Pain Medication

Lyrica (pregabalin)

Greg — Thu, 17 Apr 2008 07:46:59 -0700

Brand name: Lyrica (generic: pregabalin)

Overall comments
Lyrica (pronounced LEER-i-kah) is an anti-convulsant (seizure) medicine and considered by many to be a pain relief medication. It is indicated for treatment of four specific conditions, and though it is not indicated or FDA approved for use to treat pain, it is prescribed (off label) by doctors to treat certain types of chronic pain.

NSAIDs: Non-Steroidal Anti-Inflammatory Drugs

spine-health — Mon, 17 Dec 2007 08:42:12 -0800

Because most episodes of back pain have inflammation as a contributing factor, anti-inflammatory medication such as non-steroidal anti-inflammatory drugs (NSAIDs) is often an effective pain medication treatment option.

About Celebrex (Celecoxib) COX 2 inhibitor

spine-health — Mon, 17 Dec 2007 08:42:12 -0800

Since the September 2004 recall of Vioxx, recent studies have raised questions about the potential side effects of COX-2 inhibitors. For more information, please see Understanding COX-2 inhibitor side effects.

Celebrex is the brand name of a prescription pain medication in the COX-2 inhibitor class of drugs. The active ingredient in Celebrex is celecoxib. Celebrex works by reducing inflammation, which often is a component of arthritis, back pain and neck pain.

About Celebrex and Bextra

spine-health — Mon, 17 Dec 2007 08:42:12 -0800

On April 7, 2005 the Food and Drug Administration requested that Pfizer suspend sales of Bextra in the United States. As a result, Bextra will no longer be available to patients in the United States.

Since the September 2004 recall of Vioxx, recent studies have raised questions about the potential side effects of COX-2 inhibitors. For more information, please see Understanding COX-2 Inhibitor Side Effects.

Accelerated opiate neuro-regulation rapid detoxification

spine-health — Mon, 17 Dec 2007 08:42:13 -0800

Patients with the following characteristics may be a candidate for accelerated opiate neuro-regulation form of rapid detoxification:

Patients with chronic pain who have needed to escalate their dose of pain medications, or who have not needed to escalate their dose, indicating tolerance and lack of effect of the drugs
Patients who are physically dependent upon narcotic drugs (including methadone, heroin, Vicodin, OxyContin, HydroCodone or other medications containing codeine or morphine)
read more

Acetaminophen

spine-health — Mon, 17 Dec 2007 08:42:12 -0800

Acetaminophen is probably the single most effective non-prescription medication for lower back pain and has the fewest side affects. Tylenol is an example of a well-known medication that has acetaminophen as its active ingredient.

Alcohol avoidance

spine-health — Mon, 17 Dec 2007 08:42:12 -0800

While alcohol is sometimes used as a self-prescribed medication to help deal with chronic pain, it probably causes far more problems than it solves and should not be used to treat low back pain. Although alcohol will act as a muscle relaxant, it does not have any actual analgesic (pain killing) effect.

Anti-seizure medications (neuroleptic drugs)

spine-health — Mon, 17 Dec 2007 08:42:12 -0800

Neuroleptic drugs are often prescribed to help patients with nerve type pain (which typically shows as leg pain) and for patients who have neuropathy (degeneration of the nerves). These drugs can also be helpful for patients who have continued leg pain after surgery.

Antidepressants: Definitive Guide

spine-health — Mon, 17 Dec 2007 08:42:12 -0800

Antidepressant drugs for treatment of depression as well as other disorders that may occur alone or in combination with depression, such as chronic pain, sleep disorders, or anxiety disorders.

The class of drugs known as antidepressants is used primarily to treat clinical depression (also called major depression).

See the following for causes, symptoms, diagnosis and treatment of depression:

Are Your Medications Making You Sick?

spine-health — Mon, 17 Dec 2007 08:42:12 -0800

If you are feeling so-so or are experiencing more serious symptoms, it's possible that your back pain medications are the cause. While the recent media attention to certain drugs has certainly raised a red flag for many patients, the sometimes misleading or contradictory headlines have also created confusion and unnecessary fear for many. In this newsletter and on Spine-health.com, we profile (based on the facts) potential side effects and risks of several commonly used drugs for back pain.

Arthritis and NSAIDs for Pain Relief

spine-health — Mon, 17 Dec 2007 08:42:12 -0800

Joint pain from arthritis

In general, arthritis is a condition that involves any inflammation of joints. In the back, facet joint osteoarthritis can be a very painful condition. Facet joint osteoarthritis (degenerative arthritis) causes a breakdown of cartilage between the facet joints in the back and generally occurs in adults over the age of 60. When the joints move, the lack of cartilage causes pain as well as loss of motion and stiffness.

COX-2 inhibitor risks and complications

spine-health — Mon, 17 Dec 2007 08:42:12 -0800

As with all medications, COX-2 inhibitors like Celebrex have risks and potential side effects and complications. While a few major risks and potential side effects are outlined here, patients should always read the label and package insert and consult with their physician for a complete understanding of risks and other issues.

COX-2 Inhibitors: Celebrex

spine-health — Mon, 17 Dec 2007 08:42:12 -0800

COX-2 inhibitors background information

Arthritis pain is one of the most prevalent medical problems in the world and afflicts tens of millions of people. For those who suffer from rheumatoid arthritis or osteoarthritis (degenerative arthritis) the pain can be chronic and disabling. Relief from arthritis pain is critical in order improve their functional ability and—importantly—their overall quality of life.

FDA advisory on Bextra withdrawal, Celebrex and other NSAIDs

spine-health — Mon, 17 Dec 2007 08:42:12 -0800

FDA information on Bextra and Celebrex

Fibromyalgia: Medications for fibromyalgia

spine-health — Tue, 11 Dec 2007 21:25:43 -0800

Various classes of medications have been evaluated in the treatment of fibromyalgia, including:

Tricyclic anti-depressants

Muscle relaxants

Sedatives/hypnotics

Non-steroidal anti-inflammatory medications (NSAID’s)

Cortico steroids

Medications for Back Pain and Neck Pain

spine-health — Mon, 17 Dec 2007 08:42:12 -0800

There are multiple over-the-counter (non-prescription) and prescription medications that can be helpful in relieving pain and addressing related symptoms while an episode of low back pain is getting better. Careful attention to pain management is a critical component of a patient’s recovery, as acute or chronic low back pain can lead to depression, difficulty sleeping, and difficulty exercising and stretching, all of which in turn can exacerbate and prolong a painful back condition.

Muscle relaxants

spine-health — Mon, 17 Dec 2007 08:42:12 -0800

Muscle relaxants are not really a class of drugs, but rather a group of different drugs that each has an overall sedative effect on the body. These drugs do not act directly on the muscles, rather they act centrally (in the brain) and are more of a total body relaxant.

Narcotic Pain Medications

spine-health — Mon, 17 Dec 2007 08:42:12 -0800

For severe episodes of low back pain, narcotic pain medications may be prescribed. Clearly, narcotic agents are strong and potentially addictive forms of medication and should only be administered by a physician.

All narcotic agents have a dissociative effect that helps patients manage pain. It does not actually deaden the pain, but works to dissociate patients from the pain. Commonly used narcotics, listed in ascending order of potency (strength) include:

codeine (e.g. Tylenol #3)
propoxyphene (e.g. Darvocet)
read more

New research on COX-2 inhibitors and other NSAIDs

spine-health — Mon, 17 Dec 2007 08:42:12 -0800

What led to the Vioxx recall?

Vioxx is a COX-2 inhibitor that was originally approved by the FDA in 1999 to be used for pain relief and reducing inflammation for patients with osteoarthritis, as well as for menstrual pain. It was later approved to be used for rheumatoid arthritis.

Oral Steroids

spine-health — Mon, 17 Dec 2007 08:42:12 -0800

Oral steroids, a non-narcotic type of prescription medication, are very powerful anti-inflammatory medications that are sometimes an effective treatment for low back pain. Like narcotics agents, oral steroids are intended for use for short periods of time (one to two weeks). Oral steroids come in many forms, but are usually ordered as a Medrol Dose Pack in which patients starts with a high dose for initial low back pain relief and then taper down to a lower dose over five or six days.

Osteoporosis medications

spine-health — Mon, 17 Dec 2007 08:42:12 -0800

Osteoporosis, which is a thinning of the bones as we age, can cause significant back pain if it causes vertebral body fractures. Recently, several drugs have been approved for use in the treatment of osteoporosis to reduce the risk of fractures. Osteoporosis medications work by reducing the bone loss and increasing mineral deposition in the bones.

Pain Killer Addiction Treatment

spine-health — Mon, 17 Dec 2007 08:42:13 -0800

Pain killer addiction and recovery

Potential Risks and Complications of NSAIDs

Greg — Mon, 05 May 2008 11:51:11 -0700

As with any medication, there are a number of potential risks, side effects and complications that it patients need to be aware of prior to starting to take the any form of the medication.

Preserving bone density

spine-health — Mon, 17 Dec 2007 08:42:11 -0800

After puberty, bone growth ends but bone density increases until roughly age 30. Absorption and retention of calcium decreases while calcium losses increase, leaving a requirement that is estimated to be 1000 mg/day.

The drainage of calcium from bone occurs in all humans at a steady pace, but women are clearly more at risk for losses. Variability in calcium loss is best seen in pregnancy when calcium is taken from the mother’s stores for deposition in the fetus. Also, lactation creates an ongoing need for further calcium supplementation in women.

Rapid opiate detoxification treatment

spine-health — Mon, 17 Dec 2007 08:42:13 -0800

Medical treatment strategies for opiate addiction have evolved since the 1950’s, when methadone was first used to aid withdrawal. Methadone maintenance programs, in which patients are given methadone, another opiate, as a substitute for the drug of dependence, have been a mainstay of opiate addiction treatment for decades. Now other drugs, like buprenorphine, are given in a similar way to be a substitute for the drug of addiction. For the majority of patients this is not an acceptable alternative, because the physical dependence continues, and is often a lifelong commitment.

References

spine-health — Mon, 17 Dec 2007 08:42:13 -0800

References

Albanese AP, Gevirtz C, Oppenheim B, Field JM, Abels I, Eustace JC. Outcome and Six Month Follow Up of Patients After Ultra Rapid Opiate Detoxification (UROD). J Addict Dis. 2000;19(2):11-28. ABSTR ONLY.
American Society of Addiction Medicine Public Policy Statement on Rapid and Ultra Rapid Opioid Detoxification. April 2005.
read more

Safe Use of COX-2 Inhibitors and other NSAIDs

spine-health — Mon, 17 Dec 2007 08:42:12 -0800

Patients who were taking Vioxx or who are currently taking Celebrex, Bextra, Aleve or other NSAIDs may be confused about what action to take in light of recent study findings, FDA recommendations and Merck’s decision to withdraw Vioxx. While staying educated with up-to-date and accurate information, patients should work with a physician to find the safest and most effective medication options for their particular situation.

Sleep Aids for People with Chronic Pain

spine-health — Mon, 17 Dec 2007 08:42:13 -0800

Types of NSAIDs

Greg — Mon, 05 May 2008 11:55:00 -0700

The following provides a more comprehensive list of different types of NSAIDs. Please see Most Common Types of NSAIDs for a more in-depth review of the common NSAIDs.

Types of NSAIDs

Generic name

Brand name(s)

Salycylic acids

Ultram Pain Reliever

spine-health — Mon, 17 Dec 2007 08:42:12 -0800

Ultram is a type of narcotic-like oral pain reliever that is often prescribed to treat low back pain. Ultram, also known as tramadol, was approved by the FDA in 1998 and acts centrally (in the brain) to modulate the sensation of pain.

Understanding COX-2 inhibitor side effects

spine-health — Mon, 17 Dec 2007 08:42:12 -0800

COX-2 inhibitor drugs and other NSAIDs - important new information

Using COX-2 inhibitors—Celebrex

spine-health — Mon, 17 Dec 2007 08:42:12 -0800

Discovery of COX-2 inhibitors - a new type of NSAID

The cyclooxygenase (COX) enzyme was first isolated in 1976. However, in 1991 it was discovered that there are actually two enzymes: COX-1 and COX-2.

Vioxx recall and recommendations

spine-health — Mon, 17 Dec 2007 08:42:13 -0800