What triggers my pain symptoms?
If your pain isn’t coming from an obvious source—a sore neck from a car accident, say, or broken leg from a skiing snafu—try pinpoint the trouble by keeping a pain journal, recommends Jeremy Allen, MD, medical director for American Family Care, Birmingham, Alabama, region. Record what you were doing and what was happening around the onset of pain. “Even things as simple as a shift in your diet, a reduction in the amount or quality of sleep you get, or amount of stress you’re under can impact your level of pain,” says Dr. Allen. Don’t wait to call a doc if you experience these pain symptoms.
What is my diagnosis?
All you know is that you’re in pain and want relief. Gus Crothers, MD, medical director of clinical personnel for Grand Rounds, says hang on: Pain is a symptom, not a diagnosis. “It is important to know that your doctor has a good understanding of the underlying cause of your pain,” says Dr. Crothers. “Without a correct diagnosis, it is difficult to prescribe the best treatment.” (It’s a slippery slope when you try to diagnose yourself.) If you don’t have a clear diagnosis, you may want to get a second opinion before starting any pain meds.
Are you treating me for acute pain or chronic pain?
Acute pain came on suddenly and hopefully will begin easing once you start the healing process. (Don’t miss the 24 secrets pain doctors won’t tell you.) Chronic pain means you’ve been living with it for awhile. It’s critical to understand the expected time frame of the pain and treatment. “Acute pain and chronic pain are managed very differently and there are certain strategies that might work for one but won’t work for the other,” says Dr. Crothers.
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Have you looked at all my other medications and considered all of my other health conditions?
Some medicine combos just don’t play nice in the body and can create more trouble. A bad cocktail of medication can damage your kidney or liver. Some drugs will be stronger or weaker in the presence of other pharmaceuticals, causing the prescribed doses to be too high or too low. “Opioid pain medications in particular can cause trouble if they are mixed with another medication that is processed by the same part of the liver,” warns Dr. Allen. “The two substances will end up receiving uneven amounts of critical enzymes that the body uses to process them, which could lead to inconsistent performance of both drugs, or a buildup of those substances in the body.”
Can I try non-opioid medications first?
Back pain from a sprain or strain is a very common complaint, according to Quan Nguyen, MD, a Kaiser Permanente pain specialist in California, but pain stemming from the back or any other part of the body doesn’t necessarily need an opioid prescription. Acute and chronic pain can resolve with conservative efforts such as physical therapy, analgesic balms and over the counter anti-inflammatories. “Other options include anti-inflammatories that are prescription strength or oral steroids such as prednisone if severe and without contraindications,” says Dr. Nguyen. Try these home remedies for an achy back.
I don’t want to take Rx meds: What other options do I have?
Serious pharmaceuticals shouldn’t always be the first course of action taken to manage pain. “What many people don’t realize is that often, pain can be very poorly treated with prescription medications, but responds well to over-the-counter medications,” says Dr. Allen. Before taking the prescription opioid route, there may be lifestyle changes you can try to reduce your pain, such as yoga, meditation, lose weight, exercise more, massage therapy, physical therapy and acupuncture.
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I’m doing physical therapy. Why do I still need my pain meds?
Physical therapy can “hurt so good,” meaning it may be painful to do physical therapy but the end results will help manage your pain. “Medications can help facilitate physical therapy and alleviate the process of inflammation that can trigger during a physical therapy session,” says Anita Gupta, DO, a board-certified anesthesiologist and pain specialist. Talk to your doc and physical therapist to make sure both sides are on the same page. “Doing this will make sure the end result is what both sides want and expectations are reachable.”
What are some common side effects of taking pain meds?
Side effects will vary from person to person. Any medication can carry unpleasant side effects like weight gain, fatigue, and nausea. Most people experience few problems—commonly minor issues like feeling drowsy—while an unlucky few can experience life-threatening trouble. Ask your doc what the most common side effects for your meds are, and be sure to discuss the rare ones so you will have a better idea going into treatment of what to watch for. “For example, short-acting pain medications, meant to be used for a short duration of time, can lead to a rebound pain effect if taken for too long,” says Dr. Allen. “Some medications can also cause digestive issues, liver problems and impaired adrenal function.”
What if I re-injure myself? Can I take the leftover opioids from my last injury?
Opioids are a controlled substance for a reason. They are can be very dangerous when not used under the direction and care of your doc. If that old knee injury is wreaking havoc on your daily life, don’t start popping the pills from your last episode six months ago. “The underlying pain from one injury may not be the same as for a second type of pain, or even the right medication for a similar type of pain,” cautions Dr. Asher Goldstein of Genesis Pain Centers.
Also, be sure to dispose of leftover, unwanted or expired meds properly. “Many municipalities have put into place means of disposal of medication so they do not get into our drinking water,” says Dr. Asher. You can contact your local pharmacy for information on disposing of specific drugs. Besides protecting the environment, proper disposal also keeps dangerous drugs out of the hands of children and adults who may take them accidentally or for recreational purposes. (High school seniors admitted to taking these from the medicine cabinet.) The DEA initiative, National Prescription Drug Take Back Day, provides further information to safely dispose of prescription meds.
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Can I become addicted to pain pills?
In a word, yes. “Patients need to know that it is a possible risk particularly with long term use and in patients that have risk factors,” says Medhat Mikhael, MD, pain management specialist and medical director of the non-operative program at the Orange Coast Memorial Medical Center in California. There are screening tools doctors should use to asses your risk of addiction Dr. Mikhael says. Some questions that you should be asked will address any struggles with addiction to alcohol, smoking or other substance abuse. It may be embarrassing to admit if you’ve battled addiction in the past or if your family members have, but its crucial for your doctor to know so he or she can determine the safest and most effective treatment plan for you.
What’s my exit strategy if I take opioids?
The current “best practice” for pain management is to start with around the clock non-opioid pain relievers such as acetaminophen plus a non-steroidal anti-inflammatory drug like ibuprofen, or maybe an agent like gabapentin or pregabalin, says Eugene Viscusi, MD, director of the Acute Pain Management at Thomas Jefferson University Hospital in Philadelphia. “Opioids should be added to this on an as-needed basis. The key is to use the lowest effective dose for the shortest amount of time,” says Dr. Viscusi. Talk to your doctor about your exit strategy to deal with any possible withdraws. “Generally with the short term use of low dose opioids they can be abruptly terminated without withdraw.”
What is opioid withdrawal syndrome?
Not everyone will experience withdrawal symptoms from taking opioids. It will depend on the length of treatment and the dose of the opioids, explains Dr. Viscusi. “Symptoms may be as little as mild flu-like symptoms to sever nausea, vomiting, diarrhea, anxiety, general body aches and pains,” he says.
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Should I request an Rx for naloxone?
The only reason naloxone has become so well known is due to the opioid overdose in epidemic in America. Naloxone is a life-saving drug that can save people death by reversing the effects of an opioid overdose, if it is administered in time. According to the Centers for Disease Control and Prevention, since 1999 sales of prescription opioids have quadrupled, and more than six out of ten drug overdose deaths involve an opioid. According to Ilan Danan, MD, sports neurologist at Kerlan-Jobe Center for Sports Neurology and Pain Medicine at Kerlan-Jobe Orthopaedic Clinic in Los Angeles, the majority of these deaths are unintentional. “In situations such as these, having an opioid emergency plan is an honest discussion worth having between the patient and the prescribing physician,” says Dr. Ilan. “It is imperative that patients and family members understand the signs and symptoms of an opioid drug overdose, as Naloxone could be lifesaving.”