ACPA Resource Guide To Chronic Pain Medication & Treatment 2013 Edition American Chronic Pain Association P.O. Box 850 Rocklin, CA 95677 Tel 800-533-3231 Fax 916-632-3208 E-mail [email protected] Web Site http://www.theacpa.org Copyright 2013 American Chronic Pain Association, Inc. All rights reserved. No portion of this book may be reproduced without permission of the American Chronic Pain Association, Inc. 2 Table of Contents INTRODUCTION ............................................................................................................................................................. 6 PAIN TYPES & CHRONIC PAIN CLASSIFICATION ......................................................................................................... 8 PAIN IN CHILDREN ........................................................................................................................................................ 9 PAIN IN OLDER PERSONS .............................................................................................................................................. 9 CLINICAL TRIALS ....................................................................................................................................................... 10 MEDICATIONS AND CHRONIC PAIN ............................................................................................................................ 11 HOW MEDICATIONS CAN HELP & HARM .................................................................................................................. 12 ADVICE FROM THE ACPA .......................................................................................................................................... 13 WARNING ABOUT INTERNET MEDICATION PURCHASES .......................................................................................... 14 MEDICATION PICTURES.............................................................................................................................................. 16 MEDICATION SIDE EFFECTS, DRUG ALLERGIES, & DRUG INTERACTIONS .............................................................. 17 OFF-LABEL MEDICATION USE ................................................................................................................................... 19 IF MEDICATIONS ARE NOT WORKING ....................................................................................................................... 21 OVER-THE-COUNTER (OTC) PAIN RELIEVERS ........................................................................................................ 23 ACETAMINOPHEN SPECIAL COMMENTS .................................................................................................................... 26 NON-OPIOID PAIN RELIEVERS (NON-NARCOTIC) ...................................................................................................... 28 GASTROINTESTINAL (GI) PROTECTIVE MEDICATIONS ............................................................................................ 30 NON-OPIOID ANALGESIC DRUGS & THEIR USES ...................................................................................................... 32 OPIOID ANALGESIC PAIN RELIEVERS ........................................................................................................................ 34 WHAT ARE OPIOIDS? .................................................................................................................................................. 35 OPIOID DELIVERY ....................................................................................................................................................... 36 SHORT-ACTING AND LONG-ACTING OPIOID AGONISTS ............................................................................................ 36 ALERT: PROPOXYPHENE (DARVON®, DARVOCET®) – DISCONTINUED FOR SALE IN THE USA ............................ 42 GENERAL OPIOID ADVERSE SIDE EFFECTS ............................................................................................................... 43 DEFINITION OF TERMS REGARDING OPIOIDS ............................................................................................................ 46 THE EVIDENCE FOR OPIOID USE ................................................................................................................................ 50 KEY STEPS TO USE OPIOIDS SAFELY ........................................................................................................................ 51 OPIOIDS & THE GOALS OF PAIN MANAGEMENT ....................................................................................................... 52 MONITORING YOUR MEDICATION USE ......................................................................................................... 53 OPIOID TREATMENT AGREEMENT ............................................................................................................................. 54 URINE DRUG TESTING (UDT) / URINE DRUG SCREENING (UDS) ............................................................................ 55 ANTI-DEPRESSANTS .................................................................................................................................................... 56 ALERT: MIXING ANTI-MIGRAINE AGENTS & CERTAIN ANTIDEPRESSANTS ............................................................ 62 ANTICONVULSANT (ANTIEPILEPTIC) DRUGS ............................................................................................................. 64 SODIUM CHANNEL BLOCKING & ORAL ANTI-ARRHYTHMIC AGENTS .................................................................... 66 TOPICAL PAIN RELIEVERS ......................................................................................................................................... 67 COMPOUNDED MEDICATIONS .................................................................................................................................... 70 SEDATIVES AND ANTI-ANXIETY MEDICATIONS ........................................................................................................ 72 MUSCLE RELAXANTS .................................................................................................................................................. 74 ANTI-PSYCHOTIC MEDICATIONS ............................................................................................................................... 75 ANTI-HYPERTENSIVE MEDICATIONS ......................................................................................................................... 75 BOTULINUM TOXINS ................................................................................................................................................... 76 NMDA INHIBITORS .................................................................................................................................................... 78 ADRENERGIC DRUGS, BISPHOSPHONATES, THALIDOMIDE, & CALCITONIN ............................................................ 79 ACTIVATING MEDICATIONS (CENTRAL NERVOUS SYSTEM STIMULANTS) ................................................................ 80 MIGRAINE HEADACHE TREATMENT .......................................................................................................................... 81 HERBAL MEDICINES, SUPPLEMENTS, & VITAMINS ................................................................................................... 83 TOBACCO, ALCOHOL, MARIJUANA, AND ILLICIT SUBSTANCES ................................................................................ 86 INVASIVE INTERVENTIONS ......................................................................................................................................... 91 American Chronic Pain Association Copyright 2013 3 INTRA-ARTICULAR STEROID INJECTIONS ................................................................................................................. 91 SPINAL CORD STIMULATION (SCS) .......................................................................................................................... 91 IMPLANTED INTRATHECAL DRUG DELIVERY SYSTEMS (PAIN PUMPS) ..................................................................... 94 EPIDURALS, NERVE & FACET BLOCKS, & RADIOFREQUENCY ABLATION (RHIZOTOMY) ......................................... 96 COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM) ....................................................................................... 98 PASSIVE THERAPIES & PHYSICAL MODALITIES ....................................................................................................... 99 HYPERBARIC OXYGEN.............................................................................................................................................. 99 ACUPUNCTURE ......................................................................................................................................................... 99 MANIPULATION & MOBILIZATION ......................................................................................................................... 100 ELECTRICAL STIMULATION DEVICES (EXTERNAL) ................................................................................................. 100 TRIGGER POINT INJECTIONS ................................................................................................................................... 101 ACTIVE INTERVENTIONS - MONOTHERAPIES .........................................................................................................