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DRUG THERAPIES ARE NOT A CURE BUT THEY CAN OPTIMIZE PAIN CONTROL AND PROVIDE THE RELIEF NECESSARY TO REGAIN FUNCTION, ALLOW THE PATIENT TO PARTICIPATE IN PHYSICAL THERAPY, AND HELP THEM REGAIN SOME SEMBLANCE OF A NORMAL LIFE.
For Chronic Pain patients drug therapies allow them to regain a balance in their lives and resume many activities they had previously stopped. Here we will try to give some of the basic medication types, an example, and what they are typically used for.
ADDICTION & CHRONIC PAIN?
Addiction and Opiods tend to be in the news a lot lately and before we share information on the types of medications best used to treat CRPS we felt the need to address the situation that is going on across the country right now regarding the use/abuse of chronic pain medications and efforts to control it.
It seems some people, especially out in Washington, DC, feel the need to add even more legislation to 'safeguard' those of us who CORRECTLY AND LEGALLY use medications to treat chronic pain. Casio 991ex.
Due to the actions of a small group of individuals who choose to abuse the system and break the laws regarding the proper use of opiods and other prescription medications, a small group of physicians and individuals are trying to push the FDA and congress into enacting legislation to 'protect'ALL users of medications and their Physicians from what they see as the obvious abuse that is occurring. People are dying. That is true, no one is disputing that. But PLEASE people, look at the real data, look at who is abusing the medications!
* According to the study 'Fewer than five percent ofpatients prescribed narcotics to treat chronic pain become addicted to the drugs, according to a new analysis of past research.'
'The finding suggests that concerns about the risk of becoming addicted to prescription painkillers might be 'overblown,' said addiction specialist Dr. Michael Fleming at Northwestern University's Feinberg School of Medicine.'
'To get a sense ofhow addictive opioid painkillers are for those patients who do have a prescription, researchers from The Cochrane Collaboration, an independent group that reviews research on medications, collected the results from 17 studies covering more than 88,000 people.
All of the patients had been prescribed opioids to treat chronic pain, and nearly all of them had pain unrelated to cancer.
In 10 of the studies, patients used the painkillers for anywhere from three months to several years, while one study included just short-term use of several days and the others did not report the length of time patients were on the drugs.
Taken together, the studies found that 4.5 percent of people developed a dependency on the painkillers. (bold print added by us).
Please understand that there is a significant difference between dependency and addiction, because chronic pain patients understand the difference.
'It's a low percentage,' said Dr. Silvia Minozzi, lead author of the study and a member of the Cochrane Drugs and Alcohol Group in Rome.'
So why are they saying that so many people are addicted to prescription drugs?
Because of a couple of things especially. One is what is included or not included when you are talking about this issue with the public/media, and the second is the importance of buzz words.
1) They include studies like this;
'For instance, a study by Boscarino and his colleagues that was included in Minozzi's review found that 25 percent of patients became addicted.'
That is pretty high. Much higher than 4-5%. However when you read further, IF you read further, you would have found this information ..
'The group of patients Boscarino surveyed had a high rate of alcoholism and illegal drug use, though.'
Is it really a surprise then that people with these types of addictive predispositions had issues with drug addiction????
2) The second reason is the importance of buzz words. Words like 'prescription drugs'. They use those two little words and everyone assumes that the people abusing the drugs HAVE a prescription but when you delve into the research or into the articles you often find that no, the drugs, as described above, were not their own but instead, were illegally obtained drugs that were legally prescribed for other people who were in real pain, by their Physicians who knew exactly what they were doing; taking care of their patients.
These new laws they are trying to enact are taking that ability away from the Drs. and patients are being sent away from practices in search of new physicians. Drs are afraid to prescribe these much needed chronic pain medication now and patients have a terrible fear of their much needed medication supplies being cut off.
Chronic pain patients don't take these medications for fun and games, or to get high, or to escape life for a few hours. Chronic pain patients take opiod medications in order to survive their diseases, to enable them to live another day, week, month with some semblance of normalcy.
People who abuse drugs need help, yes. They need counseling, yes. Some are dying from overdoses from their illegal use of prescription medication, yes. Absolutely. But please don't lump those of us who have to use chronic pain medications every day, the same as someone with diabetes has to use insulin every day, or an MS patient has to have their daily dose of medicine, or any other chronically ill patient has too have their dose of medication, don't lump chronic pain patients in the same category with drug abusers simply because they abuse our drugs. It just is not right or fair to punish us for their abuse.
Information provided by an article titled 'Painkillers Not As Addictive As Feared'.
Read also'Dependency, Addiction, Or Tolerance? What is the Difference Regarding the Use of Opiod Medications?'
This is an excellent article because it is a confusing area, the difference between these words; Dependence - Addiction - and Tolerance? How does it affect your body and more importantly does it affect how insurance companies, Doctors offices, and Hospitals issue medications to patients? YES!
Please feel free to print out this information out and share it with your physicians if they share concern regarding the use of pain medications to treat your CRPS. The proper combination of medications is vital in treating CRPS and it takes both you and your Doctor working together tounlock relief for you.
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MEDICATIONS - DRUG THERAPIES OFTEN USED IN TREATING CRPS
These are some of the more often used medications used to treat CRPS. Because it is a syndrome it typically is treated with a combination of medications rather than simply just one, say a pain medication for instance. You usually will present with a number of symptoms that will usually require two or more medications to treat. Below, we offer some of those options but different physicians will have their own favorites.
Use the internet to do a search of the medications given by your Dr. to learn more.
Don't be afraid to ask your Dr.;
- questions about the medications he suggests/writes scrips for you
- what each medication will do/won't do
- what his/her success rate has been in the past with that drug
- when you should start seeing a difference in your symptoms because of the medication(s)
- what the plan is if this doesn't work
- what medication can you try next if this dose does not work to treat some of your other symptoms.
- what medication can we try next if this dose does work, for my other symptoms.
These are just some of the questions you can ask. I am sure you can think of others. Remember, the Doctor works for you. You/your insurance are paying him, work with him to find the best solution for managing your pain or even eliminating it.
Always plan your work and work your plan! Figure out your long distance goals because CRPS is a long distance disease. It can be managed fairly well with a good combination of medications, exercise, diet, and mental attitude. For me, Keith, that also includes a lot of faith. Your journey may be different. Look to your family and friends if possible and don't try to do this alone.
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ANALGESICS:
OPIATE AGONISTS – These medications attempt to reduce central nervous system activity and thereby reduce pain. Opiate agonists act on opiod receptors to initiate analgesia sedation and euphoria. Commonly used opiate agonists are MS Contin, Morphine, Oxycontin, Opana, Hydrocodone, and the Fentanyl patch.
These types of medications, opiate agonists, seem to be one of the most effective medications for CRPS for most patients, however, since both Opana and Oxycontin have changed their formulations for their ER versions) recently (Opana in 2012 and Oxycontin back in 2010) many patients reported a loss of effectiveness as well as some intestinal side effects that they were not experiencing before. Many of these patients reported switching to another medication or if intestinal issues. For those patients for whom intestinal issues, especially severe constipation, was an ongoing problem many prefer moving to a medication such as the Fentanyl Patch to eliminate (no pun intended) the issues associated with these oral opiods altogether.
OPIATE ANTAGONISTS - Opiate Antagonists block and reverse the effects of opiod agonists by competively adhering to opiod receptors. An example of an opiate antagonist is Naltrexone.
NARCOTICS - Used to mask pain by blocking pain receptors from sending pain messages to the brain. Narcotics are also known as Opiods. Some examples include; Oxycontin CR and IR, Percocet, Percodan,, MS Contin, Vicodin, Lortab, and Lorcet.
Most Drs will prescribe the ER (extended release) or CR (controlled release) versions of these narcotics for a more evenly distributed release of medicine during the day, and to help the patient sleep better through the night.
Individual medications may vary and each patient will vary slightly as well but it gives you an overall idea.
Also included in the NARCOTICS family isFENTANYL, either in the more common PATCH ( a 3 day stay-on patch), or the less common LOLLIPOP FORM; ACTIQ. Fentanyl is becoming more popular lately with all the formulation changes to Oxycontin and other opiods. You can read more aboutFENTANYL HERE.
ANTIDEPRESSANTS –Originally only used to treat depression, studies have shown that these medications, both the newer antidepressants and the older tricyclic versions, can alleviate pain in certain situations. Furthermore, they have the added benefits of not only helping some patients sleep better, but also reducing some of the headaches associated with CRPS; although some have a tendency to cause weight gain and drowsiness. Paxil, Zoloft, Elavil, Pamelor, and Trazadone are good examples of these medications.
* Note - Teens need to be especially cautious regarding antidepressants because there have been studies showing that some teens placed on antidepressants have developed an increased rate of suicidal thoughts. There has been a link to increased suicide rates as well.
* Note 2 - Always talk over these issues with your physician; never stop, increase, or decrease your medications without talking to your Dr or pharmacist and always discuss any changes in mood or symptoms with your physician.
ANTICONVULSANTS – These medications are used to try and decrease the random neurons firing, thereby decreasing the burning pain and sensitivity associated with CRPS. This can sometimes also decrease the pain. Not always very successful in decreasing the pain or symptoms of CRPS but seems to be one of the first options used by Physicians. Be careful with regards to the maximum daily dosage. Visit their websites to learn more. Examples include Tegretol, Topamax, Lyrica, and Neurontin ( Gabapentin), (also with Neurontin be very aware of the maximum effective dose).
ANTISPASMODICS / MUSCLE RELAXANTS – Muscle spasms are very common with CRPS, typically rolling in nature. The medications used to treat this can include Baclofen, Clonazepam, Flexeril, Soma, and Zanaflex. Sometimes a Dr may prescribe a benzodiazepine for this; these can include Klonopin, Valium, andXanax.
NSAIDS – Used to treat swelling and inflammation. These can include Celebrex and Feldene. Accodring to Dr Timothy Sams, 'Most research has demostrated the efficacy of the Cox-2 inhibitors, (Celebrex/Feldene) but has clearly not found them to be better pain relievers tha the older of even nonprescription NSAIDS.'
NMDA RECEPTOR BLOCKERS - THIS WOULD INCLUDE THE DRUG KETAMINE. I would suggest you check out our information on Ketamine and CRPS if you are interested in learning more about this exciting drug therapy.
TRANSDERMAL MEDICATIONS – Pain Patches, LIDOCAINE and DURAGESIC/FENTANYL. Most important with these are their placement! Check with your physician but typically they are not placed directly over the CRPS-affected area. Again, if you would like to learn more about the Fentanyl Patch, even if you have been on it before, CLICK HERE!
AMINO BISPHOSPHONATE - NEW MEDICATION TO TREAT CRPS ON THE WAY ? It is called an Amino Bisphosphonate - Neridronate
There is NEW HOPE on the horizon for CRPS patients this year, in 2015. There is a medication that has been developed to help treat the symptoms of CRPS. One specific version, Neridronate, has enjoyed tremendous success over in Europe since its introduction for those patients with CRPS Type I and it is currently undergoing its' first trial here in the United States. The trial began earlier this year (2015) and is expected to be concluded in 2016.
CLICK HERE TO READ MORE ABOUT THIS EXCITING DEVELOPMENT!
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TO READ ABOUT THESCHEDULES OR CLASSES OF PRESCRIPTION DRUGS, CLICK HERE
We at American RSDHope are not medical professionals. We are family, friends, patients, and loved ones dedicated to helping you and your loved ones deal with the disease of CRPS and move forward with your life. Do not start or stop any medications or treatment without first consulting your physician.

Narcotics are natural opioid drugs derived from the Asian poppy Palaver somniferous or semi-synthetic or synthetic substitutes for these drugs.

Narcotics are drugs that dull the sense of pain and cause drowsiness or sleep. They are the most effective tool a physician has to relieve severe pain. Narcotics are also given pre-operatively to relieve anxiety and induce anesthesia. Other common uses are to suppress cough and to control very severe diarrhea. In large doses, they can suppress the ability to breathe and cause coma and death. Narcotics are also taken illegally for recreational use.

Narcotics should only be taken under the direction of a physician. These drugs depress the central nervous system and should not be taken with other drugs, such as alcohol, barbiturates, antihistamines, and benzodiazepines that also depress the central nervous system.

Opioids are broken down by the liver. Individuals with liver damage may not detoxify these substances as rapidly as healthy individuals, leading to potential accidental overdose. Street narcotics are of uncertain strength and may be contaminated with toxic chemicals or contain a mixture of drugs that can cause life-threatening reactions.

Natural narcotics are derived directly from the sap of the unripe seed pods of the opium poppy. Morphine and codeine are the most familiar natural narcotics and are the narcotics most frequently used in medical settings. Often they are prescribed in combination with other non-narcotic drugs. Heroin is a semi-synthetic narcotic. It has no medical or legal uses. Other completely synthetic narcotics are made in the laboratory. These include drugs with medical uses such as fentanyl and oxycodone and illegal 'designer drugs' synthesized for recreational use. Some man-made narcotics are hundreds of times more potent than natural narcotics.

Narcotics depress the central nervous system. They work by binding chemically with receptors in a way that blocks the transmission of nerve impulses. These drugs do not cure the source of the pain; they simply block the individual's perception of pain. When used to treat cough or diarrhea, they slow or block muscle contractions.

Morphine (Roxanol, Dura morphine, morphine sulfate, morphine hydrochloride) is the most commonly used medical narcotic for managing moderate to severe pain. It can be also be used to control extreme diarrhea caused by cholera or similar diseases. Morphine sulfate is a white powder that dissolves in water. It is usually given by injection into a muscle or intravenously by injection into a vein. When given intravenously, its effect occurs almost immediately. Individuals given morphine regularly have a high potential for developing dependence on the drug. Morphine can cause withdrawal symptoms if stopped abruptly. It is not a common street drug.

More codeine is prescribed medically than any other narcotic. Concentrations of codeine in the sap of the opium poppy are low, so most codeine is manufactured by chemical alteration of morphine. For pain control, codeine is combined with other non-narcotic painkillers such as aspirin (Empirin with Codeine,) acetaminophen (Tylenol with Codeine) or non-steroid anti-inflammatory drugs. These combination painkillers are manufactured as tablets (most common) or liquids and come in a variety of strengths based on the amount of codeine they contain. Codeine is also found in some cough syrups (Robitussin A-C, for example) and is used to control dry cough. Occasionally codeine is used to control severe diarrhea, although diphenoxylate (Lomotil) is used more often.

In Canada, certain low-dose codeine pain relievers are sold without prescription. In the United States pain medication with codeine requires a prescription. The likelihood of physical or psychological dependence on codeine is much lower than with morphine.

Hydromorphone (Dilaudid) is a narcotic synthetically produced from morphine. It is available in tablets or as an injectable solution and used for pain relief. It is one of the most common pain relievers prescribed for patients who are terminally ill, because it combines high effectiveness with low side effects.

Mederidine (Demerol) was originally developed to treat muscle spasms but is as of 2005 used mainly for pain relief. It is manufactured as tablets of varying strengths. Another synthetic pain relief narcotic whose use parallels mederidine is propoxyphene. When combined with aspirin this narcotic is known under the brand name Darvon.

Oxycodone (Oxycontin), a synthetic narcotic used for pain relief, is manufactured both alone and with aspirin (Percodan) or acetaminophen (Percoset) in tablets of various strengths. OxyContin is a controlled release formula of oxycodone that controls pain continuously for 12 hours at a time. Oxycodone has a high potential for prescription drug and street abuse. Hydrocodone with acetaminophen (Vicodin) is another synthetic narcotic whose use and potential abuse parallels oxycodone.

Fentanyl (Sublimaze, Actiq, Duragesic) is used as a surgical anesthetic. It is available as an injectable solution and as a skin patch.

Methadone is a synthetic narcotic used mainly as a substitute for heroin in heroin withdrawal treatment, although it does have pain-killing properties. Methadone, when taken by mouth (liquid, wafers, tablets) provides little of the euphoria of heroin, but it blocks heroin cravings and withdrawal symptoms.

The first international attempts to control narcotic drugs were made in 1909 with the formation of the Opium Commission Forum, which developed the first international drug control treaty in 1912. In the early 2000s narcotics are regulated internationally by the International Narcotics Control Board (INCB), established in 1961. The INCB regulates the cultivation of raw materials to make narcotics and natural and man-made drugs. Cocaine and marijuana also fall under the board's control, although they are not technically narcotics. Narcotic drugs are also regulated by federal and state governments. In law enforcement, the term narcotics is extended to include other, mainly illicit drugs such as cocaine that have little medical use.

No special preparation is required before being treated with narcotics, although, as with all medications, individuals should tell their physician about all prescription and non-prescription drugs, supplements, and herbal remedies that they are taking, as certain medications may enhance the effects of narcotics.

When an individual is prescribed narcotics regularly for an extended period, tolerance may develop. With tolerance, the individual must take higher and higher doses to achieve the same level of pain control. In some cases, when narcotics are stopped abruptly, withdrawal symptoms may develop. These include:

In order to prevent withdrawal symptoms, the dose of narcotics can be gradually diminished, a process known as tapering, until they can be discontinued completely without unpleasant effects. Individuals may also be treated with the drug cloindine (Catapres) to relieve some withdrawal symptoms.

All narcotics have the potential to become physically and psychologically addictive. When used regularly, tolerance can develop. Abuse and dependence on narcotic prescription drugs in an increasing problem among the elderly particularly and among members of the middle class generally.

Overdose and withdrawal symptoms and reactions caused by contamination with other drugs or toxic chemicals are common reasons for drug-related visits to the emergency room by individuals using street narcotics recreationally. Overdose is treated with the drug naloxone (ReVia). Naloxone blocks and reverses the effects of narcotics. When given intravenously it is effective within one to two minutes.

Tapering — Gradually reducing the amount of a drug when stopping it abruptly would cause unpleasant withdrawal symptoms.

When used as prescribed, narcotics are a generally safe and effective way to relieve pain and control cough and severe diarrhea. Individuals should not be afraid they will develop an addiction after a short-term course of narcotics following a dental or medical procedure, provided that they follow their physician's instructions for taking the drugs.

National Institute on Drug Abuse/National Institutes of Health. 6001 Executive Boulevard, Room 5213, Bethesda, MD 20892-9561. (301) 443-1124. http://www.nida.nih.gov.

United States Drug Enforcement Administration. Dr Mailstop: AXS, 2401 Jefferson Davis Highway, Alexandria, VA 22301. (202) 307-1000. http://www.dea.gov.

'Narcotics.' United States Drug Enforcement Administration (undated) [cited March 25, 2005] http://www.usdoj.gov/dea/concern/narcotics.html.

National Institute on Drug Abuse. February 4, 2005 [cited March 25, 2005]. 〈http://www.nida.nih.giv/ResearchReport/Prescription/Prescription.html〉

Stephens, Everett. Toxicity, Narcotics January 7, 2005 [cited March 25, 2005]. http://www.emedicine.com/emerg/topic330.htm.