You may have read several articles in the news lately about opioids and pain medications. Earlier in July, The New York Times printed two separate articles on the dangers and abuse of prescriptions drugs in the States. On July 1st, Sabrina Tavernise’s Prescription Overdose Deaths in Florida Plunge After Tough Measures, Report Says, appeared in the Health section and on July 3rd, The Op-Ed editors wrote a piece entitled States and Painkiller Overdoses.
Obviously, the media is very concerned regarding the large number of pain medications being prescribed, the amount of medications being misused and/or diverted, and the adverse effects of the medication, particularly addiction.
Back in the day, alcohol was used as anesthesia for surgeries – patients were given a bottle of bourbon and told to bite the bullet. Modern medicine introduced Ether and chloroform for surgical procedures and morphine to control the pain after the surgery. Morphine was thought to only be effective by injection, but then we found that morphine tablets and liquid taken by mouth could be just as effective in relieving pain. Morphine was then used for patients with terminal cancer pain. Why not make a dying patient comfortable?
The availability of oral instead of injectable morphine allowed doctors caring for cancer patients to more easily relieve the suffering that many dying cancer patients experienced. If it was good for cancer pain, why not use it for back pain and neck pain? Short acting and long acting morphine-like drugs were developed and a new approach to pain control became the standard of care. Use morphine and other related drugs, such as oxycodone, Oxycontin, Dilaudid, and hydrocodone, and if the patient has more pain, raise the dose of pain medication.
Although overdose could interfere with breathing and cause death, the most troublesome side effect with careful use was thought to be constipation. Other adverse effects of these medications began to be observed, such as addiction and opioid-induced hyperalgesia (when the morphine-like pain medication actually causes more pain).
In addition, people who had been using mind-altering drugs like heroin recognized that they could get the same effect from prescribed medications, which could be cleaner and cheaper. The illicit use of prescription pain drugs is a growing problem in the USA, and are actually the preferred street drug after marijuana.
At NMPI, we only use prescription drugs like oxycodone, Oxycontin, Dilaudid, and hydrocodone to relieve severe pain when patients are unresponsive to our usual therapies. We take a holistic approach to the treatment of pain. Our treatments include:
- Exercises
- Muscle/tendon injections (no cortisone or any other steroids are ever injected into the muscle tissue)
- Low-level laser therapy, which can aide in the healing of damaged muscle tissue and sensitized fibers found in the muscle attachments.
- Traditional and novel medications, relaxation therapy, and counseling
In the next few blogs, I will discuss the problems arising with prescription drugs for pain relief and what steps are being taken to try to manage this problem.
Tagged with: Dr. Marcus • Dr. Norman Marcus • Norman Marcus • Norman Marcus Pain Institute • pain medication • prescriptions
Filed under: pain management
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What about tramadol and codeine with or without and NSAID ?
I was asked if Tramadol and codeine pose the same problems as other strong pain medications (opioids). Tramadol was originally thought to be a drug of minimal abuse but it turns out that it is commonly abused by narcotic addicts, chronic pain patients, and health professionals. The American Association of Poison Control Centers reported a total of 13,067 tramadol related events in 2012 and 9 associated deaths. The Drug Abuse Warning Network estimated that 16,251 emergency department visits were related to the nonmedical use of tramadol in 2010, which rose in 2011 to an estimated 20,000 visits. With this experience, the FDA has reclassified Tramadol so that beginning mid-August 2014, the rules of prescribing tramadol are stricter.
Codeine is typically weaker than most other drugs in its class (opioids). Codeine-containing cough syrup is a drug frequently abused by adolescents. Its sale is now closely monitored. Codeine is converted to morphine in your body. The amount of morphine produced and the potential for life-threatening side effects are determined by two factors: 1. The genetic make-up of the individual (which determines if the codeine will be converted to morphine minimally or maximally), and 2. The use of another drug. Typically, the drugs that can interact with codeine are antidepressants (such as bupropion, fluoxetine or paroxetine), a depressant (such as alcohol, a benzodiazepine (such as diazepam or lorazepam), or another opioid (such as oxycodone or hydrocodone). The vast majority of patients who had an accidental death rather than obvious suicide were taking one or more of these drugs; therefore patients prescribed any opioid should be warned about the dangers of drug interactions.