Don't Lose Heart

There are many pain relievers out there, both over-the-counter, and prescription. Finding the right one for you or your loved one is important. Here are the main types of pain relievers; what they do; how they work; what kind of pain they’re good for; what to watch out for. And remember, if you’re taking a prescription medication you should always check with your doctor before taking a pain reliever, to make sure there will be no adverse drug interactions. Overuse of any pain reliever can have hazardous consequences – be sure to read and follow the recommended doses on the bottle.

OVER THE COUNTER (OTC) PAIN RELIEVERS
Drugs available without a doctor’s prescription

POSSIBLE SIDE EFFECTS

• Acetaminophen rarely has side effects, but liver damage can occur if taken in conjunction with alcohol.
• NSAIDs may cause stomach upset, bruising, or bleeding. When taken regularly, they may cause kidney damage.
• NSAIDs can interfere with the stomach’s ability to produce mucus and bicarbonate,  which can lead to ulcers.
• Use of some common pain relievers, including NSAIDs, may be an important cause of secondary hypertension. Among the NSAIDs that may increase blood pressure are ibuprofen (Advil, Motrin, Rufen) and Naproxen (Anaprox, Naprosyn, Aleve). In one important study, women who used an NSAID for five or more days a month had a significantly higher risk for hypertension.

WARNINGS

Do not take acetaminophen if you:

• Have severe kidney or liver disease
• Have three or more alcoholic drinks per day
• Are taking another product containing acetaminophen

Talk with your doctor before you take an NSAID (especially aspirin) if you:

• Are allergic to aspirin or other pain relievers
• Have three or more alcoholic drinks per day
• Have bleeding in your stomach or intestines, or have stomach ulcers
• Have liver or kidney disease
• Have heart disease
• Take blood-thinning medicine or have a bleeding disorder.

Children and teenagers under the age of 18 who may have the flu or chickenpox should not take aspirin because of the risk of Reye’s syndrome, which is a serious illness that can lead to death.

NSAIDs can interact with blood pressure medicines. People who takes medicine for high blood pressure and also takes an NSAID may find that their blood pressure medicine does not work as well as it should.Many OTC cold medicines contain acetaminophen. Be sure to check the list of ingredients to make sure you don’t take too much acetaminophen.

PRESCRIPTION PAIN RELIEVERS
Drugs available only with a doctor’s prescription

• Prescription NSAIDs  (Diclofenac, Etodolac, Fenoprofen, Flurbiprofen, Ibuprofen, Indomethacin, Meclofenamate,  Mefenamic Acid, Meloxicam, Nabumetone, Naproxen, Oxaprozin, Piroxicam, Sulindac, Tolmetin) There are 2 classes of prescription NSAIDs, Traditional, and COX-2 inhibitors.  COX-2 inhibitors include Celecoxib. Nonsteroidal anti-inflammatory drugs (also called NSAIDs) stop cyclooxygenase enzymes (also called COX enzymes) in your body from working. COX enzymes speed up your body’s production of hormone-like substances called prostaglandins. Prostaglandins cause the feeling of pain by irritating your nerve endings. They are also part of the system that helps your body control its temperature. By reducing the level of prostaglandins in your body, NSAIDs help relieve pain from conditions like arthritis. They also help reduce inflammation (swelling), lower fevers and prevent blood from clotting.Traditional NSAIDs stop both COX-1 and COX- 2 enzymes from doing their jobs. When COX-1 enzymes are blocked, pain and inflammation is reduced, but the protective lining of your stomach is also reduced. This can cause problems such as upset stomach, ulcers, bloating and bleeding in your stomach and intestines.COX-2 inhibitors only stop COX-2 enzymes from working. Since the COX-2 enzyme doesn’t help to protect your stomach, COX-2 inhibitors may be less likely to irritate your stomach or intestines. Read more at FamilyDoctor.org
• Corticosteroids (Deltasone, Hydeltrasol and Solu-Medrol) provide relief for inflamed areas of the body by easing swelling, redness, itching and allergic reactions. Corticosteroids can be used to treat allergies, asthma and arthritis. When used to control pain they are generally given in the form of pills or injections.
• Opioids/Narcotics (Morphine, Fentanyl, Oxycodone, Codeine) are narcotic pain medications that contain natural, synthetic or semi-synthetic opiates. Opioids are often used for acute pain, such as short-term pain after surgery and do not cause bleeding in the stomach. It’s rare for people to become addicted to opioids when used to treat pain for a short period of time. Opioids have been used for centuries to relieve pain. Those opioids that are derived from the seedpod of the poppy plant (papaver somniferum) are referred to as opiates. Morphine and codeine are commonly known opiates derived from opium. Other opioids include synthetics such as meperidine (Demerol) and chemicals naturally found in the body, such as endorphin. Opioids work to relieve pain in two ways. First, they attach to opioid receptors, which are specific proteins on the surface of cells in the brain, spinal cord and gastrointestinal tract. These drugs interfere and stop the transmission of pain messages to the brain. Second, they work in the brain to alter the sensation of pain. These drugs do not take the pain away, but they do reduce and alter the patient’s perception of the pain.
• Opioid/Acetaminophen Combinations (Endocet, Magnacet, Percocet, Perloxx, Primalev, Roxicet, Tylox, Xolox) contains a combination of oxycodone and acetaminophen. Oxycodone is in a group of drugs called narcotic pain relievers. Acetaminophen is a less potent pain reliever that increases the effects of oxycodone. Endocet is used to relieve moderate to severe pain. Do not use Endocet if you are allergic to acetaminophen (Tylenol) or oxycodone. Oxycodone may be habit-forming and should be used only by the person it was prescribed for. Endocet should never be given to another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it.If you have certain conditions, you may need a dose adjustment or special tests to safely use Endocet. Before you take this medication, tell your doctor if you are allergic to any drugs, or if you have: asthma, COPD, sleep apnea, or other breathing disorders; liver or kidney disease; a history of head injury or brain tumor; epilepsy or other seizure disorder;low blood pressure; a stomach, intestinal, or pancreas disorder; underactive thyroid; Addison’s disease or other adrenal gland disorder; enlarged prostate, urination problems; curvature of the spine; mental illness; or a history of drug or alcohol addiction. Tell your doctor if you drink more than three alcoholic beverages per day or if you have ever had alcoholic liver disease (cirrhosis). You may not be able to take medication that contains acetaminophen.It is not known whether Endocet is harmful to an unborn baby, but it could cause breathing problems or addiction/withdrawal symptoms in a newborn. Before you take Endocet, tell your doctor if you are pregnant or plan to become pregnant during treatment. Acetaminophen and oxycodone may pass into breast milk and could harm a nursing baby, so don’t use Endocet without telling your doctor, if you are breast-feeding a baby.
• Antidepressants (Selective Serotonin Reuptake Inhibitors (SSRIs) such as Celexa, Prozac, Paxil, and Zoloft; Tricyclic antidepressants such as Elavil, NorpraminSinequan, Tofranil, and Pamelor; Selective Serotonin and Norepinephrine Reuptake Inhibitors (SSNRIs) such as Effexor and Cymbalta) treat pain and/or emotional conditions by adjusting levels of neurotransmitters (natural chemicals) in the brain. These medications can increase the availability of the body’s signals for well-being and relaxation, enabling pain control for people with chronic pain conditions that do not completely respond to usual treatments. Chronic pain conditions treated by low-dose antidepressants include some types of headaches (like migraines) and menstrual pain. These drugs require a steady dose of the medicine build up in the body over a period of time to work. The doses needed to treat pain are often lower than those needed to treat depression.
• Anticonvulsants (Tegretol, Neurontin and Lyrica) are usually used to treat seizure disorders. Some anticonvulsants can be effective in treating pain as well. How these medicines control pain is unclear but it is thought that they minimize the effects of nerves that cause pain.
• Topical pain relief (Lidoderm patch) are patches placed on the skin to send signals that reduce or stop pain.
• Cannabinoids(Medical Marijuana) Numerous studies have now established that cannabinoids help lessen pain and help those suffering from AIDS, anorexia, arthritis, cachexia, cancer, chronic pain, glaucoma, migraine, persistent muscle spasms, multiple sclerosis, epilepsy, and severe nausea. Such research has also demonstrated that cannabinoids may work together with opioids to enhance their effectiveness and reduce tolerance. Marijuana was listed by the U.S. Pharmacopeia, the organization that sets quality standards for approved drugs in the United States, until the 1940s, when political pressure against marijuana’s recreational use triggered its removal. Arizona, Alaska, California, Colorado, Hawaii, Maine, Maryland, Michigan, Montana, Nevada, New Mexico, Oregon, Rhode Island, Vermont, Washington; all allow medical marijuana use.When taken orally, cannabinoids are not very well absorbed and often have unpredictable effects. Patients often become sedated or have intoxication-like symptoms. Inhaling cannabinoids, especially THC, also may cause problems for many patients. Blood levels rise suddenly and then drop off sharply, which may produce significant intoxication, particularly in patients who are new to cannabinoids.  This is the very reason that recreational users prefer the inhaled route. Patients, however, generally wish to avoid these effects, and it is unclear how difficult it might be to find a dosing pattern that enables them to have pain control without intoxicating side effects.The pharmacological properties of cannabis have led thirty-six states to permit its use as a therapeutic drug for, among others, those suffering from AIDS; various painful, incurable and debilitating illnesses, the side effects of chemotherapy, and glaucoma. Additional research is being conducted concerning the use of marijuana on the treatment of anxiety and mental disorders. Marijuana is like any other powerful prescription drug: it has potentially dangerous side effects, and the decision to use it to treat patients must involve the same balancing test as the one required for any potent drug. Smoking marijuana regularly (a joint a day) can damage the cells in the bronchial passages which protect the body against inhaled microorganisms and decrease the ability of the immune cells in the lungs to fight off fungi, bacteria, and tumor cells. Read more…  The Pros and Cons of Medical Marijuana
  States that allow Medical Marijuana in 2011

Common side effects of prescription NSAIDs may include the following:

• Dizziness
• Headache
• Nausea
• Diarrhea
• Excess gas
• Constipation
• Extreme weakness or fatigue
• Dry mouth

Serious side effects of prescription NSAIDs may include the following:

• Allergic reaction, such as difficulty breathing, hives, swelling of the lips, tongue or face
• Muscle cramps, numbness or tingling
• Rapid weight gain
• Black, bloody or tarry stools
• Bloody urine or bloody vomit
• Decreased hearing or ringing in the ears (also called tinnitus)
• Jaundice (the yellowing of the skin and the whites of the eyes)
• Abdominal cramping
• Heartburn
• Indigestion

In addition to the side effects listed above, people taking a COX-2 inhibitor may be at risk for the following side effects:

• Swelling or water retention
• Skin rash or itching
• Unusual bruising or bleeding
• Difficulty sleeping (insomnia)

Side effects of Corticosteroids may include:

• Weight gain
• Upset stomach
• Headache
• Mood changes
• Trouble sleeping
• Weakened immune system

Side effects of Opioids may include:

• Drowsiness
• Nausea
• Constipation
• Itching
• Breathing problems
• Addiction

Side effects of Antidepressants may include:

• Blurry vision
• Constipation
• Difficulty urinating
• Dry mouth
• Fatigue
• Nausea
• Headache

Side effects of Anticonvulsants may include:

• Drowsiness
• Dizziness
• Fatigue
• Nausea

Call your doctor as soon as possible if your side effects become severe.