• The Management of Chronic Pain

• What You Need to Know About Narcotic Pain Medications

The Management of Chronic Pain
An overview of our stepladder approach to treat patients suffering from Chronic Pain

STAGE 1:

  • Medication
  • Injection Procedures

STAGE 2:

  • Functional Restoration
  • Re-Injury Prevention

STAGE 3:

  • Pain Coping Strategies
  • Healthy Lifestyle Living

If your pain condition has been lingering for more then 2 months, chances are you have a chronic pain condition. As such, treatment can be quite difficult and challenging, to say the least.

Here are a few things that you should know that will make a big difference in the success of your treatment plan.

  • If you are on any narcotic pain medication(s), you must have a strong desire to get off them when the time is right.
  • You must have realistic expectations on what your treatment goals are.
  • You must have a burning desire to be a “functional” and a productive person once again at home and at work instead of letting your pain take control of your life.

The program is designed to allow you to progress in stages. For example, controlling your pain with medications and injection procedures (Stage 1) is needed before you can progress to the next stage (Stage 2: functional restoration with physical therapy / chiropractic).

Stage 1: Use of pain medications in “cocktail combinations” offers the best way to control your pain. Do not rely on narcotics alone as they cause more harm in the long run if used as the only option. Injection procedures will be discussed with you to identify and to treat the source of your pain (epidurals, nerve blocks, joint injections, etc.) Once your pain is better controlled or cured, then you can proceed to -

Stage 2: Once the healing process has been initiated, you need to know that re-injury will be the sole event that will hinder your progress and thus lead to treatment failure. To prevent that, you will need to undergo a rigorous activity program to get your body moving again that way it was designed to do so. This will consist of Physical therapy to stretch tightened and reinjury-prone ligaments and muscles, exercises to strengthen already weakened and injured supporting muscles and manuel treatments (ie. chiropractic care) to restore optimal realignment of the moving parts of your body or spine. You will also be taught techniques to protect your injured body part in real life situations at home and at work (ergonomics).'

Stage 3: If you can reach this stage, then you can give yourself a much needed pat on the back. You will be in full control of your pain by knowing how to self-manage episodic flare-ups. You will have the mindset to exercise properly and regularly, to eat healthy and to live your life with satisfaction.

Each pain clinic or center uses a program or plan tailored to treat their patients. What we, at HCPR offer, is a proven step-by-step approach that works for many patients suffering from chronic pain.
A few “Pearls of Wisdom” here:

  • Movement is the best therapy; a body and mind that is stagnant and passive will not heal.
  • Chronic pain is controllable if not curable with a combination of treatments that include appropriate medications and injections, physical therapy and stress management techniques.
  • Pain is not just a physical experience (ie. “it hurts!); it is also a mind / emotional experience (ie suffering, depression, anxiety and resulting narcotic addiction).
  • The goal is always 100% cure of your pain, but for some this cannot be always attained. Realistic expectations are needed for you in order to move forward in your total healing. For example, if your pain is at most only 50% better, you may still be in pain but now you can control it better with medications, with exercises and techniques that help prevent frequent flare-ups. As such, you can now do certain activities that make you a more productive person.
  • If your pain is a result of an injury and there is an on-going litigation for monetary reward that you are expecting, chances are your pain will not fully heal, no matter what is done. The same holds true if your pain is a result of an injury at work and you are on disability payments and you want to stay on disability; this a proven fact.
  • Narcotic pain medications only mask the pain - they do not treat pain. They are bad for you if you depend on them too much to manage your pain, especially if used long-term.
  • We at HCPR, will do our best to give you the best treatment options, but all these have limitations and there are no guarantees; it will be up to you to use whatever pain relief we can give you in order for you to get on with your life.

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A What Yo Need to Know About Narcotic Pain Medications

Narcotic Pain Medications have recently gained acceptance and popularity in the medical community for the treatment of Non-Cancer Pain.Here are some facts that you need to know about these medications.

Narcotic Pain Medications have traditionally been used to control pain in patients dying from Cancer. Their long-term use in Non-Cancer Pain can be argued for selected cases, such as:

  • chronic low back pain & neck pain
  • severe arthritis pain
  • abdominal pain (ie. pancreatitis)
  • nerve injury pain (ie. RSD, Sciatica)

If you have any of the conditions above, these medications should never be used as the first option to treat your pain problem. Neither should they should be used alone as the only medicine to control your pain. Most often, they work best when used in combination with other, more “traditional” pain medications, such as:

  • Anti-inflammatories: Aleve, Celebrex, Ibubrofen, Vioxx, etc.
  • Muscle Relaxers: Flexeril, Robaxin, Soma, Baclofen
  • Neuroleptics: Neurontin, Ultram, Elavil, Pamelor

The medications listed above are called Pain Adjuvents. The power of using narcotic pain medications in “cocktail” combination with other medicines is due to a Narcotic-Sparing Effect, meaning less of the narcotic dose is needed to control your pain effectively.
The less of the narcotic you have in your system, the better it is for you. Narcotics are associated with many notorious side-effect that do damage to your body and to your mind, if used indiscriminately, such as:

  • Overdose, leading to coma or even death
  • Tolerance, meaning your body needs more frequent and higher doses over time to achieve the same pain relief
  • Lowered pain threshold, meaning you become more sensitive to pain
  • Deterioration of the mind, manifested as poor concentration, poor memory, extreme sleepiness or listlessness, mood swings
  • Liver and Kidney failure
  • Sexual Impotence
  • Addiction and Criminal Behaviour

How do Narcotics Work to Relieve Pain?
Pain signals from your body reach the brain through nerve impulses which carry the information to your spinal cord. Narcotics interrupt these signals from reaching your brain by blocking them in specific centers of your brain (called the Limbic System) Unfortunately, these areas of your brain where narcotics work are also the same areas that control your emotions and desires. Thus, it is no surprise that narcotics are associated with unwanted behaviour changes such as; passivity, depression, dependency, negativity and ultimately, addiction and criminal behaviour.

About Narcotic Drug Tolerance
When it comes to the bad side of narcotic pain medications, there seems to be a lot of focus on addiction. But addiction is not the same as drug tolerance. Addiction implies that there is a criminal or a devious behavior associated with narcotic use, such as stealing, lying, falsifying prescriptions, exaggerating pain in order to get more narcotics and ultimately, to criminal behaviour, such as buying or selling the drug in the streets.
Tolerance means that the dose you are currently using is no longer effective in controlling your pain, as time goes on, you need more narcotics to effectively control your pain. This happens because your threshold for pain worsens with the prolonged narcotics use. In other words you become more sensitive to pain because of continued use of the drug, despite the fact that you may not be having any new injury. Tolerance happens more frequently when you depend too much on the “Quick-Acting” Narcotics for pain relief.

Types of Narcotics:
There are generally two types of narcotic pain medications available:

  • Quick-Acting, Short Duration Narcotics: Percocet, Vicodin, Codeine, Darvocet, OxyIR, Lorcet, Dilaudid, Demerol, etc.
  • Long Acting, Sustained Released Narcotics: OxyContin, Duragesic Patch, Methadone MS Contin

Quick-Acting Narcotics are used to control pain that is not expected to last more then 7-10 days (acute pain, such as pain after a sprain or after an operation). It is when you depend too much on the quick-acting narcotics to control long-term pain that tolerance and all the other bad effects associated with narcotics becomes a real problem.

The Correct Way to Use Narcotics for Pain to control chronic pain effectively and reasonably with Narcotics, you must strictly adhere to the following.

  • If prescribed by the doctor, minimize the use of any Quick-Acting Narcotic to control your pain. Do not take them on an everday basis so that you can give yourself a better chance to respond effectively to other non-narcotic pain medications, as listed below.
  • Have other non-narcotic pain medications on-board at the same time to help control your pain, like Neurontin, Ultram, Flexeril, Celebrex, etc. for their Narcotic-Sparing Effect.
  • Open your mind to the fact that there are other treatments available that can help control or even eliminate your pain, like spinal injections and nerve blocks, physical therapy and chiropractic, stress management and biofeedback techniques, acupuncture, etc.
  • During times of pain flare-ups, try to self manage your pain with maneuvers like bed rest and relaxation, use of ice packs and exercises. If you feel the need to increase medications, try using more of the pain adjuvants first. In other words, use of more narcotic medications in these situations should be your last resort.

Some Pointers for You

  • When given a prescription for a quick-acting narcotic to help control break-thru pain, like Percocet, Vicodin, Darvocet, etc., avoid at all times the temptation to take them on a daily fixed-schedule basis. "To be taken only as needed" means to take the narcotic only on the days when your pain flares up at its highest peak and not for your daily baseline pain.
  • All narcotics do not treat your pain; they just mask your pain. There are treatments that will be offered to you to help better control or to even cure your pain. As such, the long-term goal in your over-all pain management program is to eventually get you off these drugs when the time is right.
  • Don’t rely on narcotics as the only solution to you pain problem. Your prevailing attitude should be that they are a “necessary evil” to temporarily relieve your pain.

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