PAIN is the body’s language to indicate that something is not right, and unabated pain is definitely worrisome. Therefore you are advised to communicate to your doctor any experience with pain and to describe it clearly and precisely as possible for quicker targetted approach that is unique to you only. Pain management plan of action is never a one size fits all since each person has a different reaction to treatment. Therapeutic pain management with injectable requires specialised certified skills to deal with various administrative techniques, which, if done incorrectly, can have debilitating effects or even fatal incidents.

Types of pain are chronic pain (e.g. leg, knee, back), refractory pain (uncontrollable pain in spite of aggressive measures), acute pain (e.g. toothache or delivery), neuropathic pain (caused by nerve irritation e.g. shingles), nociceptive pain (e.g. due to injury to tissue), radicular pain (radiating from the back and hip into the legs through the spine) or functional pain (no obvious origin).

Chronic pain is a serious health condition and may have consequential effects on your quality of life. Persons with a history of depression may experience a worsening of their condition especially when pain affects your sleep. Simple tasks at home become burdensome and if you are employed, your work performance as well may be affected which may lead to financial instability.

Types of pain medication include OTCs like tylenol, NSAIDS like advil/ diclofenac/ naproxen, muscle relaxants like carisoprodol/ buscopan, anti-anxiety like valium, anti-depressants like amitriptyline, neuropathic pain meds like gabapentin and pregabalin and opioid analgesic like cocodamol, tramadol and oxycodone.

The mechanism of action for NSAIDs (nonsteroidal anti-inflammatory drugs) is to inhibit an enzyme cyclooxygenase (COX) which is released when the tissue is damaged. Drugs that inhibit this enzyme are further divided into COX1 and COX2 inhibitors, where the latter was designed to have an enhanced beneficial response with less pronounced risk on the stomach; so it may be considered favorable for persons with chronic pain. However the downside is that it is not suitable for the elderly or those persons with an impairment to the kidney. It increases your fluid retention thereby it may induce hypertension. So careful selection is required before placing patients on COX inhibitors.

There is a proposed theory that acetaminophen is a COX 3 inhibitor since it does not have any pronounced anti-inflammatory effect for swelling. It is used as a fever and pain reducer. Acetaminophen (US name) or paracetamol (British name) with brands as tylenol, panadol, cetamol and patanol are the safest on the stomach. Safe use is expanded to categories such as pregnancy, elderly, patients with compromised kidney function and those on other medications. But if the dosage is increased or if it is used over a prolonged period can still cause damage especially to the liver since it is metabolised in the liver. Hence a red flag alert with alcohol and other drugs such as anti-fungal which have to go through that same breakdown route. Anti-coagulants like warfarin and anti-seizure drugs like carbamazepine may also interact with acetaminophen.

Non pharmacological pain treatment includes yoga, lifestyle changes and meditation. Alternative treatment may be considered, for example medical marijuana. Other complimentary activities are physiotherapy, massage, acupuncture, hot and cold treatments.

Common drug formulations for pain meds are tablets, topicals like creams/ gels/ spray and patches. These formulations suppress pain through absorption by the skin so bypassing the stomach which can be appropriate for users of chronic pain medication. There are various methods to administer pain medications such as swallowing, sublingual absorption, suppositories, intravenous, subcutaneous, transdermal, intrathecal or nerve block.
Nerve blocks are used in situations where there is acute pain such as epidural in delivery, local anesthetics used by dentists or steroids used for the nerve and joint

Side fffects of pain medication are constipation, nausea, vomiting, sedation, drowsiness, impaired judgement and slowed breathing. Depending on the individual patient presentation, side effects are dealt with accordingly. So if the patient is constipated and his/her gastric condition permits you can increase fiber intake either in the natural form or as powder or other formulations. If the patient is able-bodied, exercise can also help with constipation, if not stool softener or laxatives can be added to the combo. In the case of the patient experiencing nausea or vomiting then an anti-nausea medication for example gravol or ondansetron is taken at least 30 minutes prior. In the case of a history of gastritis or stomach ulcer then a proton pump inhibitor like omeprazole or pantoprazole or the brand Nexium is used before pain meds. With respect to pronounced disorientation after use of especially opioid analgesia, then either a downward dosage adjustment or different drug can be prescribed once you alert the physician of your reaction to the dosage initially prescribed. In cases where oral medications are vomited up then injectable, intramuscular or patches especially in opioid analgesia are optional, depending on their availability and expertise for administration.

Other drug Interactions include antihistamine (piriton, diphenhydramine and loratidine) for allergy. Also CNS (central nervous system) depressants and general anesthetics require monitoring with concomitant use. In terms of narcotics the following may pose a challenge such as anti-seizure medications (carbamazepine, dilantin), some antibiotics (clarithromycin) and anti-depressants, muscle relaxant and sedatives (valium).

Opioid analgesia releases endorphins in the brain, a neurotransmitter which dulls the pain and produces a pleasurable experience. Addiction to opioid analgesia is a big problem in the countries that do not have strict protocols and control mechanisms in place to deal with genuine cases. Tolerance may be developed to the dosages and the person may request the drug more often to experience that feeling of powerful sense of well-being.
Generally pain management is a niche market opportunity but must include a multidisciplinary approach for the management of symptoms and side effects.

For further pharmacological guidance and physician referral, consult the pharmacist at Medicine Express PHARMACY located at 223 Camp Street, between Lamaha and New Market Streets. If you have any queries, comments or further information on the above topic kindly forward them to medicine.express@gmail.com or send them to 223 Camp Street, N/burg. Tel #225-5142.