:

Used for pain treatment and management, nerve blocks are injections of medication into specific areas of the body. Various problems need diverse types of nerve blocks including:

  • Therapeutic nerve blocks used to treat painful conditions.
  • Diagnostic nerve blocks used to determine pain sources.
  • Prognostic nerve blocks predict the outcomes of given treatments.
  • Pain from other procedures may be avoided by preemptive nerve blocks.
  • Nerve blocks can be used to avoid surgery.

Note, however, if your pain isn’t related to pain in a single or group of nerves, nerve blocks may not work for you. Your physician will advise which nerve block is beneficial for relieving your pain.

Radiofrequency Neurotomy for Facet and Sacroiliac Joint Pain

Radiofrequency Neurotomy (RFN) treats facet or sacroiliac joint pain which may result from an injury or deteriorating problems like arthritis. The goal of interrupting pain signals to the brain is using a heat lesion on specific nerves to alleviate pain. RFA and RFN, used reciprocally, refer to a procedure that ruins the performance of the nerve using radiofrequency energy.

There are two primary types of radiofrequency ablation (RFA) 1- A medial branch neurotomy (ablation) affects the nerves carrying pain from the facet joints and 2- A lateral branch neurotomy (ablation) affects nerves that carry pain from the sacroiliac joints.[1]

Prior to the RFA a lateral branch or medial branch nerve block is usually performed to prove the patient’s pain is transmitted by those nerves. Additional injections including sacroiliac joint injection or facet joint injection along with other treatments may be requested prior to the RFA.

Facet Rhizotomy and Sacroiliac Joint Block Injections:

A Facet Rhizotomy injection is recommended if the patient has experienced satisfactory results from three Facet Block Injections. By disabling the sensory nerve that goes to the facet joint, long lasting pain relief is provided by the Facet Rhizotomy injection.

Sacroiliac Joint Block Injections (SI Joint) are used for diagnosing and treating pain associated with sacroiliac joint dysfunction. The SI Joint lies next to the spine connecting the sacrum (bottom of the spine) with the pelvis (hip)

Trigger Point Injections

Trigger Point Injections (TPIs) treat muscles that contain trigger points or knots of muscle formed because the muscles do not relax and are painful. In some cases, the knots can be felt under the skin. The nerves around the trigger points may become irritated and referred pain may develop. The pain felt in another part of the body is commonly known as ‘referred pain.’

Trigger point becomes inactive and the pain alleviates when the trigger point injection is provided. In most cases, a brief course of treatment results in sustained relief.

There are instances when physicians will prescribe only one injection for your pain. If your physician explains this is the course he follows, simply ask why? Why not three? In cases studied throughout the country, it is stated that the ‘single-shot blocks’ do not give the patient’s pain the full recovery that a set of three shots gives. Many studies conclude that ‘single-shot blocks’ are of short duration and only add the patient’s increased need for narcotics.

*************************

In any case, injections, like many other forms of pain relief, are temporary. As you begin a course of treatment to relieve CHRONIC PAIN your pain will not be gone for good. Chronic pain does not go away. The best we can hope for is the ability to function in our daily lives with as little pain as possible. The ongoing battle against the DEA and CDC have triggered more problems to the action of lowering dosages or stopping opioids altogether – the name of the nonexistent Opioid Epidemic. This morning I read another article about a Montana woman, Jennifer Adams, young, beautiful, with her whole life in front of her. She was unable to live by the ‘rules’ of physicians telling her to reduce her opioids to help her deal with her pain. Seriously? When will the public along with the DEA, CDC, and our government begin listening to chronic pain patients?

I don’t know, but I do know this. We have to fight…now, or we are going to lose and there will definitely be an epidemic of suicides among the chronically ill patients who know of no other way to relieve their pain.

 

Next week, we explore the surgeries of implants and other forms of relief! Until then, have a wonderful week!

[1] www.spine-health.com/treatment/injections/radiofrequency-neurotomy-facet-and-sacroiliac-joint-pain article

Posted in aches, Arthritis, Chronic lower back pain, chronic pain, Coping with Chronic Pain, Fatigue, Fibromyalgia, Health Care, Knee pain, Muscle and joint stiffness, Rheumatoid Arthritis, Surgeries, U.S. Pain Foundation

DEA’s Latest Attempt to Punish Chronic Pain Patients

Now the DEA’s newest proposal targets drug manufacturers by giving them quotas as to the number of controlled substances they will be allowed to produce. Here we go again … another attempt to bully and force decreases in the manufacturing of pain medications – which hurt millions of Americans suffering with some form of chronic pain. But there is little empathy toward chronic pain patients suffering from back issues, hidden illnesses, and even surgeries.

And the number of patients who have been refused pain prescriptions for diagnoses they’ve lived with for decades continues to increase as will the suicides by these patients who can find no other form of relief. Following this is the comment I submitted to the DEA and I urge you to send your story to them ASAP. In the article, “DEA Wants to Target Drug Manufacturers in Opioid Supply, by Ed Coghlan and found in the National Pain Report dated April 21, 2018, click on the article title which will take you to the proposal docket  with instructions on submitting your comments. This is opened to the public until May 4th so please send your comments in today.  Thank you.

To Whom It May Concern:

I am pleading with you to cease, overthrow, and forget about the proposal to decrease the manufacturing of controlled substances, namely, opioids.

Scoliosis, Spinal Stenosis, herniated discs, and six fusion surgeries on my back due to Scoliosis have left my spine with 2 inches of bone-free fusions. It was decided not to fuse that area because of assumed increased complications. My back pain increased resulting in quitting my job and stop instructing, choreographing, and dancing line dances, restricted my love of gardening, house cleaning, and shopping due to the impact of pressure forced on those 2 inches of my spine.

Since July 2012 I have been on disability, spent the year of 2013 contemplating suicide and wallowing in a sea of depression as new health issues arose. Less than six months ago I was diagnosed with Restrictive Lung Disease and am now on oxygen 24/7 along with the myriad of medications to address my severe chronic back pain, restless leg syndrome, fibromyalgia, depression, and lack of sleep.

Taking Percocet at the dosage of 7.5/325 mg four times a day allows me to walk on the treadmill at 2.0 mph for 30 minutes (3-4 times weekly), dress myself, make the bed, and wash dishes. I go shopping with my husband at least once a week to get out of the house and unfortunately, we come right home after the first stop because the back pain will not allow me to spend an afternoon of shopping. I walk with a cane and sometimes ride in a wheelchair. And I’ve tried to dance a little bit for exercise but the oxygen tubing gets in my way.

If I didn’t take the Percocet four times a day my day would look like this: Wake up, go to the bathroom, sit back on the recliner with heating pad and moan in pain – and this is where I would spend my day. Activity increases my pain, therefore, physical activity is gone. Going out to shop is out of the question. Household chores including picking up items around the house, making the bed, or washing dishes is out of the question because the back pain travels down both legs and stirs up the RLS … forcing me to get back on the recliner. I’d get fat. I’d be depressed. And I’d be thinking of other options that would take away the misery of my painful life.

It was revealed that the CDC inflated the numbers of opioid suicides in its report per this article: (https://www.painnewsnetwork.org/stories/2018/3/21/cdc-admits-rx-opioid-deaths-significantly-inflated) And there have already been a few suicides by pain patients who were refused pain medication, leaving the patients with suicide as their only option to relieve their pain.

Controlling substance quotas isn’t going to remove suicides amount the citizens of this country – it is going to escalate suicides. For some reason people who do not live with chronic pain, believe it can be remedied with physical therapy, acupuncture, massage therapy – all great options, but they do not last. And they are expensive.

I cannot live a semi-normal life without Percocet. I’ve tried cutting down and find myself eventually taking the required number because the pain escalates quickly. How am I suppose to live? How am I suppose to enjoy visiting my son and his family including two grandchildren? How do I face a day without pain relief?

PLEASE, I BEG you to remove this proposed rule and reconsider your actions. This rule will escalate suicides, remove quality of life, and force pain patients to spend their days and nights in bed. Is this the society you are striving for?

Respectfully,

Carolyn Robinson

Posted in aches, Arthritis, Chronic lower back pain, chronic pain, Fibromyalgia, Inflammation, Knee pain, Muscle and joint stiffness, Rheumatoid Arthritis

PART 5 – INJECTIONS, SURGERY IMPLANTS, AND MORE…OH MY!

Part 5A – Injections

 Good afternoon and thank you for stopping in to review Part 5A – Injections of the Relief Options for Chronic Pain series! This week’s information is familiar to me because I have had most of the injections discussed here, along with a Spinal Cord Stimulator implant. As I write I’ll be inputting my experience in italics.

Let’s start with the injections recommended by doctors as being an option other than opioid use. These are the injections most prescribed for chronic lower back pain as well as other chronic pain:

Epidural Steroid Injections                                 

Selective Nerve Root Blocks (SNRB)

Facet Joint Block                                              

RFA (Radiofrequency Ablation)               

Facet Rhizotomy                                              

Sacroiliac Joint Block

Trigger Point Injection                           

Nerve Block

There are other branches of injections that are extensions of these, but the above injections appear to be the ‘primary’ injections selected.

Epidural Steroid Injections (ESI):

These injections are prescribed as relief for chronic lower back pain and are injected in the lumbar section of the spine. However, Epidural Steroid Injections injected in the cervical (neck) and thoracic (mid spine) areas of the spine are very common. The consensus from most pain physicians is ESIs offer temporary relief spanning from one week to one year. And those patients reporting long-term relief are less credible.

(I was given this injection while living in Mt. Pleasant, SC thirteen years ago. Due to extreme lower back chronic pain I agreed to the injection with the hope it would alleviate the pain, and it did – for one year. Coupled with the injection I saw a physical therapist for six months but eventually the pain returned.) 

The use of fluoroscopy or X-ray assists the physician with placing the medication in pain and inflammation area. Earlier studies show that doctors did not use this method of determining the placement of the injection. A request for more studies has been issued even though most studies report 50% or more patients report pain relief with ESI. A word of warning – be sure to seek a professional with considerable experience directing injections with fluoroscopy for careful placement.

The attraction of ESIs is the medication is delivered directly into the pain source whereas oral pain medications have a less-focused contact with undesirable side effects. An ESI helps control inflammation (it has been determined chemical inflammation produces pain) and flushes out chemicals and inflammatory proteins from the area. ESIs are performed up to three times per year and usually given in sets of three. More detailed information regarding ESIs can be found here.

Selective Nerve Root Block (SNRB):

Used to diagnose the source of Nerve Root Pain and provide relief of low back or leg pain, a Selective Nerve Root Block (SNRB) is provided. A compressed or inflamed nerve root will produce back or leg pain. Because a MRI doesn’t show which nerve causes the pain, a SNRB assists in isolating the pain source. This may be used a treatment for pain management of a far lateral disc herniation (when a disc ruptures outside the spinal canal)

The nerve is approached where it exits the foramen (the hole between the vertebral bodies) with an injection of steroid (relieves inflammation) and lidocaine (numbing agent.) Fluoroscopy, which is a live x-ray, assists the professional in finding the specific area of pain. If the patient reports no pain, then it is surmised the injected nerve root was the source of pain.

Success depends upon whether the injection was administered to alleviate pain from a primary diagnosis or if the injections’ purpose is to confirm a diagnosis. SNRBs are limited to three times a year. And because of the difficulty of administering SNRBs, be sure to seek an experienced professional.

Facet Joint Block (FJB):

Paired joints, or facet joints, have side by side surfaces of cartilage (the tissue that cushions between the bones) and a surrounding capsule:

 

{illustration from Google search (innova-pain.com)}

 

Degeneration of cartilage with aging and injuries of twisting (dancing?) may cause damage to either one or both facet joints. A Facet Joint Block can alleviate the pain and/or confirm the specific source of back pain for patients. FJBs are like SNRBs and should be administered by an experience physician.

Nerve Block:

Used for pain treatment and management, nerve blocks are injections of medication into specific areas of the body. Various problems need diverse types of nerve blocks including:

  • Therapeutic nerve blocks used to treat painful conditions.
  • Diagnostic nerve blocks used to determine pain sources.
  • Prognostic nerve blocks predict the outcomes of given treatments.
  • Preemptive nerve blocks avoid successive pain from procedures causing problems.
  • Nerve blocks can be used to avoid surgery.

Note, however, if your pain isn’t related to pain in a single or group of nerves, nerve blocks may not work for you. Your physician will advise which nerve block is beneficial to you and your pain.

Radiofrequency Neurotomy for Facet and Sacroiliac Joint Pain

An injection procedure that is used to treat facet or sacroiliac joint pain caused by arthritis, other deteriorating changes, or from an injury is called a Radiofrequency Neurotomy. The goal of interrupting pain signals to the brain uses a heat lesion on certain nerves to eliminate pain. Radiofrequency ablation and radiofrequency neurotomy, used reciprocally, refer to a procedure that ruins the performance of the nerve using radiofrequency energy.

There are two primary types of radiofrequency ablation (RFA) 1- A medial branch neurotomy (ablation) affects the nerves carrying pain from the facet joints and 2- A lateral branch neurotomy (ablation) affects nerves that carry pain from the sacroiliac joints.[1]

Prior to the RFA a lateral branch or medial branch nerve block is usually performed to prove the patient’s pain is transmitted by those nerves. Additional injections including sacroiliac joint injection or facet joint injection along with other treatments may be requested prior to the RFA.

(I had the RFA as a last-ditch effort to find another form of pain relief prior to the implant of the Spinal Cord Stimulator. With hopes that the RFA would last at least one year (or minimal one month) I went through three different nerve blocks until the radiofrequency ablation was finally performed. Painful, stressful, and just downright annoying … I had the RFA which lasted three months to the day. Unfortunately, there’s no if, or, maybe that circles this procedure. Most insurance companies require all avenues be followed before going forward toward other pain treatment options.)

Facet Rhizotomy and Sacroiliac Joint Block Injections:

A Facet Rhizotomy injection is recommended if the patient has experienced satisfactory results from three Facet Block Injections. By disabling the sensory nerve that goes to the facet joint, long lasting pain relief is provided by the Facet Rhizotomy injection.

Sacroiliac Joint Block Injections (SI Joint) are used for diagnosing and treating pain associated with sacroiliac joint dysfunction. The SI Joint lies next to the spine connecting the sacrum (bottom of the spine) with the pelvis (hip).

Trigger Point Injections

Trigger Point Injections (TPIs) treat muscles that contain trigger points or knots of muscle formed because the muscles do not relax and are painful. In some cases, the knots can be felt under the skin. The nerves around the trigger points may become irritated and referred pain may develop. Pain felt in another part of the body is commonly known as ‘referred pain.’

Trigger point becomes inactive and the pain alleviates when the trigger point injection is provided. In most cases, a brief course of treatment results in sustained relief.

There are instances when physicians will prescribe only one injection for your pain. If your physician explains this is the course he follows, simply ask why? Why not three? In cases studied throughout the country it is stated that the ‘single-shot blocks’ do not give the patient’s pain the full recovery that a set of three shots gives. Many studies conclude that ‘single-shot blocks’ are of short duration and only add the patient’s increased need for narcotics.

In any case, injections, like many other forms of pain relief, are temporary. If you proceed into any course of treatment with expectations that your pain will be gone for good, stop. Chronic pain does not go away. The best we as pain patients can hope for is the ability to function within our daily lives with as little pain as possible. Believe me, I’ve tried just about everything and have found that a pain level of 4 sure beats the heck out of a level 10!

Next week, we explore the surgeries of implants and other forms of relief! Until then, have a wonderful week!

[1] www.spine-health.com/treatment/injections/radiofrequency-neurotomy-facet-and-sacroiliac-joint-pain article

Posted in aches, Arthritis, chronic pain, Fatigue, Fibromyalgia, Inflammation, Knee pain, Muscle and joint stiffness, Rheumatoid Arthritis

Part 4 – Marijuana

Thank you for your patience with the delays in finishing the series, “Chronic Pain Relief Options.” Over the last months, I’ve endured a few setbacks healthwise and have finally found my voice again. I appreciate your support and hope you will continue to enjoy this series along with future posts for chronic pain sufferers.

As we continue our research into the different options available to patients suffering from chronic pain, Medical Marijuana is fast becoming one of the preferred forms of chronic pain relief by patients. However, regardless of the positive effects patients report from using Medical Marijuana, astigmatism continues to surround this natural drug.

This is, without a doubt, the hardest subject I’ve written about for many reasons. First, I know persons who use Medical Marijuana and respond with excellent results. Secondly, I know persons who are dead set against legalization, keeping marijuana from extensive research.

How does voting against the legalization of Medical Marijuana hinder research? On a federal level marijuana remains a Schedule 1 drug, regardless of its legality in 30 states including the District of Columbia and maintains the strictest category with criminal penalties. Therefore, if you live in a legalized state, you can be arrested on the federal level. However, we have a voice somewhere in this country and I believe if we open our minds to the positive outcomes of marijuana we may find a cure for the opioids issues we face today.

Without further ado, here is what I found.

What is Medical Marijuana?

The National Institute on Drug Abuse (NIDA) does not encourage Medical Marijuana use because of the lack of detailed data from research studies. It remains ‘unsafe for the public.’ To strengthen their decision, the FDA hasn’t approved Medical Marijuana as a viable medication.

The NIDA defines Medical Marijuana as “referring to the use of the whole, unprocessed marijuana plant or its basic extracts to treat symptoms of illness and other conditions.”

However, the NIDA recognizes the approval of two medications in pill form. Dronabinol and Nabilone, (a man-made form of marijuana) contain THC (delta-9-tetrahydrocannabinol) and treat nausea from chemotherapy as well as increase the appetites of AIDS patients. There is the possibility more medications may be developed once extended research is finished.

(Other countries approved a mouth spray containing THC (tetrahydrocannabidiol)and CBD (cannabidiol) – nabiximols (Sativex) – for muscle control problems related to MS. And for the possible treatment of epilepsy in children, testing of CBD-based liquid drug (Epidiolex) is in trials.)

WHOA…What is CBD & THC?

           The Harvard Health Publishing Blog cites CBD, (also known as cannabidiol) is the extract from the hemp plant and has very little if any intoxicating properties. THC, tetrahydrocannabinol, is the chemical that causes the ‘high’ when using Marijuana. Patients reported no change in consciousness and instead reported many benefits when using Medical Marijuana. Strains with little or no THC are listed as CBD-dominant strains and studies show that patients report little change in consciousness. Benefits reported from patients using CBD include relief from insomnia, anxiety, spasticity, and pain.  However, there are more than 100 active components within the marijuana plant. Testing is needed before informing the public of the different strains and benefits and/or effects of marijuana use.

Frustration from scientific groups is heightened because of the inability to perform thorough research due to the Federal government’s marijuana restrictions. If research groups are unable to obtain marijuana, then how are they expected to perform tests to relay results to the public? Perhaps that’s the real deal. If research studies are stymied from researching marijuana then it remains a threat to the public, thus the government’s agenda??

A couple of days ago I received an email from The National Pain Report citing a proposal that would add “intractable pain” to the approved conditions list for medical cannabis was appealed by the Illinois Department of Health. The Director of the Health Department claimed there ‘wasn’t enough high-quality data from clinical trials’ to add intractable pain to the approved conditions list.

Although there are several reports showing that ‘intractable pain’ is on the list. Those reports were viewed by the following states:

Government officials will continue to halt legalization until we as a people vote for legalization. This one simple act encourages further testing of different strains and helps patients make informed decisions when considering Medical Marijuana as a pain relief option.

Side Effects?

Fast becoming the ‘go-to’ method for relieving pain, Medical Marijuana’s ability to reduce pain, improve quality of life and reduce side effects of other medications has improved lives of many chronic pain sufferers. Numerous studies show patients on Medical Marijuana reduce opioid usage by 64% – dramatically diminishing the risks of overdose and dependency.

Surprisingly, the side effects of medical marijuana are like those of any medication – if you abuse it, you’re going to have side effects. Marijuana products derived from CBD are considered safe and are federally legal in the U.S. These products are commonly found as ‘oil products.’ Doses of up to 300 mg daily may be safe for up to six months per the Medical Marijuana Inc. website. Doses of 1200-1500 mg daily may be used safely for up to four weeks.

 

Health information site reports that lightheadedness, drowsiness, low blood pressure, and dry mouth are symptoms reported by some patients. Throughout my research, I did not find symptoms of moving to a stronger drug (heroin, cocaine) as a side effect of using Medical Marijuana. However, if you try other forms of marijuana not inclusive of Medical Marijuana, and you’ve never used marijuana before, then you may experience stronger effects. The key is moderation.

 

Please consider reading this with an open-mind, perform your own research and remember the probability Medical Marijuana is becoming an integral part of all our lives. Therefore, research and testing are necessary to ensure the safety of the public.

This post is derived from the results of my personal research and may not agree with your opinion of Medical Marijuana usage. I encourage everyone considering Medical Marijuana as a chronic pain reliever, to perform your own research asking the questions I haven’t answered in this post. Opinions are strong on both sides, but I think you’ll be surprised at the growing number of benefits for persons suffering from pain, MS, Crohns Disease and Parkinson’s Disease (to name a few medical diagnoses) reported by patients.

Stay tuned for PART 5 of the Chronic Pain Relief Options series – Injections and Surgeries!

 

Posted in aches, Arthritis, Chronic lower back pain, chronic pain, Coping with Chronic Pain, Inflammation, Knee pain, Rheumatoid Arthritis, Surgeries

Relief Options for Chronic Pain

PART 3  –  OPIOIDS

Except for Marijuana, controversy surrounds Opioids more than any of the previous medications discussed in Parts 1 and 2. Suicides, accidental overdoses, and misuse of Opioids by prominent celebrities fill the headlines and invoke a strong media reaction. This escalated attention cautions healthcare physicians to seek other options for their patients.

The American Academy of Pain Medicine, National Institutes and Health, American Chiropractic Association, and American Society of Addiction Medicine provide chronic pain and prescription opioids statistics. These statistics cover the United States only:

Chronic pain statistics indicate more people suffer from pain than the combination of diabetes, heart disease, and cancer. Excluding acute pain conditions and children suffering from pain, 50 million to 100 million adults suffer from chronic pain. Of those adults, 27% seek treatment for lower back pain, 15% for severe headaches to migraine pain, and another 15% for neck pain. Alarmingly, these numbers continue to grow daily.

Research of the prescription pain pill epidemic for 2015 shows 20,404 people died from Opioids overdoses. Prescription opioids account for substance abuse disorders by two million people. Increased national crime, pharmacy burglaries, and overdose deaths were tied to Opioids abuse.

Since the rise of prescription drug overdoses, especially prescription Opioids, views have changed among healthcare providers for prescribing Opioids for the treatment of chronic pain. However, Opioids are prescribed in cases of short-term to help patients recover from fractures or post surgery.

Your primary care physician will no longer prescribe Opioids for moderate to severe chronic pain. Instead, you’ll be referred to a Pain Management Facility where specialists evaluate and monitor prescriptions of Opioids.

Many chronic pain patients find themselves suffering more and receiving little or no assistance of treatment for their pain due to the abuse and misuse epidemic. As the fear of overdosing heightens many physicians, including specialists, seek other options to treat chronic pain. Physical therapy, minimally invasive procedures, and lifestyle changes are the preferred options. However, these options, exhausted by most chronically ill patients, bring little to no relief.

So, how do chronic pain patients find relief? If Opioids are the only option available for severe chronic pain then understanding the risks involved with these drugs is mandatory. The specialists associated with Paindoctor.com (and most pain management specialists) treat chronically ill patients using a 12-step Opioid Checklist to ensure patient safety. (You can find the risks of Opioids listed after the checklist.)

Taking Opioids is a risk. But most chronic pain sufferers take that risk to acquire a fraction of the quality of life they enjoyed prior to the onset of chronic pain.

What are Opioid medications?

As the oldest known class of drugs in the world, Opioids refer to either morphine or other opium poppy-based medications – narcotics. Opioids suppress the pain perception by reducing pain signals as they are transmitted through the nervous system.

Below are some types of Opioids (and their generics) used for chronic pain treatment. ALL of these medications require a prescription.

Hydrocodone (Hysingla ER, Zohydro ER)

-*Hydrocodone/acetaminophen (Lorcet, Lortab, Norco, Vicodin)

Hydromorphone (Dilaudid, Exalgo)

Oxycodone (Oxycontin, Oxecta, Roxicodone)

-*Oxycodone and Acetaminophen (Percocdet, Endocet, Roxicet)

Oxycodone and Naloxone (Targiniq ER)

Morphine (Astramorph, Avinza, Kadian, MS Contin, Ora-Morph SR)

Meperidine (Demerol)

Methadone (Dolophine, Methadose)

Fentanyl (Actiq, Duragesic, Fentora)

Codeine (only available in generic form)

(*Includes Acetaminophen in the compound. Avoid other products containing acetaminophen (ex: Tylenol) due to increased risk of liver problems.)

For pain relief all day and through the night your doctor may prescribe specific doses of your pain medication. However, there is a chance you may experience “breakthrough” pain. Breakthrough pain is a flare of pain experienced even though you receive round-the-clock pain medication.1 In this case, you may be given a prescription with “as needed” instructions.

Regular visits to the pain specialist are a requirement of care if you are prescribed Opioids. These visits include questions asked by your specialist:

          1. Are you responding to the Opioid?
          2. Are you experiencing any side effects?
          3. Have you developed a medical condition or potential interaction that may increase the risk of side effects?
          4. Are you taking the medication as directed?2

NOTE:  Never change the dosing of any Opioid medication without first checking with your physician. If your pain isn’t managed by the medication prescribed, your physician may change the dose or try another Opioid drug.

Opioids can be dangerous if taken with 1) antidepressants, 2)antihistamines, and/or 3)sleeping pills. Be sure your doctor knows all medicines you are taking. Other prescription drugs, over-the-counter drugs, and herbal supplements may cause additional problems when taken with Opioids.

When you’re ready to quit the Opioids, your pain specialist will advise a slow weaning off from the Opioids to help your body adjust to the removal of the pain medications. Withdrawal symptoms occur if you stop the Opioids abruptly.

As reviewed in Parts 1 & 2 of this series, most medications have side effects and Opioids are no different. Common side effects include:

*Constipation                       *Sedation

*Fatigue                                 *Nausea

*Vomiting                              *Confusion

*Dry Mouth                           *Constricted pupils (miosis)

*Itching (pruritis)

However, there are more serious side effects including:

**Urinary retention              **Hearing loss

**Respiratory depression    **Hallucination

**Hypothermia                       **Delirium

**Hyperalgesia (increased sensitivity to pain)

**Abnormal heartbeats (arrhythmias)

LARGE doses can induce:

***Serious respiratory problems              ***Depression

***Oxygen deprivation                                ***Unconsciousness

***Overdose                                                   ***Death

Taking Opioids for the long-term may cause tolerance, dependency, and/or addiction.

Tolerance occurs when the need for Opioids causes increasing the dosages.

Dependence is a physical or psychological effect. A physical dependency occurs when you (abruptly) stop taking your Opioid medications resulting in a withdrawal syndrome. Psychological dependency occurs as an emotional need for the drug when there is no physical need.

A small percentage of patients who use Opioids long-term may suffer from addiction.3 The characterization of addiction is a constant pattern of inappropriate Opioid use and may include the following serious problems:

    • Loss of control of using Opioids
    • A preoccupation of acquiring more Opioids even though pain relief is achieved
    • Although adverse physical, psychological, or social consequences may occur, the patient continues using Opioids
    • Overdose and death increases as an adverse effect

Should you take Opioids? If you suffer from moderate to severe pain, Opioid drugs can make a significant difference in your pain levels. However, you must take them safely and follow your doctor’s instructions carefully to avoid the negative effects of Opioids.

Next week, we’ll explore Marijuana and its treatment of chronic pain. Have a great week!

1Opioid (Narcotic) Pain Medications article, WebMD, LLC, 2017

2Opioid (Narcotic) Pain Medications article, WebMD Medical Reference, Minesh Khari,MD, April 30, 2017

3What are Opioid Medications? Article, paindoctor.com

 

.

Posted in Arthritis, Chronic lower back pain, chronic pain, Inflammation, Knee pain, Muscle and joint stiffness, Rheumatoid Arthritis

Options for Pain Relief

PART 2

Exploring Anticonvulsants, Muscle Relaxants, and Corticosteroids

In part one of this series of Options for Pain Relief, I wrote about NSAIDs, acetaminophen, and antidepressants. This post focuses on anticonvulsants (anti-seizure) medications, muscle relaxants, and corticosteroids. Because there is so much information regarding Opioids and Marijuana for treatment of chronic pain, I’ve decided to write two separate posts for each of these. The next post (Part 3) will be devoted to the pros, cons, and debates of Opioid use for chronic pain treatment.

Now, let’s discover how anticonvulsants, muscle relaxants, and corticosteroids are used as a relief for chronic pain.

ANTICONVULSANT (antiseizure) MEDICATIONS

Anticonvulsant medications are used for specific types of nerve pain (burning, shooting pain) and must be taken on a daily basis or as prescribed by your physician. Whether pain is experienced or not, this medication must be taken as directed for maximum results. This medication is not intended for an “as needed” dosage.

Some common side effects include sleepiness (which may improve the longer the medication is taken) and weight gain (one reason I stopped taking this medication), dizziness, and fatigue. If you suffer from kidney stones or glaucoma tell your doctor as anticonvulsants are not recommended for patients with these conditions. Newer anticonvulsant drugs do not require liver monitoring, however, if you have a kidney disease use caution when taking this medication.

Anticonvulsants are another example of a medication that is developed to treat one condition and is used to relieve the symptoms of an entirely different condition. Dual purpose anticonvulsants help patients manage their seizures while also helping chronic pain patients manage their pain. Studies provide conflicting views of treating chronic pain with anticonvulsants. Although there are studies advising other forms of treatment for chronic pain, other studies indicate that anticonvulsants are vital for managing chronic pain because of fewer long-term side effects.

Listed below are frequently prescribed Generic forms of anticonvulsants: (the brand name is noted in parenthesis)

  1. Gabapentin (Neurontin)*
  2. Carbamazepine (Tegretol)*
  3. Pregabalin (Lyrica)
  4. Phenytoin (Dilantin)
  5. Topiramate (Topomax)

*FDA approved the medication for treating chronic pain.

Many patients experience lower pain levels with anticonvulsants. Your doctor may use the trial-and-error method to find the drug form and dosage that treats your pain. Be sure to inform your doctor of side effects other than those he advised when taking anticonvulsants. Read the paperwork accompanying your medicine thoroughly, making note of any restrictions (no alcohol, etc.) while taking this medication.

*******

MUSCLE RELAXANTS

In the United States alone, an estimate of $100 Billion is spent annually for chronic pain management.  And among the numerous forms of chronic pain, one form is the Musculoskeletal pain. Its symptoms and discomfort are felt within the muscles, nerves, tendons, bones, and ligaments of the body. These symptoms may develop as an acute onset (rapidly and grow to severity quickly) or as chronic pain (slowly and long-lasting.) Like most chronic pain, Musculoskeletal pain that continues for three months or more is considered ‘chronic.’

Chronic musculoskeletal pain may be widespread or centered in one area of the body. Some of the more common parts of the body include lower back pain, myalgia (muscle pain), tendinitis, and stress fractures. The causes are as varied as the types of musculoskeletal pains – injury, overuse, poor posture, arthritis, and/or prolonged confinement.

To effectively treat the symptoms of pain and discomfort muscle relaxant medications may be used. Unlike their name, muscle relaxant drugs don’t act on the muscles themselves. Instead, the impact of the effects center on the central and peripheral nervous system.

Reported symptoms treated with muscle relaxants include:

  1. Bone Pain (dull, deep, penetrating pain)
  2. Connective Tissue Pain (felt within tendons or ligaments)
  3. Muscle Pain (less intense than Bone Pain, but causes range from injury to tumor)
  4. Tunnel Syndromes (result from compression of nerves)
  5. Joint Pain (aching, stiffness, swelling or burning within a joint(s))
  6. Fibromyalgia (ligament, tendon, muscle pain)

The most commonly prescribed muscle relaxant medications are Baclofen, Carisoprodol, and Chlorzoxazone. All three work on the central nervous system, but each is prescribed for different pain problems. Baclofen is prescribed for muscle spasticity which occurs as a result of multiple sclerosis and spinal cord injuries. Carisoprodol is more commonly prescribed for the treatment of several musculoskeletal system disorders that cause acute pain. And Chlorzoxazone is typically prescribed for lower back pain and muscle spasms. Only one of these medications have received rare reports of acute liver injury. Chlorzoxazone use may be associated with liver injury, but, again these reports are rare.

However, two muscle relaxant drugs have been associated with causing acute liver damage (severe to fatal.) If you are prescribed either of these drugs, speak to your doctor extensively regarding this warning. The drugs are:

Dantroline (for chronic spasticity)   and

Tizanidine  (for acute symptoms of muscle spasms or chronic muscle spasticity)

The normal side effects of dizziness, drowsiness, and headaches accompany most of the drugs mentioned above. As with all medications prescribed or discussed in your doctor’s office, research the side effects online if your doctor fails to discuss them with you. It is your right to know exactly what you are putting into your body and the effects that may accompany those medications.

*******

CORTICOSTEROIDS

Administered in the form of a pill, a topical cream, or an injection, another class of anti-inflammatory drugs is Corticosteroids. As a stronger drug used to control severe swelling and pain, corticosteroids are prescribed for specific pain conditions. They were created to act like the natural steroids in your body. By altering the immune system, they control inflammation that causes decreased movement and pain in most joints and muscle tissues.

These drugs are periodically administered to treat cases of acute pain or flare-ups. Another common treatment is chronic swelling in the tendons and joints. To reduce pain and escalate joint and tissues flexibility, corticosteroids are used for the following conditions:

*Osteoarthritis

*Rheumatoid arthritis

*Synovitis

*Tendonitis

Common types of corticosteroids:

**Hydrocortisone

**Prednisone

**Methylprednisone

**Cortisone

And the possible side effects include:

-Headaches

-Nausea or vomiting

-Sleep problems

-Dizziness

-Changes in the skin (acne, redness, increased hair growth)

-Mental changes (anxiety, mood swings, depression

Again, let your doctor know of any extreme side effects including hands, feet, or face swelling, eye pain or other visual changes, a rash that will not disappear, new muscle pain/weakness, and/or tarry bowel movements.

Corticosteroids do work but injections are limited to a maximum number every six to twelve months each year. Pills are given in large increments and dwindle down to nothing in a matter of six to ten days. And topical creams are usually applied as needed or per your doctor’s orders. Be sure to talk extensively with your healthcare physician to understand the side effects and the likelihood you’ll receive pain relief with corticosteroids.

Next week I will post Part 3 of Options for Pain Relief – Opioids. Thank you for your patience and I hope you enjoy reading this information!

Carolyn

 

Posted in Uncategorized

Options for Chronic Pain Relief

PART 1

Exploring NSAIDs, Acetaminophens, and Antidepressants 

If you suffer from any form of BACK PAIN, you know (or maybe you don’t) there are numerous options to help relieve your back pain. These options are placed in one of these categories:

Medications     –    Injections  –    High-Tech Treatments    –    Surgery

Because the research on these different options is extensive, I plan to cover each category over the next six to eight posts. Today, I’ll begin the first part of MEDICATIONS by talking about the first two categories: NSAIDs & Acetaminophens, and Antidepressants. These medications are used for treating pain and chronic pain in the back and other parts of the body.

Medications:

This category appears to have the highest percentage of usage for treating back pain –temporary or chronic. I found five categories of medications:

1) NSAIDs and Acetaminophen,

2) Antidepressants,

3) Anti-seizure or (Anticonvulsants),

4) Muscle Relaxers, and

5) Opioids

 

NSAIDs or Nonsteroidal Anti-inflammatory Drugs encompass a wide variety of medications that may be found OTC (over-the-counter) or may need a prescription from your doctor. In either form use caution when taking anti-inflammatory drugs. Be sure to administer the drug precisely as directed by your doctor and/or the package instructions.

There are numerous articles online for OTC Anti-Inflammatory medications and I urge you to surf the net for more information. I always look at the most recent article – try to avoid older articles because there is constant change in this industry. However, one site (Healthline.org) is beneficial and includes a guide to OTC Anti-Inflammatories.

This guide lists the common NSAIDs, how they help with pain, the side effects, and comments regarding drug interactions. Before using any of the medications listed in this post, please contact your doctor first. Your doctor needs to know your history and the drugs (you are presently taking) before deciding the best NSAID for you. Some drugs interaction with NSAIDs will make the NSAIDs less effective.

Note: If you’ve had chronic pain for more than six months, call your doctor’s office. Your pain may be chronic and this list of medicines may not be suggested by your doctor.

In the Guide to OTC Anti-Inflammatories … Aspirin (Bayer, St. Joseph), ibuprofen (Advil, Motrin, Midol) and naproxen (Aleve, Naprosyn) were noted as common NSAIDs.

 

ACETAMINOPHEN (Tylenol) is one of the most common pain medicines used for fever reduction and pain.

Acetaminophens are used for arthritis pain, common aches, or headaches. These drugs have good results except in the cases of pain lasting more than six months. If this is the case you may have ‘chronic’ pain and require a prescription for a stronger pain reliever. Check with your healthcare provider for more information.

Keep in mind acetaminophens do not reduce inflammation.

 

ANTIDEPRESSANTS

In the world of searching for drugs to help alleviate chronic pain, some drugs developed for other diseases have become the most effective and commonly used ways to treat chronic pain.

Case in point: antidepressants, which were developed for the treatment of depression. And although depression may not be a condition of the patient, antidepressants have become a pillar in the treatment of chronic pain conditions. Although it isn’t understood the connection between antidepressants and their treatment of pain; it is believed neurotransmitters in the spinal cord are increased by antidepressants which would reduce pain signals.

This type of medication must be taken daily – regardless of a low or non-existent pain level. And the relief isn’t experienced immediately. It can take several weeks to feel the effects of an antidepressant. Moderate relief has been reported by most patients who take antidepressants. If this medicine does not effectively lower your pain, your doctor may pair your antidepressant with an anticonvulsant.

There are three groups of antidepressants due to how they work and their chemical structure. Considered one of the most effective group for pain relief is the tricyclics.

A few Tricyclic Antidepressants (TCAs¹):

  • Amitriptyline
  • Amoxapine
  • Clomipramine
  • Desipramine
  • Doxepin
  • Nortriptyline

Side effects include:

Blurred vision, drowsiness, dry mouth, lightheadedness upon standing up (due to drop in blood pressure), weight gain, constipation, heart-rhythm, difficulty urinating, and difficulty thinking clearly.

To help prevent or reduce these side effects, you will begin with a lower dose and your healthcare provider will increase the dosage as needed. Ironically, the lower doses tend to be more effective for pain than the doses used for depression.

Serotonin and norepinephrine reuptake inhibitors (SNRIs) are the second group of antidepressants. Often, patients with chronic pain will develop depression. Drugs in this group help treat depression at the same dosages used for treating chronic pain.

Medicines in this group include duloxetine (Cymbalta), venlafaxine (Effexor), and milnacipran (Savella). Side effects are drowsiness, insomnia, nausea, dry mouth or elevated blood pressure. If your doctor suggests one of these medications, be sure to check the specific side effects by searching the drug online.

The third group of antidepressants, Selective serotonin reuptake inhibitors (SSRIs), include the drugs paroxetine (Paxil) and fluoxetine (Sarafem, Prozac). As medications for treating depression with chronic pain, these medications work well. However, they do not relieve pain on their own. Fluoxetine may be prescribed along with other tricyclic antidepressants to boost their painkilling agents.

Then there are antidepressants that are considered “atypical antidepressants” because they don’t fit into their own category. Atypical antidepressants are bupropion, trazodone, and mirtazapine.

Like most antidepressants, the side effects of atypical antidepressants include nausea, fatigue, dry mouth, diarrhea, nervousness, and headaches. Again, ask your healthcare provider questions about these drugs and their side effects. You can also go online and read reviews by patients who have taken or are taking these drugs.

 

(Please note: Slightly increased risk of suicidal thoughts or actions are associated with antidepressant medications. Please talk to your doctor before accepting these medications if you have entertained suicidal thoughts.)

 

[¹] Published April 13, 2016. Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ.