Gaining access to effective prescription medications for your pain can be difficult due to the impact of postcode prescribing influenced by pressures on NHS budgets. Naturally some people are concerned about potential side-affects linked to some medications along with concerns about becoming dependent or addicted to stronger prescription drugs which can be effective in treating your pain. Today sees a greater awareness amongst pharmaceutical companies as they develop effective patient information in a format that it is clear and easy to understand. Medications can provide a valuable tool in dealing with your pain but should not close your eyes to other treatment options that may be available in your area . Informed and impartial information or advice is available from your local pharmacist or other relevant healthcare professional. Pharmacies in particular are moving rapidly to develop the range of treatment they can provide for pain relief.

Prescribing of medications by Healthcare Professionals

Your GP is likely to be your first port of call when trying to ease your pain. Many will try established prescribing treatments in order to find medication that can work on your pain. This can take time as your GP seeks to find the medication that is most effective in dealing with your pain whilst minimising the possible side effects. Some people expect the “instant fix” which is usually not the case as medications often need time to work and may not work at all for you. It is easy to get frustrated over the perceived lack of progress with the temptation to stop taking the medication because it appears not to work. If in any doubt do chat to your doctor or the Practice Nurse who may well be able to reassure you or adjust your medication. A good tip is to talk to your local pharmacist who has a good understanding of the various attributes of the various medications.

It is customary for GP’s to prescribe medications from the following two categories of drugs.

Analgesics which treat the pain directly. Often your GP will aim to maintain an acceptable amount of pain control for you by prescribing painkillers at one of three levels. This may involve them steadily increasing the dosage of the medicines they prescribe which will become more powerful as the pain worsens and you move up to the next a level of drug treatments.

At the start you doctor is likely to prescribe relatively low doses of low-potency analgesic medications like paracetamol. It may be appropriate for them to also prescribe an anti-inflammatory like ibuprofen or another type of NSAIDs

If the pain persists or becomes more severe, a stronger painkiller like codeine may be needed, and you GP will try different dosage levels with or without NSAIDs to control the pain.

In the final stage, if the pain persists or increases to a moderate-to-severe level, then higher strength opioid analgesics (again with or without NSAIDs) can be prescribed.

Psychotropic agents: like antidepressants and anti-anxiety drugs which tackle problems of depression and anxiety which are commonly experienced by people with chronic pain.

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Pain Consultants and Specialist Pain Nurse Practitioners have the experience and training to provide more specialist forms of treatment and they are therefore able to prescribe a wider range and combination of drug therapies.

As you probably already know through personal experience, back pain can be very complex and difficult to accurately diagnosis and treat. There are myriad causes and underlying factors, and a wide range of potential treatments that may or may not work for the same condition. Different drugs are prescribed according to what sort of pain is being targeted. Sometimes finding a painkiller that is right for the job can be difficult, because different types of pain respond better to particular types of treatments e.g.

Pain which is felt in the tissues and organs e.g. muscles, bones and liver is called nociceptive pain and is likely to respond well to classic painkillers such as aspirin, paracetamol, codeine and in severe cases of pain opiods like morphine may be warranted.

Pain which is felt from nerves is called neuropathic pain and is often responds poorly to the traditional analgesics like aspirin, codeine and morphine. Pain Specialists will often prescribe painkilling drugs which are usually used for treating other conditions like epilepsy and depression. e.g. Gabapentin and Tegretol (antiepileptics); Amitriptyline and Dothiepin.(antidepressants).

If your specialist recommends you try such drugs, it is not because they think you have these other conditions, but rather because they can help to combat certain kinds of pain.

These drugs work by preventing the random firing of nerve impulses from nerve cells, which is what causes the pain. The greatest problem with using these medications is that they give patients unpleasant side effects much more frequently than aspirin, paracetamol etc.

The recent advent of aspirin-like analgesics such as Ibuprofen, Voltarol, Mefanamic Acid, Ketoprofen, has opened up several effective options for treating nociceptive pain. Known as non-steroidal anti-inflammatory drugs (NSAIDS), the downside of these newer analgesics drugs is they may cause severe side effects i.e. gastric ulcers and kidney damage so they need to be used with caution. Newer COX-2 NSAID�s like Celecoxib, and Parecoxib/ Valdecoxib have now also been found to have some incidence of causing cardiovascular problems in “at risk” groups. Obviously care needs to be taken by health professionals when prescribing these anti-inflammatory drugs and provided there are no medical reasons to preclude you from being prescribed these analgesics the benefits in pain relief may be valuable.

The prescribing of pain relieving drugs by Pain Practitioners is rarely the only aspect in the treatment and control of chronic pain. A holistic approach is often helps you to start taking control over your pain. This may involve attending a pain management programme, seeing a physiotherapist or occupational therapist, or having sessions with a Clinical Pain Psychologist. This enablest you to learn the skills and techniques that can help you to still enjoy you life despite the pain.

What should I ask my doctor about the medications I am taking?

Doctors appointments may be rushed and pressurised so it can be difficult to remember all the questions about your medication when you are there. Make a list of your questions and concerns before the appointment and ensure that you are satisfied with the answers you have received before you leave. Confident communication is central to ensuring you obtain the best medical care available, so it is important that you receive clear answers to your concerns. If you feel you need a double appointment be sure to ask the receptionist when you phone.

It is important to know why the doctor has prescribed a particular drug;

You should know how it should help or relieve your condition or symptoms;

You need to understand when and how often you need to take the medication; whether it must be taken before or after meals; if it must be taken with water and whether you must avoid alcohol; and whether you must avoid taking any other prescription or over the counter medicines at the same time.

You should ask how long it is likely to be before you start to feel or see the benefits of the medication.
If your doctor does not have the time to answer all you questions or you remain unclear on some points, ask to see someone else in the practice who can answer your questions. Many health care providers now have nurse practitioners and health care assistants who are trained to help.

Will my doctor and/or pharmacist tell me about any side effects?

Many doctors will tell you about the side affects of your medication if you ask them, however your local pharmacist is far better placed to give this information. They have far more comprehensive knowledge about the range of drugs available. In addition, all prescriptions have package inserts that describe possible side effects which your pharmacist will be able to explain to you.

Dependency on a medication is not the same as addiction

Dependency arises when your body becomes accustomed to a medication and reacts negatively to its absence or any reduction in dosage. e.g. a diabetic will react negatively if they do not get their insulin but this does not mean that they are addicted to their medication.

Addiction on the other hand is a neurobiological disease distinguished by activities that include a lack of control over use of the drug, compulsive use, continued use despite harm, and craving.

What is tolerance?

Tolerance is a situation in which the use of a drug brings about adaptive changes within the body that cause a reduction in one or more of the drug’s effects over time. It is because of this that it is advisable to regularly review your medication with your doctor.

… and then sometimes it is up to you….

Often patients will end up at a pain clinic after taking various medications which are either simply not working on their pain or are giving them inadequate pain relief

There may be many reasons for this, but the simplest and probably most common one is non-compliance; that is they are not taking the drugs regularly as prescribed. Drugs are formulated to work in a particular way and therefore it is important to take the medication as prescribed. If the body has a constant, adequate level of a drug then it can fight the pain much more effectively. It often pays to be a “patient” patient!