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Treatment of Pain : Pain can occur for many reasons, and strike in a variety of locations. Back pain, disc pain, facet and nerve root pain, chronic headache pains and migraines are just a few of the problems that we can diagnose and treat: Acute and Chronic Back Pain Pelvic Pain Post-surgical Failed Back Syndrome Diabetic Neuropathy Disc Pain, Facet and Nerve Root Pain Atypical Facial Pain Complex Regional Pain Syndromes; RSD Herpetic and Post-Herpetic Neuralgia Chronic Headache Pain; Migraines Other painful conditions resulting from disease and injury
Analgesics OTC : Many pain medications are available over-the-counter (without a prescription, or OTC) in the U.S. for short-term relief of joint pain, muscle aches, headache, menstrual cramps, and fever. These OTC analgesics are generally well tolerated and safe when used properly. But side effects do occur and in some instances can be serious. Today, we will ask Dr. William Shiel how to use these analgesics properly in order to minimize risks and side effects. We will also ask him to compare traditional pain relievers with the newer pain relievers, the selective COX-2 inhibitors. There are two major classes of pain relievers available in this country without prescription; they are acetaminophen (Tylenol) and Nonsteroidal antiinflammatory drugs (NSAIDs).
Non-steroidal anti-inflammatory drugs : Non-steroidal anti-inflammatory drugs are medications that impair the production of prostaglandins in the body. Prostaglandins are natural compounds that are responsible for producing fever, pain, and inflammation. They are called non-steroidal anti-inflammatory drugs because they reduce inflammation without the side effects of steroids. Steroids (Prednisone, Cortisone, Medrol, etc.) are potent medications that reduce inflammation, but steroids have predictable and potentially serious side effects, especially with long-term use. Non-steroidal anti-inflammatory drugs do not have these steroid side effects. They are called non-steroidal anti-inflammatory drugs because they reduce inflammation without the side effects of steroids. Steroids (Prednisone, Cortisone, Medrol, etc.) are potent medications that reduce inflammation, but steroids have predictable and potentially serious side effects, especially with long-term use. Non-steroidal anti-inflammatory drugs do not have these steroid side effects. In fact, many over-the-counter NSAIDs have the same active ingredients as prescription NSAIDs. The difference is in the amount of active ingredient contained in each tablet or capsule, and in the dosing requirements. Acetaminophen reduces pain and fever by acting on the brain. NSAIDs reduce pain and fever by reducing prostaglandin production and inflammation at the site of pain (ankle, knee, shoulder, etc.) Acetaminophen is generally considered easier on the stomach than NSAIDs. Aspirin, Aleve, Advil/Motrin are similar in reducing pain, fever and inflammation. But aspirin has more prolonged anti-platelet effect than the other NSAIDs. Different people respond differently to pain relievers. Therefore, choosing the right pain reliever can be somewhat of a trial and error process. I recommend that patients use the pain reliever that has worked for them in the past. This will increase the likelihood of effectiveness and decrease the risk of any side effects. Different people respond differently to pain relievers. Therefore, choosing the right pain reliever can be somewhat of a trial and error process. I recommend that patients use the pain reliever that has worked for them in the past. This will increase the likelihood of effectiveness and decrease the risk of any side effects.
Chronic pain treatment : One of the most serious problems in modern medicine is the undertreatment of patients in chronic pain. More than 30 million patients suffer from chronic pain, and seven million of them cannot relieve their pain without opioids (narcotics), but only few doctors in the country are willing to prescribe them, according to the National Chronic Pain Outreach Association. Today's massive denial of pain medication is a consequence of the social, regulatory and law enforcement climate created by the War on Drugs. Doctors can suffer loss of license or even incarceration, when the inevitable mistake of providing medicine to a dishonest patient who may be misusing or diverting medication occurs. The climate has led to a situation in which most physicians are incorrectly trained in pain management and under- or non-treatment of pain is the norm. Doctors who treat pain correctly typically must exceed the usual prescribed dosages, and in so doing draw the scrutiny of state medical boards and the U.S. Drug Enforcement Administration (DEA). The DEA demands that doctors and pharmacies regularly provide them with records of every prescription for controlled substances that is written or filled. The fate of pain patients in the "police state of medicine" is grim. Day after day of constant torment drives many to depression or even suicide. Many patients receive enough medicine to provide relief for four hours out of the day, and have to decide which 20 hours of the day they will spend in extreme pain. Frightened doctors sometimes "fire" patients, cutting them off from pain meds suddenly, thereby putting them at risk for shock or withdrawal. And those patients receiving adequate prescriptions live in fear that their doctors could be put out of business by the government or frightened into cutting them off. Former addicts as well as former prisoners are in the worst situation of all, being automatically suspect -- but pain patients from these backgrounds need and deserve proper treatment nonetheless.
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