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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.

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Posted in Chronic lower back pain, chronic pain, Uncategorized

Keeping a Pain Diary or Journal

Cheers to a rainy Friday! (Rather a rainy day where I live.)

Lately, I’ve read several articles about the need for keeping a journal or diary of chronic pain levels. At first, I skipped the articles and went to my business of writing. However, the more I read, the more I decided this activity would be beneficial in many ways.

You ask, “How will keeping a pain diary or journal help me?”

I’m glad you asked! Keeping a journal or diary of your daily pain activity chronicles your “ups and downs” with pain. For example:

  1. your pain level is higher on rainy days 
  2. your sleep is disrupted because your pain woke you up 
  3. a change in medication dosage may lower or increase your pain

These are a few of the actions you can chronicle with a pain diary. Over time, you’ll have a detailed report for your personal needs and for your doctor to review. Depending on Your pain results help your doctor manage your pain more effectively. He will see the symptoms of your pain and how it varies depending on the time of day.

There are “apps” specifically for tracking your pain levels. But after reading Jo Young’s article, “How I Started a ‘Pain Diary” (and Why I Think You Should, Too) I created my own diary with columns specific to my needs. Using Excel or a spreadsheet of your choice,  below are sample column headings you may find beneficial:

  • DATE
  • MORNING  (Pain level 1-10)
  • AFTERNOON  (Pain level 1-10)
  • NIGHT  (Pain level 1-10)
  • DOSAGE OF MED-X (Dosages and frequency can affect your pain level.)
  • DOSAGE OF MED-Y
  • DOSAGE OF MED-Z
  • WENT OUTSIDE? (Sometimes we just don’t feel like going outside, like today)
  • MENTAL STATE   (Bad, Very Bad, Neutral, Good, Very Good are some suggestions)
  • HOURS OF SLEEP  (Hours of uninterrupted sleep, not including naps.)  
  • EXERCISE   (Amount of, type, time spent)
  • NOTES:  (Put anything here as additional info for yourself or your doctor)

Your entries offer valuable information to help you cope with your pain. In addition, your pain diary helps your doctor’s decisions to manage your pain more effectively. And remember – start a pain diary if you were just diagnosed or experienced pain for years! After a few weeks, you’ll begin to see a pattern of your pain levels and what appears to affect it.

Would you mind letting me know when you start your pain diary or journal? And would you share your findings? I won’t share your personal information but may use your findings (along with other readers) in a blog post!

Thank you for stopping in to read! I appreciate your time and look forward to your comments!

Blessings sent your way,

Carolyn

webmd_rm_photo_of_pain_journal

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Part 3 – Chronic Pain and Depression

First, an apology. This third part of the series, “Chronic Pain and Depression,” should have been written and posted a long time ago. Unfortunately, LIFE got in the way and I’m just now writing and posting it! There are so many events coming up that have kept me from posting on this blog in the professional manner that I should. Therefore, I’m committing to writing something on this blog at least weekly and then move it up to every day. The next post will give more details about what is going on and how it is affecting my Chronic Pain.

But now, let’s finish our series on Chronic Pain and Depression…

As you begin your relationship with your therapist these are items to consider after your meeting(s). If there is ever a question in your mind about the therapy you are receiving, stop and seek out a new therapist – for peace of mind if nothing more. Your mind will give you warning signals if:

37.  During the session, your therapist answers his phone. (Not professional! This is time you are paying for!)

38.  As you talk about your culture or religion, your therapist throws insensitivity comments your way.

39.  Denying or ignoring the importance of your spirituality is another warning signal from your counselor.

40.  Your therapist tries to push her thoughts or convictions regarding spirituality or religion onto you.

41.  You find your therapist doesn’t empathize at all.

42.  Or, your therapist empathizes too much.

43.  As you talk about your problems, your counselor appears overwhelmed. You begin to feel like you are abnormal with so many problems. Not true! It’s time to start looking elsewhere.

44.  Your feelings or issues make your therapist overly emotional, affected or triggered. 

45.  Against your wishes, you are pushed into highly vulnerable feelings or memories.

46.  Or, you find your therapist avoids exploring your emotional or vulnerable feelings.

47.  Your permission is not asked when your therapist begins using various psychotherapeutic techniques with you.

48.  Without helping you to appreciate and resolve the underlying causes, your counselor tries to get you to exert overt control over your impulses, compulsions, or addictions.

49.  Instead of teaching you coping skills to manage your impulses, your therapist prematurely or exclusively focuses appreciating and resolving the underlying causes you have with an issue or compulsion.

50.  Your therapist is consistently late for your appointment. Signs of canceling or missing your appointment on a consistent basis is another warning sign.

Those conclude the 50 Warning Signs to look out for during your first few appointments with a therapist. Some of these signs may not show up until you are well into a therapy program. When you feel uncomfortable with the lack of progress or the overt pressure you receive from your therapist, ask your doctor for another recommendation. There is no time limit on switching therapists.

It is better to adhere to the warning signs your brain picks up on rather than do nothing and become trapped within your therapist’s expectations or program. You should not be forced into doing anything you don’t feel comfortable doing.

I hope this three-part series has given you some enlightenment and permission to move to another therapist. When I read this article online at GoodTherapy.org it helped me to understand the reasoning behind a family member’s actions. The problem is if your loved one has succumbed to questionable therapy, there isn’t anything you can do about it. It is the person’s choice to continue with the therapist and all you can do is hope he/she will eventually see the therapy given was incorrect.

Thanks for reading and if you know of other “warning signs,” please be sure to let the author know them at the link for Good Therapy.

Carolyn

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Part 2 – Depression and Chronic Pain

Welcome Back!!!

As many Chronic Pain Sufferers know, depression attaches itself to the excruciating pain you already suffer through. This occurs for a variety of reasons:

  • you just don’t feel well
  • you don’t feel like going out with friends
  • you may feel abandoned by your friends
  • you can’t do the things you did before the pain became “chronic”

And I’m sure there are many other reasons to spark your depression, but I found these to be the top four that hit me wth depression faster than my pain meds took effect.

We talked about the warning signs of questionable therapy and counseling to look for when you decide to go to a counselor or therapist in Part 1 and we’re going to continue with the next 18 items:

19. Without authorization, your therapist discloses your identifying information.

20. Your therapist begins to tell you the identity of another client.

21. You learn your therapist has never participated in personal therapy work.

22.You find you therapist cannot admit mistakes or accept feedback.

23.Without helping you to change, your therapist focuses extensively on diagnosing.

24.Counselor talks way too much, without giving you a chance to speak.

25.Or, your therapist doesn’t talk at all.

26.Leaving you confused, your therapist speaks in “psychobabble.”

27.Without considering your feelings and somatic experiences, your therapist focuses on thoughts and cognition at your expense.

28. At the exclusion of thoughts, insight, and cognitive processing, counselor focuses on feelings and somatic experience.

29. Acting as if they have the answers/solutions to everything, therapists spend time telling you how to best fix or change things in your life.

30. Your Counselor gives frequent unsolicited advice, makes decisions for you, or tells you what to do.

31.Your dependency is encouraged by your therapist by allowing you to get your emotional needs met from the therapist.

32. Against your will, your therapist attempts to keep you in therapy.

33.The belief factor of the therapist is that only her counseling works and she ridicules the approaches of other therapists.

34.Making you feel uncomfortable, your therapist is contentious with you or may be confrontational.

35.Your counselor doesn’t remember your name or your interactions from one session to the next.

36. Appearing to be in her own little world, your therapist doesn’t pay attention to you, listen to you, or understand you.

I’m sure you will agree these are powerful factors to take into consideration when you are paying your hard earned money to see a therapist for help and guidance. Be sure to print these items out here or go to GoodTherapy.org for the full article. Part 3 is the last blog regarding the warning signs of questionable therapy. After that blog, we will look into the positive signs of therapy.

I hope these series are helping you with your therapy if you are going to a therapist or counselor or if you are considering going to a therapist. And hopefully, you are not seeing any of these negative factors with your therapist.

Take care of YOU, and I look forward to hearing from you,

Taking pain one day at a time,

Carolyn

 

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Things are tough….

Things are really tough right now between the constant changing of my pain medicine and now with the Type 2 Diabetes diagnosis. I’m having a hard time trying to keep up with diabetes as far as what I should be eating and shouldn’t be eating and I’m not sure the pain medicine I’ve switched to (due to $$$) is helping like I had hoped. So, I’ll be away longer than usual until I can get this worked out.

Thanks for stopping by and if you have any suggestions for me, I’d really appreciate them.

Take care,

Carolyn

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Moving Around

I know it’s been a while since I’ve written anything here. But I’ve been tied up with a Chronic Pain episode of my own that was rather nasty and mean. It made every part of my body hurt (fibromyalgia), and my lower back throbbed, ached, and felt like knives were stabbing it. The fibro pain was from the days of rain, dampness, and overcast days we had in a row. Those of you who have fibromyalgia know what I mean. You can tell the weather with the pain in your joints and muscles. And you know you have a rough day or days ahead of you.

Then my lower back pain increased to the point nothing was helping. For a while, I was on Methadone for about a month, and it seemed to be working. But then I felt as if I wasn’t taking any medicine at all. The pain was so severe I could barely walk, depression set in, and when we did go to the pain doctor, I couldn’t talk to him without crying the entire time. It was a disaster. Thankfully, Rick was with me and did most of the talking for me, and the doctor decided to put me on Fentanyl patches.

If you don’t think I wasn’t wary about Methadone, (which made me think of “Breaking Bad”), you know I thought Fentanyl patches were going to be the end of me for sure. As usual, the patches would not be in for five days, and all I was on was hydrocodone which I would be on with the patches until my brain got used to the patches, and then I would off the hydrocodone.

For the past 12 days, I have been in the worse pain since I can remember. And the depression just ate me up. I didn’t go anywhere, just stayed home and waited. Finally, the patches came in, and Rick put the first patch on me. Of course, he thought it would take the pain away immediately, but of course, it didn’t do that. It did though give me some hope. For the last week I’ve been taking the hydrocodone and wearing one patch for 72 hours and today changed the patch for the first time. I can say I feel 75% better! Still a little dizzy and achy but I feel like la change is coming.

We’ll see what happens over the next week, and hopefully, things will begin to get better, and the pain will be under control. I’ll keep you up on the details.

I’m also getting the new blog ready and writing up some articles and blogs to add to the new site. I’d love for you to give me ideas of what you would like for me to write. After all, if it weren’t for you, there would not be a blog site! When the new site comes up, I’ll be giving away items, and offering podcasts, e-books, and webcasts. So, there are so many exciting things coming up in the future as a way of getting information to Chronic Pain Sufferers!!

Please tell your friends about my blog and I look forward to seeing you again very soon. And take care of yourselves! I’d love to hear from you and how you are coping with your pain!

The very best to you,

Carolyn