Medications (20)

Thứ hai, 20 Tháng 10 2014 17:34

The journey from pain relief to addiction

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(ĐTĐ) - New research reveals that Australians are consuming more prescription drugs than ever before. Among the most dangerous and addictive families of drugs are opioids, strong pain killers used for people with injuries and drug dependencies. Increasingly the drugs seem to be being abused, as Shevonne Hunt writes.

(ĐTĐ) - On October 6th, all hydrocodone combination products will be reclassified in the U.S. as a Schedule II drugs under the Controlled Substances Act. For all of those involved in dealing with chronic pain — prescribers, pharmacists, and patients — the impact could be more than minimal.

Thứ sáu, 06 Tháng 6 2014 21:33

New Drugs May Help Prevent Migraines

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(ĐTĐ) - Two experimental drugs may help prevent migraines in people who suffer multiple attacks a month, according to preliminary findings from a pair of clinical trials.

The drugs, one given by IV and one by injection, are part of a new approach to preventing migraine headaches. They are "monoclonal antibodies" that target a tiny protein called the calcitonin gene-related peptide (CGRP) -- which recent research has implicated in triggering migraine pain.

In one study, patients saw a 66 percent reduction in their migraine attacks five to eight weeks after a single dose of the IV drug -- known for now as ALD403. That compared with a 52 percent decrease among patients who were given a placebo, or inactive, infusion.

In the other trial, patients receiving the injection drug saw a similar benefit from three months' worth of biweekly treatments.

The findings, scheduled to be presented Tuesday at the American Academy of Neurology's annual meeting in Philadelphia, are preliminary. And experts stressed that many questions remain.

Still, migraine sufferers can "take heart" that new drugs, specific to the pain condition, are under development, said Dr. Peter Goadsby, a neurologist at the University of California, San Francisco, who worked on both studies.

Right now, he said, the drugs used to prevent migraines are all older medications that were originally developed to treat other conditions. They include certain antidepressants, high blood pressure medications and anti-seizure drugs.

In contrast, the experimental medications aimed at CGRP are the first "designer drugs" for preventing migraine, said Dr. Richard Lipton, a headache expert who was not involved in the studies.

These early findings are "very encouraging," said Lipton, who directs the Montefiore Headache Center in New York City. "To me, this proves the concept that targeting CGRP can be effective," he said.

However, larger, longer-term studies are still needed to confirm the drugs' effectiveness and safety, Lipton and Goadsby said.

The trial testing ALD403, the IV drug, included 163 patients who were randomly assigned to receive either a single dose of the drug or a placebo infusion. Before treatment, all of the patients were suffering migraines five to 14 days out of every month.

Five to eight weeks later, patients given the drug were having 5.6 fewer "migraine days" per month on average -- a 66 percent drop. The placebo group also saw an improvement, of 4.6 fewer migraine days. Still, the benefit of the drug was significant in statistical terms, Lipton pointed out.

In the other trial, 217 patients received either the injection drug -- by the name of LY2951742 -- or a placebo, biweekly for 12 weeks.

Again, both groups got some migraine relief, but the benefit was bigger for patients on the real drug. They had 4.2 fewer migraine days a month, or a 63 percent decline. The placebo patients had three fewer migraine days, or a 42 percent decrease.

Some big questions remain, however. Researchers have to figure out how long the effects of the medications last, and how often they would need to be given, Goadsby said.

In the short term, the drugs seemed "well tolerated," Lipton said. People in the injection-drug trial had higher rates of abdominal pain and respiratory infections than the placebo group. And in the IV-drug study, people on the real drug had no more side effects than the placebo group.

Still, Lipton said, "a lot more people need to be followed to prove [the drugs'] safety."

He acknowledged that some patients might balk at the idea of an IV drug, which would have to be given by a doctor. An injection drug might be more acceptable, he said.

About 12 percent of Americans suffer migraine headaches, according to the U.S. National Institutes of Health. Many of them can manage with pain relievers, but about one-third need preventive medication, Lipton said.

However, he added, only around 10 percent take preventive drugs, often because they don't work or the side effects are intolerable. "There's a huge need for new preventive medications," Lipton said.

The current studies were funded by Alder Biopharmaceuticals, which is developing ALD403, and Arteaus Therapeutics, the developer of LY2951742.

Research presented at meetings should be viewed as preliminary until published in a peer-reviewed medical journal.


(ĐTĐ) - Question: Are medication overuse headaches associated with use of nonsteroidal anti-inflammatory drugs?

Response from Jenny A. Van Amburgh, PharmD, CDE (Assistant Dean of Academic Affairs; Associate Clinical Professor, School of Pharmacy, Northeastern University; Director, Clinical Pharmacy Team Director, Residency Program, Harbor Health Services, Inc., Boston, Massachusetts):

Medication overuse headache (MOH), previously called "rebound headache," is a secondary chronic daily headache associated with an overused therapeutic agent in a headache-prone patient.[1] MOH is a headache that is present for at least 15 days per month in the setting of overuse of acute headache treatment.[1,2]

"Overuse" is defined as the use of any analgesic over a 3-month period for a minimum number of days per month, depending on the type of medication. For simple analgesics, overuse is defined as use on 15 or more days per month.[3] That number drops to 10 days per month for ergotamine, combination analgesics, triptans, opioids, or the combination of short-term medications. MOH is markedly worsened during the period of overuse and typically resolves within 2 months of discontinuation of the offending agent.[2]

About 1% of the North American population experiences MOH.[2] Patients with primary headaches (eg, migraines, tension-type headaches, or cluster headaches) are more likely to develop MOH than are those who use long-term analgesics for other types of pain.[1,2] Transformation from primary headache to MOH is insidious and takes place over months to years.[2] The clinical picture varies depending on the causative medication, but headaches generally occur soon after awakening and present with neck pain.[4] Any medication indicated for the treatment of headache can cause MOH if used excessively.[2]

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most common over-the-counter (OTC) medications used to treat headache, and therefore it is critical to understand the propensity of NSAIDs to cause MOH. Scher and colleagues[3] evaluated patterns of medication use among individuals with episodic headache and MOH. Aspirin and ibuprofen were negatively associated with development of MOH; however, OTC analgesic combination products containing caffeine were associated with increased risk.

Bigal and colleagues[5] assessed the role of various medications in the development of MOH in patients with episodic migraine. They found that NSAIDs were protective against development of MOH in patients with less than 9 days of use per month but were associated with increased risk in patients with 10 or more days of use per month. In addition, women using NSAIDs were at higher risk of developing MOH than men.

Starling and colleagues[6] examined the evidence for MOH risk associated with NSAID use in patients with migraine. They found that acute NSAID use was associated with development of MOH in patients with a high baseline frequency of migraine, but might be protective in patients with low baseline migraine frequency. Although causality of NSAIDs and headache progression has not been established, patients having 10-14 headache days per month may be at risk for MOH with NSAID therapy.

MOH is more easily prevented than cured.[2] The recommended treatment is withdrawal of the offending agent, a process that may be difficult and painful for the afflicted individual. Therefore, it is important that clinicians provide strategies for appropriate use of MOH-causing agents.

Individuals should be counseled to limit use of any headache medication, including NSAIDs, to less than 10 days per month and avoid use of caffeine combination products entirely unless otherwise directed by their healthcare provider. Those who experience frequent headaches should consult their healthcare provider to discuss preventative behavioral modifications and prophylactic medications.

Acknowledgment: The author wishes to acknowledge the assistance of Tayla N. Thompson, PharmD; Karrie E. Juengel, PharmD; and Clara C. Ofodile, PharmD, PGY1 Residents, at Northeastern University School of Pharmacy, in collaboration with Federally Qualified Health Centers and the Program of All-Inclusive Care for the Elderly, Boston, Massachusetts.


  1. Headache Classification Committee of the International Headache Society (HIS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013;33:629-808.
  2. Abrams BM. Medication overuse headaches. Med Clin North Am. 2013;97;337-352.
  3. Scher AI, Lipton RB, Stewart WF, Bigal M. Patterns of medication use by chronic and episodic headache sufferers in the general population: results from the Frequent Headache Epidemiology Study. Cephalalgia. 2010;30:321-328.
  4. Tepper SJ. Medication-overuse headache. Continuum (Minneap Minn). 2012;18:807-822.
  5. Bigal ME, Serrano D, Buse D, Scher A, Stewart WF, Lipton RB. Acute migraine medications and evolution from episodic to chronic migraine: a longitudinal population-based study. Headache. 2008;48:1157-1168.
  6. Starling AJ, Hoffman-Snyder C, Halker RB, et al. Risk of development of medication overuse headache with nonsteroidal anti-inflammatory drug therapy for migraine: a critically appraised topic. Neurologist. 2011;17:297-299.
Thứ bảy, 26 Tháng 4 2014 21:04

Greater Use of Meds to Halt Opioid Overdose Epidemic Urged

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(ĐTĐ) - US addiction experts are urging expanded use of medications to combat the "opioid overdose epidemic" plaguing the country.

In a commentary published April 23 (2014) in the New England Journal of Medicine, National Institute of Drug Abuse (NIDA) director Nora Volkow, MD, and colleagues from other US Department of Health and Human Services (HHS) agencies call upon healthcare providers to expand their use of medications to treat opioid addiction and reduce overdose deaths.

In addition, they describe a number of misperceptions that have limited access to these potentially lifesaving medications.

The reasons include inadequate provider education and misunderstandings about addiction medications by the public, healthcare providers, insurers, and patients. One common, long-held misperception is that medication-assisted therapies (MATs) merely replace one addiction for another ? a view that is not backed by science.

"When prescribed and monitored properly, medications such as methadone, buprenorphine, or naltrexones are safe and cost-effective components of opioid addiction treatment. These medications can improve lives and reduce the risk for overdose, yet medication-assisted therapies are markedly underutilized," Dr. Volkow said in a release.

Between 1999 and 2010, the death rate from prescription opioid overdose in the United States more than quadrupled, a rate that far exceeds the combined death toll from cocaine and heroin overdoses.

Rates of emergency department visits as well as substance-abuse treatment admissions related to prescription opioids also increased markedly during the past few years, as have prescription opioid–abuse costs to insurers.

These health and economic costs are similar to those associated with other chronic diseases, such as asthma and HIV infection, the authors note. These "alarming trends" have prompted the HHS to take multiple federal, state, and local actions, including expanding access to medication-assisted therapies to help patients recover.

"A key driver of the overdose epidemic is underlying substance-use disorder," the authors write. Similar to other chronic diseases, "addiction is generally refractory to cure, but effective treatment and functional recovery are possible."

Part of that functional recovery must involve the appropriate use of existing MATs, including use of methadone, buprenorphine, and naltrexone.

These medications have been shown to reduce the risk for overdose and improve lives, the authors note. In Baltimore, for example, increasingly, the availability of methadone and buprenorphine roughly halved the number of fatal overdoses from heroin between 1995 and 2009.

Many treatment facilities also favor abstinence as the best treatment model for addictions and do not routinely offer MATs. Inadequate dosing when MATs are used is also systemic and further reinforces lack of faith in their use, inasmuch as patients often return to opioids because treatment was ineffective, the authors note.

Other barriers to appropriate use of MATs include both policy and regulatory issues, including limits on the dosages prescribed; annual or lifetime medication limits; initial authorization and reauthorization requirements; and "fail first" criteria that require the use of other therapies first before attempting to introduce an MAT.

As Dr. Volkow and colleagues point out, HHS agencies are now actively collaborating with public and private stakeholders in an effort to both expand access to and improve the use of MATs.

They are also directing efforts toward the development of new pharmacologic treatments for opioid addiction and improved delivery systems for current medications, including the development of nasal sprays.

At the same time, Dr. Volkow emphasizes that it is critical to make sure policies that curb inappropriate prescribing of opioid analgesics not infringe on the critical and even lifesaving use of the same agents when clinically indicated.

Charged with providing access to treatment programs, the Substance Abuse and Mental Health Services Administration (SAMHSA) is encouraging MATs through the Substance Abuse Prevention and Treatment Block Grant as well as through regulatory oversight of medications used to treat opioid addiction. In addition, it has developed an Opioid Overdose Toolkit designed to educate first responders in the use of naloxone to prevent overdose deaths.

"It also gives local governments the information they need to develop policies and practices to help prevent and respond appropriately to opioid-related overdose," she added.

In addition, the Centers for Medicare and Medicaid Services is working to enhance access to MATs through a more comprehensive benefit design, as well as a more robust application of the Mental Health Parity and Addiction Equity Act.

However, the authors point out that success of these strategies requires engagement and participation of the medical community.

The authors report no relevant financial relationships.

N Engl J Med. Published online April 23, 2014. Full article


(ĐTĐ) - Patients receiving an anticoagulant for deep vein thrombosis (DVT) or pulmonary embolism (PE) who take a nonsteroidal anti-inflammatory drug (NSAID) or aspirin for pain or headache, even for a few days, are at heightened risk for a major bleed, according to a new study published online April 14, 2014 in JAMA Internal Medicine [1].

The researchers examined bleeding risk from aspirin or an NSAID (other than aspirin) in patients in the EINSTEIN-DVT and EINSTEIN-PE trials who were randomized to either the low-molecular-weight heparin enoxaparin followed by warfarin or acenocoumarol or to the oral anticoagulant rivaroxaban (Xarelto, Bayer/Janssen).

The trials discouraged the use of NSAIDs, yet about a quarter of the patients took them. Compared with patients who avoided these painkillers, those who took an NSAID had a 2.4-fold higher risk of a major bleed and those who took aspirin had a 1.5-fold higher risk.

"Even though [this warning about major bleeds with NSAIDS or aspirin] is on the warfarin label . . . I don't think people believed it," lead author Dr Bruce L Davidson (University of Washington School of Medicine, Seattle, WA), told heartwire . "I certainly didn't believe it," he said. "The risk had not been quantified, and the notion that one-quarter of the major bleeds happened within eight days of use is stunning."

Doctors who manage patients taking warfarin or the new oral anticoagulants should tell them which over-the-counter (OTC) drugs are NSAIDs, Davidson said.

They should warn patients, "Don't take an NSAID [and] don't take casual aspirin. . . . Take aspirin if you need it for coronary artery disease. Otherwise, take [acetaminophen, not more than 4 g a day] for pain, discomfort, or fever. Don't risk it."

OTC Ibuprofen, Aspirin, or Acetaminophen

In the past, to treat a headache or sore muscles, many people took aspirin or acetaminophen, but now people commonly take an NSAID such as ibuprofen, Davidson noted.

Earlier work has shown that patients with atrial fibrillation (AF) who are on anticoagulants and take aspirin have an increased bleeding risk. However, the bleeding risk in patients receiving an anticoagulant for DVT or PE who take an NSAID or aspirin is poorly documented, the researchers write.

They examined the risk of clinically relevant bleeds, including major bleeds—those that were fatal, occurred at a critical site, or required a major transfusion—and nonmajor bleeds in 8246 patients in the EINSTEIN-DVT and EINSTEIN-PE trials who were randomized to rivaroxaban or enoxaparin/vitamin-K antagonist (VKA).


The increase in bleeding was similar in the rivaroxaban-treated and enoxaparin/VKA patients.

Event Events/100 patient-years HR (95% CI)
Clinically relevant bleed 37.5 16.6 1.77 (1.46–2.16)
Major bleed 6.5 2.00 2.37 (1.51–3.75)

Bleeding Risk for Patients on Anticoagulants, Aspirin Use vs No Aspirin Use

Event Events/100 patient-years HR (95% CI)
Clinically relevant bleed 36.6 16.6 1.77 (1.46–2.16)
Major bleed 4.8 2.2 1.50 (0.86–2.62)

Patients had a similar risk of bleeding whether NSAIDs and aspirin were taken for a short or long time.

"We wonder whether it is widely appreciated that NSAIDs, available over the counter in most places, put patients receiving anticoagulant therapy at nearly double the risk of clinically important bleeding," the researchers write.

"Physicians should inform patients about the potential for increased bleeding with these readily available, commonly used drugs and advise patients to curtail their casual use," they conclude.

Bayer Healthcare and Janssen Pharmaceuticals sponsored the two EINSTEIN clinical trials, collected and maintained the data, and performed the analyses that the authors requested. Davidson was paid by Bayer for steering-committee and related work for the EINSTEIN studies. Disclosures for the coauthors are listed in the paper.


(ĐTĐ) - There are numerous treatments available for the symptoms associated with fibromyalgia. Fibromyalgia is classified as a disorder of pain processing due to abnormalities in the ways in which pain signals are processed in the central nervous system.

Patients suffering from fibromyalgia often complain of depression, insomnia,irritable bowel syndrome, painful and tender points or “trigger points.” Tender points are pain points or localized areas of tenderness around joints, but not the joints themselves. These areas of tenderness or sensitivity can be felt just below the skin in specific parts of the body.

In contrast to tender points, trigger points are firm nodules that can be felt in tight, rope-like muscles and when pressure is applied on a trigger point, the pain is felt in the area and can shoot pain to other body parts. This is not the same as the feeling associated with pressing on a tender point as it is felt in a localized area only.

The types of pain associated with fibromyalgia is believed to be caused by a “glitch” or “disconnect” in the way in which pain is processed by the body. This glitch and its repercussions occur when a person has a hypersensitivity to stimuli that are not normally painful.

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) has reported that their research has shown that people who suffer from fibromyalgia have reduced blood flow levels to the parts of the brain that normally allow the body to deal with pain.This increase in sensitivity to pain and the inability of the brain to manage pain creates the conditions of a chronic pain concern.

Patients with fibromyalgia most often report symptoms associated with chronic pain. As neurochemical changes in one’s body increases one’s sensitivity to pain, the chronic pain worsens. Sufferers begin to have pain in other parts of the body that do not normally hurt.

This spread of tender points and the intensity and duration of pain results in additional stress on a patient’s ability to sleep well, and the cycle of pain and the inability to ease that pain can spiral a person into deep depression.

Below are approaches to easing some of the symptoms of fibromyalgia. Some approaches note the importance of medication while other combine medication with alternate methods to ease pain, increase one’s quality of sleep, and reduce depressive thoughts and feelings.

Amitriptyline is considered to be the most common medication prescribed to treat fibromyalgia. Its efficacy has been demonstrated in controlled studies, and it is known to enhance stage three and stage four sleep (these stages are also known as deep, slow-wave, or delta sleep). As sleep deprivation and insomnia are often-cited complaints by sufferers with fibromyalgia, Amitriptyline is an excellent choice for these patients to consider.

What is Amitriptyline?

Amitriptyline is a tricyclic antidepressant, and it is widely used to treat chronic neuropathic pain (i.e., any pain due to nerve damage) and fibromyalgia. These types of chronic pain can be treated very successfully with antidepressant drugs in small doses.

The dosage amount is noteworthy as it is below dosage sizes at which Amitriptyline acts as an antidepressant. Amitriptyline works by increasing amounts of natural substances in the brain that are necessary for the brain to maintain mental balance.


Amitriptyline may also used to alleviate post-herpetic neuralgia (the burning and stabbing pains associated with shingles), treat eating disorders and is sometime prescribed to prevent migraine headaches.

For patients with multiple sclerosis, Amitriptyline is used to treat painful paresthesias in the arms and legs (e.g., burning sensations, stabbing pains, “pins and needles”) caused by damage to the pain-regulating pathways of the spinal cord and brain.

What the Studies Say

In one study, researchers found that a 25 mg dose of Amitriptyline (Elavil) (Note: Elavil is a brand name drug that is no longer available in the U.S. by this name. Generic versions are available) or a 20 mg dose of fluoxetine (Prozac) reduced symptoms of fibromyalgia, the combination of the two medications was twice as effective as either agent when taken on its own. This study’s report also noted that dosages used are slightly lower than those needed to treat depression.

Older agents, such as Amitriptyline, may be used at a daily dosage rate of 10 mg taken two to three hours before bedtime. This dosage schedule allows for the peak sedative effect to be realized when the sufferer is sleeping.Taking this small dose earlier than at bedtime may also allow the user to avoid undesired carry-over sedation upon awakening. Moreover, administration time can be adjusted depending on individual patient’s response to its effect.


A significantly improved quality of sleep was reported in patients who participated in a study that evaluated the efficiency of Amitriptyline (50 mg doses).

In another study, results were somewhat disappointing. In 2012, results were reported from a larger study involving over 1400 participants. No supportive unbiased evidence for a beneficial effect of treating fibromyalgia with Amitriptyline was found. The authors noted, however, that its research findings must be balanced against decades of successful treatment in numerous patients suffering from neuropathic pain or fibromyalgia who have relied on anti-depressants, such as Amitriptyline.

In the end, the use of Amitriptyline by fibromyalgia sufferers appears to help them. The side effects are often minimal, and while the benefits may not be quantifiable in studies, its success in the treatment of fibromyalgia symptoms for decades cannot be ignored.

Small Doses, Good Results

The dosage of antidepressants, such as Amitriptyline must be individualized. This is particularly true when using tricyclic agents, given their variable rates of absorption, metabolism and excretion.

It is strongly recommended that dosages should be gradually increased so as not to exceed the recommended maximum dosage for the drug. Even those patients who are able to tolerate very small amounts of these types of medications may derive benefit from them.

There are some side effects of using Amitriptyline to treat fibromyalgia. These side effects may include morning sedation (a feeling akin to having a hangover), dry mouth, confusion, and urinary retention.

Amitriptyline + Exercise = More Benefits

The 2012 study noted above suggests that Amitriptyline should be used as part of the treatment of neuropathic pain or fibromyalgia, even though only a small number of patients achieve satisfactory pain relief with it alone. Let’s explore how exercise and Amitriptyline can work together to allieviate symptoms of fibromyalgia.

Non-medical approaches to treating fibromyalgia include stress-reducing activities, such as aerobic exercise and strength training. Combined with the properly managed use of Amitriptyline, patients noted a decrease in symptoms, more effective sleep, reduced joint pain, and reduced feelings of fatigue.

One type of exercise that has demonstrated a high degree of relief is long-term aquatic-based exercise. Since they combine cardiovascular exercise with resistance training, swimming, water aerobics, and other types of aquatic-based exercise programs are very efficient types of exercise for patients with fibromyalgia. As fibromayalgia sufferers also are very sensitive to cold temperatures, it is recommended that they seek out warm water pools in climate-controlled environments for water aerobics and other activities. This way the water temperature and air temperature outside the pool will not adversely affect the patient and this piece of the treatment puzzle.

Fibromyalgia can be treated in children and teens with intense physical and occupational therapy programs too. Many of these therapies are suggested for other amplified musculoskeletal pain syndromes (AMPS), such as localized or diffuse idiopathic musculoskeletal pain and myofascial pain syndrome.

These therapy programs suggest that regular physical exercise will benefit the sufferer, even if at times they must work through the pain. Once these exercise regimens are practiced with physical or occupational therapists, they can be completed in the home and provide fibromyalgia sufferers with long-term relief.

Amitriptyline + Therapy = Even More Benefits

A variety of other types of therapies can also be used in tandem withAmitriptyline. Counseling, art therapy, and music therapy have shown great results with children. These types of programs can be found at Boston Children’s Hospital (in association with Harvard University), The Children’s Hospital of Philadelphia (associated with the University of Pennsylvania), and many other American children’s hospitals. These types of programs are evidence-based, and some report total pain resolution rates close to 88%.

The efficacy of a treatment regimen that includes counseling, art therapy, and music therapy for adults with fibromyalgiahas not been studied. More often, adults incorporate cognitive behavioral therapy (CBT) and related behavioral and psychological therapies in conjunction with antidepressants, such as Amitriptyline.

Relaxation exercises, such as guided imagery and deep-breathing exercises are shown to provide some comfort and pain alleviation. These types of therapies appear to have a small to moderate ability to reduce or minimize the symptoms of fibromyalgia.

Based on the research and study findings, it is determined that a multidisciplinary approach, often including CBT, is sometimes considered to be the “gold standard” of treatment for chronic pain syndromes such as fibromyalgia. Combining the positive effects of Amitriptyline with exercise and therapy improve the pain management and overall quality of life for fibromyalgia sufferers. As noted above, each type of treatment is part of a puzzle, and once assembled can make fibromyalgia less painful and more easily managed.

Thứ sáu, 28 Tháng 2 2014 16:30

Medications for Lower Back Pain

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(ĐTĐ) - When your lower back is achy and sore, everything you do -- from reaching into a kitchen cabinet to bending over to pet the dog -- can trigger an excruciating jolt of pain. At that time, it may feel as if nothing is more important than finding relief. Medications, like the ones listed in this guide, may help. But they should be used along with exercise and physical therapy for effective pain relief.

If you are considering medications to relieve your pain -- especially chronic back pain -- it’s also important to consider their risks and side effects. Certain drugs for low back pain may also interact with other medications you are taking. So carefully weigh your options with your doctor when choosing medication.

Over-the-Counter Pain Relievers

People with lower back pain often try over-the-counter pain relievers first.

Nonsteroidal anti-inflammatory drugs (NSAIDs) -- including aspirin, naproxen sodium (Aleve), and ibuprofen (Advil, Motrin) -- are among the most commonly used pain relievers. They work about equally well to improve mild inflammation, swelling, and lower back pain. Although NSAIDs are reasonably safe medications, it is important that you are aware of potential side effects. NSAIDs are safest when low doses are taken for brief periods. Side effects most commonly occur if you are taking large doses over a prolonged time (months or years) and can include stomach pain, bleeding, and stomach ulcers.

Naproxen and ibuprofen and certain other prescription NSAIDs may increase the risk of heart attack or stroke in people who take them for a long time or in people with heart disease. You should see your doctor before taking NSAIDs for longer than 10 days.

Acetaminophen (Actamin, Panadol, Tylenol) is not an NSAID, but it can help with pain and doesn't raise the risk of stomach problems like NSAIDs do. However, taking more than the recommended amount of acetaminophen can cause liver damage, especially if you have underlying liver disease. So it's important not to take more than the dose recommended on the package. If you have liver disease, check with your doctor before taking acetaminophen.

Opioid Pain Medications

Narcotic (or opioid) pain medicines such as codeine, oxycodone, hydrocodone, and morphine work by blocking the transmission of pain messages to the brain. Narcotic drugs should only be used under a doctor’s supervision because they can cause physical dependence and addiction. Other side effects include severe drowsiness and constipation.

Muscle Relaxants

Muscle relaxants such as diazepam (Valium) or cyclobenzaprine (Amrix, Fexmid, Flexeril) act on the central nervous system to relieve painful muscle strains and spasms. However, these drugs can be habit-forming. Muscle relaxants also can cause side effects, including sedation and dizziness.


Some drugs typically prescribed to treat depression have also been shown to help relieve chronic lower back pain, and doctors sometimes prescribe these medications to alleviate pain. Duloxetine (Cymbalta) is approved for chronic musculoskeletal pain including pain from osteoarthritis and chronic low back pain. Low doses of tricyclic antidepressants such as amitriptyline (Elavil, Endep, Vanatrip) and desipramine (Norpramin) are often used to treat low back pain. Side effects of these drugs may include drowsiness, dizziness, dry mouth, and appetite loss.

Antiepileptic Drugs

Antiepileptic drugs such as Fanatrex, Gabarone, Gralise, Horizant, Neurontin (gabapentin) or Lyrica (pregabalin) were designed to help people with seizure disorders and are often used for the treatment of painful syndromes caused by the virus that causes shingles. They also may be effective for chronic low back pain. They appear to work by interfering with pain signals from the nerves. Potential side effects include drowsiness, dizziness, and sedation. These drugs work for some people but not others, and one anticonvulsant drug may work for you while other drugs may not.


If oral medications aren't enough to relieve your lower back pain, your doctor may inject a steroid medication into the space around your spinal cord to bring down inflammation and provide short-term pain relief. And scientific studies show mixed results about whether they are effective at relieving back pain.

Other options are injections of a numbing medicine (anesthetic) to block pain or botulinum toxin A (Botox) – the same treatment used to reduce the appearance of wrinkles. Botox injections work by paralyzing muscles to stop spasms. Although it is not FDA approved for back pain, some doctors may prescribe Botox to relieve low back pain caused by muscle tension. It may take three to 10 days to start feeling better after a Botox injection, but the effects may last for three to four months. Side effects may include muscle paralysis and difficulty swallowing.

What to Do if Medication Does Not Help

If your back doesn’t feel better within about three days after you start taking medication, call your doctor. You might need to investigate other treatment options. After four to six weeks of discomfort, your doctor may order tests such as an X-ray or MRI or refer you to a specialist.

Thứ bảy, 28 Tháng 12 2013 17:52

Fibromyalgia Medications

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(ĐTĐ) - There are many different medications used to treat fibromyalgia symptoms, including pain medicines, sleeping pills, and antidepressants. Some fibromyalgia medicines help ease pain. Others boost mood and improve sleep. Working with your doctor will help you find the right fibromyalgia medication to add to your treatment regimen. That way, you can manage your symptoms effectively.

What is the initial treatment for fibromyalgia?

The first medication doctors will often try for people with fibromyalgia is an antidepressant, which helps relieve pain, fatigue, and sleep problems. In addition, antidepressants help depression, which is commonly seen in people with fibromyalgia. Older antidepressants, called tricyclics, have been used for many years to treat fibromyalgia.

How do tricyclic antidepressants treat fibromyalgia symptoms?

The tricyclic antidepressants, including Elavil (amitriptyline) and Pamelor (nortriptyline), work by raising the levels of chemicals (neurotransmitters) in the brain.

Tricyclic antidepressants increase levels of serotonin and norepinephrine in the brain. People with chronic pain often have decreased levels of these calming neurotransmitters. Tricyclics can relax painful muscles and heighten the effects of endorphins -- the body's natural painkillers. While these medications are often very effective, the side effects can sometimes make them difficult to take as they may cause drowsiness, dizziness, dry mouth, dry eyes, and constipation.

Do other antidepressants relieve the pain and fatigue of fibromyalgia?

There are several different types of antidepressants and several of them have been shown to help relieve the pain, fatigue, and sleep problems in people with fibromyalgia.

The most well-studied antidepressants for fibromyalgia include Cymbalta (duloxetine), Savella (milnacipran), and Effexor (venlafaxine). Cymbalta and Savella are specifically FDA-approved to treat fibromyalgia. There is less medical research to show that Effexor helps fibromyalgia. Other antidepressants that have also been studied for fibromyalgia and may help include Prozac (fluoxetine), Paxil (paroxetine), and Celexa (citalopram).

Different antidepressants work differently in the body. In addition, what works for one person with fibromyalgia may not work for someone else. That's why people with fibromyalgia may have to try more than antidepressant to find the one that best relieves the pain, fatigue, and sleep difficulties associated with the condition. Your doctor may even want you to try a combination of more than one antidepressant at a time.

Which fibromyalgia medications help relieve the pain?

Different types of pain relievers are sometimes recommended to ease the deep muscle pain and trigger-point pain that comes with fibromyalgia. The problem is these pain relievers don't work the same for everyone with fibromyalgia.

The over-the-counter pain reliever acetaminophen elevates the pain threshold so you perceive less pain.

Nonsteroidal anti-inflammatory drugs (NSAIDs), when taken alone, don't typically work that well for fibromyalgia. However, when combined with other fibromyalgia medicines, NSAIDs often do help. NSAIDs are available over the counter and include drugs such as aspirin, ibuprofen, and naproxen.

What are the side effects of pain relievers for fibromyalgia?

Be careful taking aspirin or other NSAIDs if you have stomach problems. These medications can lead to heartburn, nausea or vomiting, stomach ulcers, and stomach bleeding. This risk of serious bleeding is even higher in people over the age of 60. Don't take over-the-counter NSAIDs for more than 10 days without checking with your doctor. Taking them for a prolonged period increases the chance of serious side effects. Aspirin and other NSAIDs can cause or worsen stomach ulcers. If you've had ulcers or any kind of stomach or intestinal bleeding, talk to your doctor before taking NSAIDs.

Acetaminophen is relatively free of side effects. But avoid this medication if you have liver disease. Also, make sure to not take more than recommended as that greatly increases the risk of side effects, including liver damage.

Are muscle relaxants helpful for fibromyalgia pain?

The muscle relaxant cyclobenzaprine has proved useful for the treatment of fibromyalgia. It's often prescribed to help ease muscle tension and improve sleep. Muscle relaxants work in the brain to relax muscles.

With muscle relaxants, you may experience dry mouth, dizziness, drowsiness, blurred vision, clumsiness, unsteadiness, and change in the color of your urine. These medications may increase the likelihood of seizures. Older adults sometimes experience confusion and hallucinations when taking them.

When are anticonvulsants used for fibromyalgia?

Lyrica, originally used to treat seizures, is a newer drug for treating fibromyalgia. With fibromyalgia, Lyrica affects chemicals in the brain that send pain signals across the nervous system. So it reduces pain and fatigue and improves sleep.

Neurontin (gabapentin) is another antiseizure medication that has also been shown to improve fibromyalgia symptoms.

Are there other fibromyalgia pain medications available?

Pain relievers such as Ultram (tramadol) may also be used to treat fibromyalgia. This narcotic-like medication acts in the brain to affect the sensation of pain. It is not as addictive as narcotics.

In addition, doctors may prescribe benzodiazepines such as Ativan (lorazepam), Klonopin (clonazepam), Valium (diazepam), and Xanax (alprazolam) to help relax painful muscles, improve sleep, and relieve symptoms of restless legs syndrome (unpleasant sensations in the legs that force you to move them constantly). Benzodiazepines are addictive and must be used with caution on a short-term basis. Taking more than recommended increases the risk of serious side effects -- even death.

Powerful narcotic medications, such as Percocet and OxyContin (oxycodone) and Vicodin and Lortab (hydrocodone), should only be considered if all other drugs and alternative therapies have been exhausted and there is no relief.


(ĐTĐ) - Sharing prescriptions, hoarding expired drugs, and more no-nos for taking prescription and over-the-counter pain medications.

It's been a hard day, and Joe's back is killing him.

His wife has some Percocet left over from a trip to the dentist, and there's that big bottle of Tylenol under the sink, so Joe grabs a couple of each and washes them down with a slug of beer.

Luckily for Joe, he's a fictional character invented for this article. But there are a lot of real-life Joes out there making big mistakes with over-the-counter and prescription pain pills.

Can you spot Joe's mistakes? Joe didn't make every mistake in the book. But he made quite a few.

Here's WebMD's list of common pain pill mistakes, compiled with the help of pharmacist Kristen A. Binaso, RPh, spokeswoman for the American Pharmacists Association; and pain specialist Eric R. Haynes, MD, founder of Comprehensive Pain Management Partners in Trinity, Fla.

Pain Medications Mistake No.1: If 1 Is Good, 2 Must Be Better

Doctors prescribe pain pills at the doses they believe will offer the greatest benefit at the least risk. Doubling or tripling that dose won't speed relief. But it can easily speed the onset of harmful side effects.

"The first dose of a pain medication may not work in five minutes the way you want. But this does not mean you should take five more," Binaso says. "With some pain drugs, if you take additional doses, it makes the first dose not work as well. And with others, you end up in the emergency room."

If you've given your pain medication time to work, and it still does not control your pain, don't double down. See your doctor about why you're still hurting.

"This 'one is good so two must be better' thing is a common problem," Haynes says. "Patients should follow the instructions their doctor gives. Ask before leaving the office: Can I take an extra pill if I still hurt? What is the upper limit for this medication?"

Another bad idea is trying to boost the effect of one kind of pain pill by taking another.

"There may be ibuprofen, acetaminophen, and naproxen in the house, and a person may take them all," Binaso says.

This can escalate into a very bad situation, Haynes says.

Pain Medications Mistake No. 2: Duplication Overdose

People often take over-the-counter pain drugs -- and even prescription pain drugs -- without reading the label. That means they often don't know which drugs they're taking. That's never a good idea.

And if they take another over-the-counter drug -- either for extra pain relief or for other reasons -- they may be getting an overdose. That's because many OTC drugs are combination pills that carry a full dose of pain pill ingredients.

In Joe's case, he's taken a prescription pain pill that contains acetaminophen along with a second full dose of acetaminophen from Tylenol, putting him at risk of injury.

Pain Medications Mistake No. 3: Drinking While Taking Pain Drugs

Pain medications and alcohol generally enhance each other's effect. That's why many of these prescription medications carry a "no alcohol" sticker.

That sticker shows a martini glass covered by the international "No" sign of a circle with a slash. But it applies to wine and beer just as much as it does to spirits.

"A common misperception is people see that sticker and think, 'I'm OK as long as I don't drink liquor -- I can have a beer.' But no alcohol means no alcohol," Binaso says.

"The patient should heed that alcohol warning, because it can be a major problem if they do not," Haynes says. "Alcohol can make you inebriated, and some pain medications can make you have that feeling as well. You can easily get yourself into trouble."

Drinking alcohol can be a problem even with over-the-counter pain drugs.

Pain Medications Mistake No. 4: Drug Interactions

Before taking any pain pill, think about what other medicines, herbal remedies, and supplements you are taking. Some of these drugs and supplements may interact with pain medications or increase the risk of side effects.

For example, aspirin can affect the action of some non-insulin diabetes drugs; codeine and oxycodone can interfere with antidepressants.

You should give your doctor a complete list of all the drugs, herbs, and supplements you take -- before getting any prescription.

If buying over-the-counter medications, Binaso recommends showing a list of everything else you're taking to the pharmacist.

Pain Medications Mistake No. 5: Drugged Driving

Pain medications can make you drowsy. Different people react differently to different drugs.

"How I react to a pain medication is different from how you react," Binaso says. "It may not make me drowsy, but may make you drowsy. So I recommend trying it at home first, and see how you feel. Don't take two pills and go out driving."

Pain Medications Mistake No. 6: Sharing Prescription Medicines

Unfortunately, it's very common for people to share prescription medications with friends, relatives, and co-workers. Not smart, Haynes and Binaso say -- particularly when it comes to pain medications.

"If a fairly healthy person is taking a medicine because she is in pain, and wants to give some pills to Uncle Joe because he is hurting -- well, this is a potential problem," Haynes says. "Uncle Joe may have a problem that keeps his body from eliminating the drug, or he may have an allergic reaction, or the drug may interact with a medication he is taking, with life-threatening results."

Pain Medications Mistake No. 7: Not Talking to the Pharmacist

It's not easy to read drug labels, even if you can make out the small print. If you have a question about either a prescription or OTC drug, ask the pharmacist.

"That's why I'm in the store," Binaso says. "You may have to wait a couple of minutes for me to finish what I'm doing. But you'll get the information you need to take the right medicine the right way. Just say, 'Tell me about this medicine; what should I be on the lookout for?'"

Pain Medications Mistake No. 8: Hoarding Dead Drugs

Joe's wife is actually to blame for one of his mistakes. She should have disposed of those extra pain pills once she was over her dental pain.

Why? One reason is that pills stored at home start breaking down soon after their expiration date. That's especially true of drugs kept in the moist environment of the bathroom medicine cabinet.

"People say, "That drug is only a year past its expiration date; isn't it good?" But if you take a pill that's broken down, it may not work -- or you may end up in the emergency room because of reaction to a breakdown product. That is really common," Binaso says.

Another reason that it's dangerous to hoard is that the drugs may tempt someone else into making a very bad choice.

"Teen drug abuse is really up, especially with pain medications," Binaso says. "It is not uncommon for kids to go to their parents' or grandparents' medicine cabinet and then go to a party and put the drugs in a bowl."

Pain Medications Mistake No. 9: Breaking Unbreakable Pills

Pills are actually little drug-delivery machines. They don't work the way they're supposed to when taken apart the wrong way.

Scored pills should be cut only across the line, Binaso says. Those without scoring should not be cut at all, unless you're specifically instructed to do so.

"When you start chopping up pills like that, the pill may not work," she says. "We find more and more people are doing this. And then they say, "Oh, that pill had a really bad taste. That is because they cut away the coating."

Reviewed By David T. Derrer, MD - Source
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