Pain management
From Drug Rehab Wiki
Pain management is a medical specialty concerned with the treatment and alleviation of pain, whether it is short-term, long-term or chronic.
About ten years ago, the Joint Commission on the Accreditation of Healthcare Organizations changed its rules about pain management. Whenever a health care professional, working either in a hospital, nursing home, doctor's office or during an at-home visit, took the four vital signs of any patient, he would now be required to ask about his patient's pain level. "Pain" became the fifth vital sign to be routinely measured along with temperature, pulse, respiration, and blood pressure. The management of pain is now a medical specialty, and the organization that oversees the specialty is called the American Academy of Pain Medicine.
The downside of changing the rules regarding pain management is that it may have contributed to an epidemic of prescription painkiller abuse in the United States. Once doctors began prescribing more and stronger painkillers, these drugs began to appear routinely in family medicine cabinets. In fact, the majority of people addicted to opioid drugs have told government researchers that they obtain them through friends and family, not street dealers.
The loosening of the guidelines surrounding pain management came partly in response to the development of a new family of painkillers in the 1990s, that included drugs with brand names like Celebrex, Vioxx, and Bextra. These drugs offered a middle ground between over-the-counter products such as ibuprofen, aspirin, and acetaminophen and strong addictive narcotics, such as oxycodone and hydrocodone. However, what happened is that drugs formally used only for terminally ill patients, who could not become addicts, began being prescribed for other conditions. Dentists, for example, now prescribe strong painkillers such as Vicodin for tooth extractions, and physicians prescribe similar products for routine injuries, such as sprains. In the past, patients with such short-term pain were often told to take aspirin.
Many kinds of over-the-counter drugs are now available for pain relief, such as non-steroid anti-inflammatory drugs like ibuprofen, aspirin, naproxen sodium (Aleve) and ketoprofen. Ibuprofen, sold as Advil, Motrin and Nuprin, is considered a short-acting, weak painkiller. Acetaminophen, sold most often under the brand name Tylenol, does not fight inflammation and is gentler on the stomach than the others mentioned, but it can damage the liver and kidneys if too much is taken. Acetaminophen, aspirin, and ibuprofen are often combined with stronger painkillers available only by prescription.
Corticosteroids, sometimes called steroids, are synthetic drugs chemically designed to mimic natural hormones. They reduce inflammation better than ibuprofen and aspirin, but because they have certain serious side effects such as ulcers, weight gain, and calcium loss, steroids are usually only prescribed on a short-term basis or as a fallback treatment.
Opiate or narcotic pain killers are chemically similar to opium, a drug made from poppy plants. Most opiate painkillers are man-made. They differ from each other in how long they last, how long it takes before they take effect, and how strong they are. The weaker ones are usually used for moderate to mild pain and sometimes combined with over-the-counter drugs that enhance their effect. Strong opiates are usually only prescribed for severe pain or for terminally ill patients.
Weak opiate painkillers include codeine, hydrocodone, and propoxyphene. The stronger ones are fentanyl, hydromorphone, levorphanol, methadone, morphine, and oxycodone.
Other drugs that are used in pain management are antidepressants and anticonvulsants. Antidepressants not only relieve depression, they can also block pain signals as they move up the spinal cord. Anticonvulsants can control the abnormal firing of nerves that bring on neuropathic pain, and they can block sodium channels and thus help stop pain-producing nerve impulses.
Some people can manage their pain by using creams and gels directly on the place that hurts. Some patients undergo surgery for pain relief. For example, joint replacement surgery can be used as a treatment for arthritis, and spinal fusion surgery can relieve back pain.
Whether pain is chronic, short- or long-term or associated with a terminal illness is a factor in how it is managed. People with chronic or long-term pain often do not like the sedative or addictive side effects of many of their prescriptions, and so they may seek relief in alternative remedies such as chiropractic, massage, physical exercises, yoga, heat treatments, weight loss, meditation, hypnosis, biofeedback, herbal drugs, and psychotherapy. Pain clinics often employ not only doctors but an entire staff of other kinds of professionals, including psychologists, naturopathic physicians, physical therapists, psychologists, and others trained in alternative medicine.
