Pain…physical pain. We’ve all had it. None of us (except those who are masochists) like it or want it. From the mildest headache to the most excruciating kidney stone, pain comes in many forms and severity. It is estimated that 100 million Americans suffer some form of chronic pain, and when you add to this the number of us who suffer from acute pain (injuries, postsurgical pain, the common headache or toothache, etc.), it is easy to appreciate the magnitude of this problem.
Whenever possible, we all want and expect relief from pain, but few of us appreciate the potential dangers inherent in the way moderate-to-severe pain has been handled by the medical community in the last few decades. For pain that is moderate to severe—from whatever cause—there had been a prevailing view that brief, controlled use of narcotic medications such as Percocet (oxycodone) or Vicodin (hydrocodone) was acceptable and appropriate. However, in light of recent studies and literature to the contrary, we now know that these medications and those similar to them have a far wider potential for abuse, danger and overdose than originally thought.
First, a little background. The human body contains untold receptors in the central and peripheral nervous system that react to a class of naturally occurring and synthetic drugs used to relieve pain. These opiates and opioid-type medicines, as opposed to the commonly known anti-inflammatory pain medicines (aspirin, ibuprofen, naproxen, etc.), interact with these receptors to cause a decrease in pain perception and an overall feeling of well-being. However, these medications not only cause side effects, including itching, constipation, slowed breathing and difficulty urinating to name a few, but they have the potential for addiction and tolerance (increasing doses are needed to achieve the desired pain-relieving effect). As a result, it is estimated by the National Institutes of Health that more than two million people in our country have become addicted to this class of medication after receiving prescriptions written to relieve pain. Alarmingly high rates of near-overdoses and overdose-related deaths are reaching the hundreds of thousands each year. The government is trying to tackle the problem of addiction in new and novel ways, but the end is nowhere in sight.
What can you, the average patient who wants relief from moderate-to-severe pain, do to get the pain in check without the inherent dangers of opioid therapy? I have a few suggestions…
- When it comes to postsurgical pain, consider skipping this class of medicine altogether. Now, this won’t always be possible because of the severity of some types of pain. It is up to you to decide your own tolerance for pain and how to deal with it. Consider asking your doctor for the newer injectable forms of the standard anti-inflammatory painkillers. Ibuprofen and naproxen now are available in injectable forms (another med in this class, injectable ketorolac, has been around for decades). These medicines may be appropriate in some cases to give you the pain relief you need.
- Consider the newer form of injectable acetaminophen, better known as Tylenol in pill form. Ofirmev is the brand name of this newer agent and it has shown promise for postsurgical pain relief. Realize, though, that this drug will not have the anti-inflammatory properties of the others mentioned above.
- A groundbreaking time-released form of the local anesthetic Exparel has emerged as a novel way to treat surgical pain. This medication, injected by the surgeon or anesthesia provider, can result in longer-lasting pain relief with much fewer side effects as compared to the nonsteroidal anti-inflammatories or narcotic medicines.
- Alternative pain relief can be achieved with the use of specific nerve blocks. Ask the anesthesia provider if this is possible. Local anesthetics can be released over time in epidurals and other nerve blocks (for the arm, hand, leg or foot, etc.) with the use of infusion pumps and other devices.
- Guided imagery and other modalities (neuro-feedback, using brain imaging technology) are showing some promise.
- The use of medical marijuana is also gaining some traction for pain relief in some areas of the country.
Because of the addiction and abuse problem of narcotic pain medicines, the pendulum is starting to swing away from their automatic use and toward a more cautious approach. The root causes of the epidemic have been identified—cavalier prescribing, social acceptance and drug-company marketing efforts let the opiate genie out of the bottle decades ago. Getting the genie back in the bottle is going to be a struggle. Along with the alternative therapies I have mentioned, drugmakers are now looking at painkilling medicines that have less potential for addiction and tolerance. Also, drugs like Lyrica and Neurontin have emerged as useful players in relieving some forms of chronic pain. In 2017, the world of pain relief has never seen such concentrated research and innovation.
You need to communicate with your doctor to avoid the pitfalls of potential addiction and abuse. Ask your doctor about the alternatives available to handle your pain. Your body will thank you for the effort.
For more with Dr. Sherer, click here for his podcast and video interviews, or purchase his memoir, The House of Black and White: My Life with and Search for Louise Johnson Morris.