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Chronic Pain

Medications - Introduction and Principles

There are a number of categories of medications that may be useful in managing pain. Each category has itís own risks and benefits. Regardless of category it is a mistake to rely entirely on medications for adequate pain control. Pain medications may mask dangerous underlying medical conditions when used inappropriately. Medications can also add to the impairment burden of patients when not carefully prescribed and monitored. If not observant, some medication regimes may actually cause additional harm equal to or greater than the condition(s) being treated.

In general, pain specialists have found there are a number of principles governing the use of pain medications including:

  • Medicine in chronic conditions should be used as much to prevent pain episodes as to treat acute "break-through" pain. When patients wait to take medicine until the pain is unbearable, larger doses are required and are less effective.
  • Addiction to medication in chronic pain situations is not a primary concern. Research indicates that taken appropriately, medicine is easily discontinued should the pain eventually diminish. Those patients who have "addictive" personalities may have real difficulty in managing medicine but drugs should not be disallowed because of concomitant problems with addictive behavior. Addiction and pain can be treated simultaneously. A significant portion of alleged "drug abuse" is actually patient self- medication of untreated chronic pain.
  • Medication should be used in the lowest doses that are effective in order to minimize side effects and adverse reactions.
  • All medications for pain participate in what is known as the "phenomenon of tolerance". Patients become tolerant to some medications more quickly than others. Over time the body compensates for the exogenous (outside) presence of pain killing agents by lowing natural levels or reducing the number of pain killer receptor sites. Those medicines producing the greatest degree of tolerance the quickest (i.e. the major narcotics) can present the greatest challenge in maintaining adequate pain control. They are also the most addictive.
  • All of the physicians treating a patient should be aware of all of the medications that a patient is using including medical cannabis. Where possible a single physician should prescribe and a single pharmacy dispense medications.
  • Medications should never be shared.
  • Medications should be stored safely in their original containers and out of the reach of children.
  • Special care should be taken in regard to drug interactions, contraindications, side effects, and adverse reactions, when prescribing for the chronically ill due to age, infirmity, and presence of multiple disorders.
  • Prescribing physicians and dispensing pharmacists need to have clear communication with each other and the patient about medications emphasizing precautions and warnings and promptly addressing any problems from prescription medication.
  • All medication therapy including cannabis aims at what is called a "therapeutic window". Below the window the dose is ineffective in providing relief while above the window the toxic effects of the medicine outweigh the therapeutic benefit. Some medications have a very "narrow" window while others are more "forgiving".



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