ACPA Resource Guide To Chronic Pain Medication & Treatment 2014 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 2014 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 & ADVICE FROM THE ACPA ............................................................................................................. 6 PAIN TREATMENT OVERVIEW...................................................................................................................................... 8 PAIN TYPES & CHRONIC PAIN CLASSIFICATION ......................................................................................................... 8 PAIN IN CHILDREN ...................................................................................................................................................... 9 PAIN IN OLDER PERSONS ............................................................................................................................................ 9 CLINICAL TRIALS ..................................................................................................................................................... 10 MEDICATIONS IN GENERAL ....................................................................................................................................... 11 MEDICATIONS AND CHRONIC PAIN .......................................................................................................................... 11 HOW MEDICATIONS CAN HELP & HARM ................................................................................................................. 12 IF MEDICATIONS ARE NOT WORKING ....................................................................................................................... 14 DETOXIFICATION AND WEANING OFF OF OPIOID MEDICATIONS .............................................................................. 15 WARNING ABOUT INTERNET MEDICATION PURCHASES ........................................................................................... 18 MEDICATION PICTURES ............................................................................................................................................ 19 MEDICATION SIDE EFFECTS, DRUG ALLERGIES, & DRUG INTERACTIONS ................................................................ 19 OFF-LABEL MEDICATION USE .................................................................................................................................. 21 CLASSES OF MEDICATIONS FOR THE TREATMENT OF PAIN ...................................................................................... 23 NON-PRESCRIPTION PAIN RELIEVERS ....................................................................................................................... 24 OVER-THE-COUNTER (OTC) PAIN RELIEVERS ........................................................................................................ 24 ACETAMINOPHEN SPECIAL COMMENTS .................................................................................................................... 27 HERBAL MEDICINES, SUPPLEMENTS, & VITAMINS ................................................................................................... 30 TOBACCO, ALCOHOL, MARIJUANA, AND ILLICIT SUBSTANCES ................................................................................. 33 NON-OPIOID PAIN RELIEVERS ................................................................................................................................... 38 NON-OPIOID PAIN RELIEVERS (NON-NARCOTIC) ...................................................................................................... 38 GASTROINTESTINAL (GI) PROTECTIVE MEDICATIONS .............................................................................................. 40 NON-OPIOID ANALGESIC DRUGS & THEIR USES ...................................................................................................... 42 OPIOID (NARCOTIC) PAIN RELIEVERS AND THEIR SAFE USE ................................................................................... 44 OPIOID ANALGESIC PAIN RELIEVERS ....................................................................................................................... 44 WHAT ARE OPIOIDS? ................................................................................................................................................ 46 OPIOID DELIVERY .................................................................................................................................................... 47 SHORT-ACTING AND LONG-ACTING OPIOID AGONISTS ............................................................................................. 47 ALERT: PROPOXYPHENE (DARVON®, DARVOCET®) – DISCONTINUED FOR SALE IN THE USA .............................. 53 GENERAL OPIOID ADVERSE SIDE EFFECTS ............................................................................................................... 54 DEFINITION OF TERMS REGARDING OPIOIDS ............................................................................................................ 57 THE EVIDENCE FOR OPIOID USE ............................................................................................................................... 62 KEY STEPS TO USE OPIOIDS SAFELY ....................................................................................................................... 63 OPIOIDS & THE GOALS OF PAIN MANAGEMENT ....................................................................................................... 64 MONITORING YOUR MEDICATION USE..................................................................................................................... 65 OPIOID TREATMENT AGREEMENT ............................................................................................................................ 66 URINE DRUG TESTING (UDT) / URINE DRUG SCREENING (UDS)............................................................................. 67 OTHER MEDICATIONS THAT CAN AFFECT PAIN ........................................................................................................ 68 ANTIDEPRESSANTS ................................................................................................................................................... 68 ALERT: MIXING ANTI-MIGRAINE AGENTS & CERTAIN ANTIDEPRESSANTS .............................................................. 74 ANTICONVULSANT (ANTIEPILEPTIC) DRUGS ............................................................................................................ 76 SODIUM CHANNEL BLOCKING & ORAL ANTI-ARRHYTHMIC AGENTS ...................................................................... 79 TOPICAL PAIN RELIEVERS ........................................................................................................................................ 81 COMPOUNDED MEDICATIONS ................................................................................................................................... 84 SEDATIVES AND ANTI-ANXIETY MEDICATIONS ....................................................................................................... 86 American Chronic Pain Association Copyright 2014 3 MUSCLE RELAXANTS ............................................................................................................................................... 88 ANTI-PSYCHOTIC MEDICATIONS .............................................................................................................................. 89 ANTI-HYPERTENSIVE MEDICATIONS ........................................................................................................................ 89 BOTULINUM TOXINS................................................................................................................................................. 90 NMDA INHIBITORS .................................................................................................................................................. 92 ADRENERGIC DRUGS, BISPHOSPHONATES, THALIDOMIDE, & CALCITONIN .............................................................. 93 ACTIVATING MEDICATIONS (CENTRAL NERVOUS SYSTEM STIMULANTS) ................................................................. 95 MIGRAINE HEADACHE TREATMENT ......................................................................................................................... 97 INTRA-ARTICULAR STEROID INJECTIONS ................................................................................................................. 99 VISCOSUPPLEMENTATION ......................................................................................................................................... 99 SPINAL CORD STIMULATION (SCS) .......................................................................................................................... 99 IMPLANTED TARGETED INTRATHECAL DRUG DELIVERY SYSTEMS (PAIN PUMPS) ................................................. 102 EPIDURALS, NERVE & FACET BLOCKS, & RADIOFREQUENCY ABLATION (RHIZOTOMY) ....................................... 105 COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM) ..................................................................................... 107 PASSIVE THERAPIES & PHYSICAL