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Self-Managing Chronic Pain (Part 3): Medications and Groups

David Spero

September 17, 2008

I’m almost done with chronic pain, but I thought I should ask a real expert some questions. I found Dr. Karen Burt-Amira, director of the highly successful Pain and Wellness Clinics at the Contra Costa Regional Medical Center in California. I asked her about drugs and herbal approaches. 

“Medications are an important part of pain management,” she said. “Remember, however, that medications are only a part of pain management. The overall vitality of your body, the tension in your muscles, the state of your mind, the quality of your emotions, the ease of your spirit—all contribute to your experience of pain.”

She prescribes medications, but she thinks other things are equally or more important. “Keep your body healthy with exercise, healthy food choices, and good sleep,” she says. “Learn to deeply relax your body and mind, and calm your spirit, to learn to let emotions come and go, to find and receive the support and help you deserve and need from others, and to keep on contributing to your family and community in whatever way you are able.”

Classes of Drugs
Here are some of the drugs that are prescribed for chronic pain.

Opiates (or narcotics) include codeine, morphine, and synthetic versions such as oxycodone (brand name OxyContin and others), hydromorphone, methadone, and fentanyl. They often work well for a while, but lose effectiveness over time. Among their downsides, they are addictive and constipating, and some doctors refuse to prescribe them, even when they will help. (I couldn’t even find a good link for opiates, as almost all links treated them only as a problem, not as useful drugs.)

Relaxers include muscle relaxers like cyclobenzaprine (Flexeril) and carisprodol (Soma), and antianxiety drugs such as diazepam (Valium). Remember that chronic pain is felt with the same parts of the brain that feel fear, anger, and depression. So drugs that treat anxiety and depression can be effective in chronic pain. They may also make you drowsy.

Anti-inflammatories include steroids such as prednisone and “nonsteroidal anti-inflammatory drugs” (NSAIDs) like ibuprofen (Advil and others), aspirin, and the newer COX-2 inhibitors.

Antidepressants drugs include the selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and sertraline (Zoloft). Also used are tricyclic antidepressants such as amitryptyline (Elavil). These drugs can all help somewhat.

Antiseizure drugs help a lot of people. This is because chronic pain, like seizures, often involves oversensitive nerves. These drugs can calm your pain nerves down. The most commonly used is gabapentin (Neurontin).

Sleep makes pain more tolerable, so sleep aids, such as hydroxyzine (Atarax) and diphenhydramine (Benadryl) can be helpful. Like narcotics, some sleep aids lose effectiveness over time, and some leave you feeling groggy the next day.

Alternative Meds and Herbs
There are many nondrug medicines that can help chronic pain. These include the homeopathic remedy arnica, which comes in pills or a cream. Capsaicin (essence of chili peppers) comes as an ointment that can relieve pain. There are many other herbs that help pain.

Nutritional approaches include taking B vitamins, calcium, magnesium, and fish oils. Dr. Burt-Amira says, “People tend to need an individualized ‘cocktail’ of help—which can include meds, natural remedies, bodywork, exercise, nutrition, mind-body practices, etc. Each person has to become their own ’scientist’ or ‘researcher’—to discover what works and does not for them.” Look online; ask friends.

Getting Help
I think the best way for many of us is to find an integrated chronic pain program, like this one: a place that combines physical, mental, and medical approaches. Some insurers may not want to pay for a program, but research like this government study showed that programs greatly increased participants’ ability to work and reduced medicine usage, among other benefits. So if you want to fight for coverage, there is research to back you up. Some public health agencies and hospitals run low-cost programs.

It is so important to get together with other people who live with pain. Being with other people who understand makes us feel better and gives us courage. This is the bottom line: Chronic pain is caused mostly by powerlessness. And when you don’t have much money or a high position, the best sources of power are: 1) self-confidence and 2) other people. The support of others makes us stronger. It increases our confidence to try new things.

If you can’t find a chronic pain program, perhaps you can find a chronic pain support group. Or perhaps you can start your own. Or join an online group. Or ask your doctor to refer you to other patients with pain issues. Or sign up for a self-management program. Chronic pain specialists often say “the group is the medicine.” So join one!

For all those who wrote in with questions about their specific pain situations, I apologize for not replying yet. I hope you have gotten some help from the blog entries and other comments. I will start replying in the comments section of the “Epidemic of Pain” blog entry. You can also comment here or write me directly through my Web site.

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