DRUG THERAPIES ARE NOT A CURE BUT THEY CAN OPTIMIZE PAIN CONTROL AND PROVIDE THE RELIEF NECESSARY TO REGAIN FUNCTION, ALLOW THE PATIENT TO PARTICIPATE IN PHYSICAL THERAPY, AND HELP THEM REGAIN SOME SEMBLANCE OF A NORMAL LIFE.
For Chronic Pain patients drug therapies allow them to regain a balance in their lives and resume many activities they had previously stopped. Here we will try to give some of the basic medication types, an example, and what they are typically used for.
ADDICTION & CHRONIC PAIN?
Addiction and Opiods tend to be in the news a lot lately and before we share information on the types of medications best used to treat CRPS we felt the need to address the situation that is going on across the country right now regarding the use/abuse of chronic pain medications and efforts to control it.
It seems some people, especially out in Washington, DC, feel the need to add even more legislation to “safeguard” those of us who CORRECTLY AND LEGALLY use medications to treat chronic pain.
Due to the actions of a small group of individuals who choose to abuse the system and break the laws regarding the proper use of opiods and other prescription medications, a small group of physicians and individuals are trying to push the FDA and congress into enacting legislation to “protect” ALL users of medications and their Physicians from what they see as the obvious abuse that is occurring. People are dying. That is true, no one is disputing that. But PLEASE people, look at the real data, look at who is abusing the medications!
* According to the study “Fewer than five percent of patients prescribed narcotics to treat chronic pain become addicted to the drugs, according to a new analysis of past research.”
“The finding suggests that concerns about the risk of becoming addicted to prescription painkillers might be “overblown,” said addiction specialist Dr. Michael Fleming at Northwestern University’s Feinberg School of Medicine.”
“To get a sense of how addictive opioid painkillers are for those patients who do have a prescription, researchers from The Cochrane Collaboration, an independent group that reviews research on medications, collected the results from 17 studies covering more than 88,000 people.
All of the patients had been prescribed opioids to treat chronic pain, and nearly all of them had pain unrelated to cancer.
In 10 of the studies, patients used the painkillers for anywhere from three months to several years, while one study included just short-term use of several days and the others did not report the length of time patients were on the drugs.
Taken together, the studies found that 4.5 percent of people developed a dependency on the painkillers. (bold print added by us).
Dependency does NOT mean addiction! (also read this on addiction) Please understand that there is a significant difference between dependency and addiction, because chronic pain patients understand the difference.
“It’s a low percentage,” said Dr. Silvia Minozzi, lead author of the study and a member of the Cochrane Drugs and Alcohol Group in Rome.”
So why are they saying that so many people are addicted to prescription drugs?
Because of a couple of things especially. One is what is included or not included when you are talking about this issue with the public/media, and the second is the importance of buzz words.
1) They include studies like this;
“For instance, a study by Boscarino and his colleagues that was included in Minozzi’s review found that 25 percent of patients became addicted.”
That is pretty high. Much higher than 4-5%. However when you read further, IF you read further, you would have found this information …
“The group of patients Boscarino surveyed had a high rate of alcoholism and illegal drug use, though.”
Is it really a surprise then that people with these types of addictive predispositions had issues with drug addiction????
2) The second reason is the importance of buzz words. Words like “prescription drugs”. They use those two little words and everyone assumes that the people abusing the drugs HAVE a prescription but when you delve into the research or into the articles you often find that no, the drugs, as described above, were not their own but instead, were illegally obtained drugs that were legally prescribed for other people who were in real pain, by their Physicians who knew exactly what they were doing; taking care of their patients.
These new laws they are trying to enact are taking that ability away from the Drs. and patients are being sent away from practices in search of new physicians. Drs are afraid to prescribe these much needed chronic pain medication now and patients have a terrible fear of their much needed medication supplies being cut off.
Chronic pain patients don’t take these medications for fun and games, or to get high, or to escape life for a few hours. Chronic pain patients take opiod medications in order to survive their diseases, to enable them to live another day, week, month with some semblance of normalcy.
People who abuse drugs need help, yes. They need counseling, yes. Some are dying from overdoses from their illegal use of prescription medication, yes. Absolutely. But please don’t lump those of us who have to use chronic pain medications every day, the same as someone with diabetes has to use insulin every day, or an MS patient has to have their daily dose of medicine, or any other chronically ill patient has too have their dose of medication, don’t lump chronic pain patients in the same category with drug abusers simply because they abuse our drugs. It just is not right or fair to punish us for their abuse.
Information provided by an article titled “Painkillers Not As Addictive As Feared”.
This is an excellent article because it is a confusing area, the difference between these words; Dependence – Addiction – and Tolerance? How does it affect your body and more importantly does it affect how insurance companies, Doctors offices, and Hospitals issue medications to patients? YES!
Please feel free to print out this information out and share it with your physicians if they share concern regarding the use of pain medications to treat your CRPS. The proper combination of medications is vital in treating CRPS and it takes both you and your Doctor working together to unlock relief for you.
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MEDICATIONS – DRUG THERAPIES OFTEN USED IN TREATING CRPS
These are some of the more often used medications used to treat CRPS. Because it is a syndrome it typically is treated with a combination of medications rather than simply just one, say a pain medication for instance. You usually will present with a number of symptoms that will usually require two or more medications to treat. Below, we offer some of those options but different physicians will have their own favorites.
Use the internet to do a search of the medications given by your Dr. to learn more.
Don’t be afraid to ask your Dr.;
– questions about the medications he suggests/writes scrips for you
– what each medication will do/won’t do
– what his/her success rate has been in the past with that drug
– when you should start seeing a difference in your symptoms because of the medication(s)
– what the plan is if this doesn’t work
– what medication can you try next if this dose does not work to treat some of your other symptoms.
– what medication can we try next if this dose does work, for my other symptoms.
These are just some of the questions you can ask. I am sure you can think of others. Remember, the Doctor works for you. You/your insurance are paying him, work with him to find the best solution for managing your pain or even eliminating it.
Always plan your work and work your plan! Figure out your long distance goals because CRPS is a long distance disease. It can be managed fairly well with a good combination of medications, exercise, diet, and mental attitude. For me, Keith, that also includes a lot of faith. Your journey may be different. Look to your family and friends if possible and don’t try to do this alone.
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ANALGESICS:
OPIATE AGONISTS – These medications attempt to reduce central nervous system activity and thereby reduce pain. Opiate agonists act on opiod receptors to initiate analgesia sedation and euphoria. Commonly used opiate agonists are MS Contin, Morphine, Oxycontin, Opana, Hydrocodone, and the Fentanyl patch.
These types of medications, opiate agonists, seem to be one of the most effective medications for CRPS for most patients, however, since both Opana and Oxycontin have changed their formulations for their ER versions) recently (Opana in 2012 and Oxycontin back in 2010) many patients reported a loss of effectiveness as well as some intestinal side effects that they were not experiencing before. Many of these patients reported switching to another medication or if intestinal issues. For those patients for whom intestinal issues, especially severe constipation, was an ongoing problem many prefer moving to a medication such as the Fentanyl Patch to eliminate (no pun intended) the issues associated with these oral opiods altogether.
OPIATE ANTAGONISTS – Opiate Antagonists block and reverse the effects of opiod agonists by competively adhering to opiod receptors. An example of an opiate antagonist is Naltrexone.
NARCOTICS – Used to mask pain by blocking pain receptors from sending pain messages to the brain. Narcotics are also known as Opiods. Some examples include; Oxycontin CR and IR, Percocet, Percodan,, MS Contin, Vicodin, Lortab, and Lorcet.
Most Drs will prescribe the ER (extended release) or CR (controlled release) versions of these narcotics for a more evenly distributed release of medicine during the day, and to help the patient sleep better through the night.
Individual medications may vary and each patient will vary slightly as well but it gives you an overall idea.
Also included in the NARCOTICS family is FENTANYL, either in the more common PATCH ( a 3 day stay-on patch), or the less common LOLLIPOP FORM; ACTIQ. Fentanyl is becoming more popular lately with all the formulation changes to Oxycontin and other opiods. You can read more about FENTANYL HERE.
ANTIDEPRESSANTS –Originally only used to treat depression, studies have shown that these medications, both the newer antidepressants and the older tricyclic versions, can alleviate pain in certain situations. Furthermore, they have the added benefits of not only helping some patients sleep better, but also reducing some of the headaches associated with CRPS; although some have a tendency to cause weight gain and drowsiness. Paxil, Zoloft, Elavil, Pamelor, and Trazadone are good examples of these medications.
* Note – Teens need to be especially cautious regarding antidepressants because there have been studies showing that some teens placed on antidepressants have developed an increased rate of suicidal thoughts. There has been a link to increased suicide rates as well.
* Note 2 – Always talk over these issues with your physician; never stop, increase, or decrease your medications without talking to your Dr or pharmacist and always discuss any changes in mood or symptoms with your physician.
ANTICONVULSANTS – These medications are used to try and decrease the random neurons firing, thereby decreasing the burning pain and sensitivity associated with CRPS. This can sometimes also decrease the pain. Not always very successful in decreasing the pain or symptoms of CRPS but seems to be one of the first options used by Physicians. Be careful with regards to the maximum daily dosage. Visit their websites to learn more. Examples include Tegretol, Topamax, Lyrica, and Neurontin ( Gabapentin), (also with Neurontin be very aware of the maximum effective dose).
ANTISPASMODICS / MUSCLE RELAXANTS – Muscle spasms are very common with CRPS, typically rolling in nature. The medications used to treat this can include Baclofen, Clonazepam, Flexeril, Soma, and Zanaflex. Sometimes a Dr may prescribe a benzodiazepine for this; these can include Klonopin, Valium, and Xanax.
NSAIDS – Used to treat swelling and inflammation. These can include Celebrex and Feldene. Accodring to Dr Timothy Sams, “Most research has demostrated the efficacy of the Cox-2 inhibitors, (Celebrex/Feldene) but has clearly not found them to be better pain relievers tha the older of even nonprescription NSAIDS.”
NMDA RECEPTOR BLOCKERS – THIS WOULD INCLUDE THE DRUG KETAMINE. I would suggest you check out our information on Ketamine and CRPS if you are interested in learning more about this exciting drug therapy.
TRANSDERMAL MEDICATIONS – Pain Patches, LIDOCAINE and DURAGESIC/FENTANYL. Most important with these are their placement! Check with your physician but typically they are not placed directly over the CRPS-affected area. Again, if you would like to learn more about the Fentanyl Patch, even if you have been on it before, CLICK HERE!
AMINO BISPHOSPHONATE – NEW MEDICATION TO TREAT CRPS ON THE WAY ? It is called an Amino Bisphosphonate – Neridronate
There is NEW HOPE on the horizon for CRPS patients this year, in 2015. There is a medication that has been developed to help treat the symptoms of CRPS. One specific version, Neridronate, has enjoyed tremendous success over in Europe since its introduction for those patients with CRPS Type I and it is currently undergoing its’ first trial here in the United States. The trial began earlier this year (2015) and is expected to be concluded in 2016.
CLICK HERE TO READ MORE ABOUT THIS EXCITING DEVELOPMENT!
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TO READ ABOUT THE SCHEDULES OR CLASSES OF PRESCRIPTION DRUGS, CLICK HERE
We at American RSDHope are not medical professionals. We are family, friends, patients, and loved ones dedicated to helping you and your loved ones deal with the disease of CRPS and move forward with your life. Do not start or stop any medications or treatment without first consulting your physician.