Pain management treatment changes

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An estimated 76 million Americans suffer chronic pain. Now, the pain field is evolving as doctors and pain sufferers look beyond opioids such as morphine, Lortab and OxyContin and take a look at meditation, acupuncture and herbs.

BY SONYA COLBERG scolberg@opubco.com    21
Published: May 29, 2011

Pain management has changed dramatically since the days when doctors placed a bullet in a patient's mouth and splashed whiskey on the wound. Now, specialists devote their lives to managing pain.

Pain researcher and patient Amy Padgett-McCue and her husband Michael walk with their three-legged dog "Jenny" at Hafer Park. PAUL HELLSTERN

Pain management treatment changes

And organizations such as The American Pain Foundation and Partners Against Pain help provide research or guidance for those in pain — an estimated 76 million Americans suffering each day

The pain field is evolving as doctors and pain sufferers look beyond opioids such as morphine, Lortab and OxyContin.

A patient's body can become tolerant of the narcotics, begin requiring more narcotic to get the same effect, and eventually risk addiction, said Dr. Rico Guerra, interventional pain management specialist with Oklahoma Heart Hospital South Campus.

“You take these medications that initially are meant to help you. But then they end up hurting you,” he said.

Additionally, there's the risk of opioid-induced hyperalgesic syndrome.

“They actually end up in worse pain being on the medication than if they weren't,” Guerra said.

And along with the growing risk of narcotic abuse that can destroy lives and kill, consistent narcotics users may develop new aches and pains that they didn't have before they began taking the medication, studies indicate.

Guerra said these medications aren't always prescribed in the manner intended. They are supposed to be used after an operation or to take the edge off acute pain such as an ankle sprain.

“But most of these medications were never meant for somebody to be on them for many, many, many years,” Guerra said.

In an attempt to reduce drug addiction, Oklahoma has instituted a drug monitoring database so that law enforcement, doctors and pharmacists can track prescription drug use.

Reducing danger

Popping over-the-counter pain remedies can be risky, too.

Acetaminophen, the pain reliever in Tylenol and numerous cold remedies found in nearly every medicine cabinet, last month came under additional scrutiny over the danger of severe liver damage.

A federal advisory panel recommended a ban on two prescription drugs containing it, Vicodin and Percocet. The group also asked the U.S. Food and Drug Administration to lower the recommended daily dose of acetaminophen from the current level of four grams or about 12 regular strength Tylenol pills to about 3.25 grams or about 10 pills.

In January, the FDA took the first of several steps to address the acetaminophen issue when it announced that prescription drugs containing opiates and acetaminophen no longer will be allowed to contain more than 325 milligrams of acetaminophen.

“Most cases of severe liver injury in association with acetaminophen occurred in patients who took more than the recommended amount in a 24-hour period. Or they took more than one product containing acetaminophen at the same time. Or they took acetaminophen with alcohol,” said Sandy Kweder, the FDA's Office of New Drugs deputy director.

“Overdoses from prescription products containing acetaminophen account for nearly half of all cases of acetaminophen related liver failure in the United States, many of which result in liver transplant or death.”

Considering the drawbacks of narcotics and over-the-counter drugs, doctors and patients are looking toward new, sometimes unusual combinations for treating pain.

“When you start putting all these together, it's good medicine these days,” Guerra said. “It's not just take this pill and call me in two weeks and let me know how you're doing.”

The American Pain Foundation endorses a multimodal approach to pain management that embraces the widest spectrum of safe and effective therapeutic options.

Alternative medicine

Desperate pain victims are turning to complementary and alternative medicine — acupuncture, meditation, mineral baths, yoga and other treatments.

Four out of 10 adults used complementary and alternative medicine therapy in 2007 — mostly natural products and deep breathing exercises — according to the most recent National Health Interview Survey released by the federal Centers for Disease Control and Prevention.

Pain treatment was one of the most common reasons people used complementary and alternative medicine, according to the study.

The most common nonvitamin, natural products taken were fish oil or omega 3 or DHA. Other favorites were glucosamine, Echinacea, flaxseed oil or pills, and ginseng. Even these aren't without risk.

By definition, complementary and alternative medicine practices aren't part of conventional medicine because there is insufficient proof that they are safe and effective, according to the federal government.

Complementary interventions are used with conventional treatments, while alternative interventions are used instead of conventional medicine.