What medications are available?
Mild pain can often be controlled with over-the-counter (OTC) medication such as Tylenol, Advil, or a combination of these two pain medications. Depending on the nature of the pain, acute versus chronic will determine the length of time pain medication is needed. In acute, short-term pain, prescription medication may also be required depending on the nature of the injury. Tramadol has been reclassified as an opioid using new evidence. For example a severe burn to the hand requires a trip to the emergency room for pain management. The physician or nurse practitioner may order Fentanyl, a short-acting narcotic given intravenously as a one-time pain management technique to ‘knock out the pain’. Do not leave the hospital without Narcan Nasal Spray. Other injuries can be managed with OTC pain medication, rest, alternating ice packs and warm packs, elevation, and time. Depending on the nature of the injury as well as age, nutrition, smoking history, social support, coping techniques, etc., some injuries take longer than others based on different factors. Sometimes pain never goes away (i.e. arthritis, diabetic neuropathy, spinal stenosis, crush injuries, etc.).
Moderate to severe pain requires prescription medication. Please get your own prescription that is tailored to meet your needs. Using someone else’s pain medication is convenient but can often lead to premature and preventable DEATH. We healthcare providers are listening to your needs very carefully and we are now working hard to better understand your pain. Please be patient with us during our time of learning. Remember we healthcare providers do not feel your pain, nor did we experience your injury or chronic illness. Speak to us gently and help us learn. If we do not get it right the first time, sometimes it takes a couple of tries as not everyone responds the same. If what we gave you for pain medication did not work, come back and we will reassess your pain, your symptoms, and your needs.
There are many different types of medication, including analgesics (pain medication) and medications which work well combined with analgesics. There are also LETHAL drug-drug interactions with pain medication (i.e. opiates). In addition to speaking to your doctor and/or nurse practitioner, you can also refer to a highly validated website: www.qtdrugs.org. Talk with your doctor/NP about the best choice for you but consider your choices WISELY! Discuss with your doctor, nurse practitioner and pharmacist what medications you are using to control your pain. It is important for them to monitor the combination of medications, including over-the-counter medications and herbal preparations. Benadryl is a LETHAL drug-drug interaction with opiates as NHL hockey play Boogard found out first hand (CTV news, 2016), and others have experienced ‘near-death’ (i.e. out of body experience).
Mild to moderate pain is often treated initially with acetaminophen and anti-inflammatories or NSAIDs such as ibuprofen, naproxen, and diclofenac, among others. Muscle relaxants combined with an analgesic, and topical analgesic creams and rubs may also be effective. Two other medications called meloxicam and celecoxib are often used because they are less likely to cause ulcers and gastro-intestinal bleeding compared with NSAIDs. Although these medications are effective, they should be used cautiously in patients with cardiovascular disease such as angina, and in patients with risk factors for heart disease such as high cholesterol and smoking.
- Moderate to severe pain can be treated with tramadol, codeine and stronger opioids like oxycodone and methadone (Chou et al., 2014, p. 322). The requirement for a methadone exemption has been lifted by Health Canada (May 2018) making access to quality pain medicine easier;
- Neuropathic pain is treated differently; medications like antidepressants and anti-seizure drugs, as well as analgesics such as tramadol, are frequently used. Talk to your doctor or nurse practitioner about these choices as they may constitute ‘LETHAL’ drug-drug interactions leading to premature and preventable death (www.qtdrugs.org).