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

 

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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