Issue link: http://viewer.e-digitaledition.com/i/872903
It may seem like the best way to manage chronic pain is through prescription medications. However, prescriptions of opioid-based pain medications, such as hydrocodone, hydromorphone, morphine, fentanyl and codeine blended with acetaminophen, are some of the most common causes of drug addiction. S O L U T I O N S DUE TO THE RISK of addiction, opioid-based pharmaceuticals are usually not an ideal first line of treatment, except for patients with serious conditions or those who have undergone major surgeries. When an opioid medication is prescribed, it is recommended that the patient take the drug only as directed and talk with the doctor about any dependency concerns. Opioids become less effective as a patient's body grows accustomed to the dosage. This may cause patients to use more of the medication than is prescribed to achieve the same relief over time—a misstep that further increases the risk of drug addiction or overdose. "The United States is in the middle of an opioid overdose epidemic," says Soheila Jafari, M.D., chief of the division of pain management at NewYork-Presbyterian Brooklyn Methodist Hospital. "Opioid overdose is the number one cause of accidental death in the U.S." In fact, opioid overdose in the U.S. caused more than 33,000 deaths in 2015, and nearly half of those deaths involved prescription medication. Such statistics underscore the need to address chronic pain in a different way whenever possible. WHEN IS PAIN CHRONIC? "It used to be common practice to consider pain chronic when it lasted for more than three to six months," Dr. Jafari says. "Today, chronic pain is diagnosed more on a case-by-case basis, usually when it lasts longer than a certain amount of time depending on the cause of the pain." Chronic pain can be caused by an ongoing medical condition like arthritis, multiple sclerosis, spinal stenosis, cancer or diabetes. It can also occur as a result of an injury or a surgery. Chronic pain can occur in any part of the body, but headaches, joint pain, back pain, cancer pain caused by tumors pressing against nerves, organs or bones, benign (noncancerous) tumor pain and neuropathic pain (associated with the nervous system) are some of the most common complaints. No matter what the origin of chronic pain, people who have it all share the same goal—to find relief. RELIEF IN MANY FORMS The cause of chronic pain drives the treatment recommendation. "For instance, in the case of chronic joint pain, doctors might prescribe drugs that carry no risk for addiction—such as topical medications or anti-inflammatory medications—in conjunction with a non-pharmaceutical recommendation like losing weight," says Dr. Jafari. "For chronic pain due to neurologic conditions like cerebral palsy or multiple sclerosis, doctors might prescribe physical therapy paired with muscle relaxants, which are less likely to be addictive than opioid-based drugs when taken as directed." MUSCLE RELAXANTS like cyclobenzaprine and methocarbamol operate within the brain and spinal cord to help alleviate the feeling of pain rather than directly affecting the muscle. INJECTIONS deliver medication directly to a problem area through a small needle. Trigger point injections, for example, target painful knots in muscle tissue while a series of epidural steroid injections is often used to provide temporary relief—up to a year for some patients—in some cases of neck, back or leg pain. NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDs) like ibuprofen and naproxen (over the counter) and celecoxib or indomethacin (prescription) are designed to reduce swelling to relieve pain. These options are often prescribed for rheumatoid arthritis and osteoarthritis. TOPICAL MEDICATIONS often prescribed as transdermal patches, gels or creams, can be applied on the skin at the source of the pain and may provide an option for people with chronic pain from muscle spasms. The skin absorbs active ingredients like capsaicin, salicylates, lidocaine and diclofenac, which distract nerves from chronic pain intensity. THE FOLLOWING PHARMACEUTICAL OPTIONS OUTLINE SOME OF THE MEDICATIONS THAT DOCTORS MAY PRESCRIBE TO ALLEVIATE CHRONIC PAIN. FOR CHRONIC PAIN FA L L 2 017/ / W W W.N Y P.O RG / BRO OKLY N 8 T H E R I G H T C H O I C E S