Chronic Pain and Medications

Key learnings:

  • The difference between chronic and acute pain
  • Chronic pain facts
  • Types of medication to support chronic pain
  • Difference between opioid and non-opioid medicines
  • How to identify if you need chronic pain medication
  • How to find out what pain medication is right for you

Listen to pharmacist Chris Campbell

  • How should we use pain medications safely and effectively?
  • What is the best way to see if a pain medication is working or not?
  • Pain medication is often a tablet. What other forms of pain medication are available?
  • How does managing pain with a multimodal approach optimise the effectiveness of pain medications?
  • When you are not sure if a pain medications is working or not, what should you do?
  • Should alcohol be used with pain medications?

Chronic Pain

Do I have chronic pain?

Difference between chronic and acute pain

Acute pain is usually the result of an injury that causes tissue damage or swelling, or from a medical intervention such as a surgical operation. In most circumstances, acute pain fades as the injury or damaged area heals and lasts for only a few days or weeks. Acute pain is considered normal as it is a necessary form of pain that acts as an alarm system, stopping us from doing things that could cause further damage to our bodies.

Chronic pain, on the other hand, is usually a result of an injury from which the body has “recovered”, but the pain sensation still remains. Chronic pain can be classified as pain that continues for three months or more and unlike acute pain, continues beyond the point of healing. It’s for this reason that chronic pain can be quite distressing and can lead to other changes in the central nervous system and body. If pain of this type is addressed early, these changes can be reduced and people can return to normal function. Identifying what contributes to a person’s chronic pain is important when deciding the best tools to help. Pain relievers should be reviewed every 3 to 6 months. Your pharmacist or GP can also help to identify the type of pain you are experiencing and the best treatments to suit that pain.

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Is a Pain Medication Check right for you?

Answer a few questions that will help you understand if you may benefit from a Pain Medication check with your pharmacist.

How does chronic pain occur?

Currently, one in five Australians including adolescents and children live with chronic pain. The prevalence rises to one in three people for those aged over 65. Injury is the leading trigger of chronic pain, with the most common injuries resulting from playing sport, car accidents and accidents at home or work.

Other ailments and conditions that can cause chronic pain include:
• Broken bones
• Virus infections such as shingles
• Trauma
• Joint problems such as arthritis
• Back injury
• Surgery in the spine
• Joint injury and surgery
• Surgery from cancer
• Internal organ operations such as prostate or bowel

Diabetes is also capable of causing chronic or persistent pain, as the high level of blood sugar irritates and damages the nerves, creating what is known as neuropathy – a form of nerve pain.

Any condition, even a small incident, that can cause a damaging change in the body can give rise to the continuing sensation of pain. If this pain lasts for longer than three months, we refer to this as chronic or persistent pain.

Diagnosis and Treatment

Early diagnosis

Early diagnosis is essential so that you understand what is happening to your body. It can be harmful if only the present symptoms are treated rather than the underlying cause. Once you have been diagnosed, it is important to quickly organise a treatment plan for your chronic pain, including a focus on the treatment of the underlying cause.

You should seek help for persistent pain when:

  • The pain has lingered for more than three months;
  • The pain is not responding to usual simple treatment and;
  • The pain is limiting your day-to-day function

Treating chronic pain

Like asthma or diabetes, chronic pain is treated as a long-term condition and is not seen as a symptom that can be easily fixed, but a condition that you can manage and control. Chronic pain management aims to reduce pain to improve your function and to help you undertake your daily activities and enjoy life despite pain. A chronic pain management plan may require input from several specialists, your General Practitioner (GP) and allied health professionals. As a starting point, reach out to your GP or TerryWhite Chemmart Pharmacist for advice on managing your pain.

We know that pain management requires more than just medication and may include non-medical products such as TENS machines, heat and cold packs, braces and more active therapies like relaxation exercises, graded physical activity and mindfulness to name a few.

Omron TENS Therapy Device

Drug-free Pain Relief Using TENS Therapy

How Product Can Help
TENS therapy devices provide soothing relief for muscular pain and tension by sending a small electrical current through the skin (via electrode pads) to stimulate the sensory nerve endings that send signals up the spinal cord to the brain.

This method can relieve pain in two ways:

  1. by stimulating the release of Endorphins, the body’s own pain-relieving hormones; and;
  2. by using a natural effect called the “Pain Gate” to block pain signals before they reach the brain.

Features / Benefits
Many TENS therapy devices come with pre-built modes to allow the user to control and adapt the pain treatment according to preferences, treatment area and pain symptoms.

ormon-tens-machine

Helpful Hints / Pharmacists Advice
TENS Therapy Devices can be used as a preventative measure, such as avoiding muscular pain after exercise as well as a pain relief and injury recovery option. It is important that you consult a healthcare professional prior to use to ensure that the product is suitable for you and your condition.

Medication

Do I need medication to manage my chronic pain?

Managing chronic pain is most often achieved through a combination of medicinal and non-medicinal therapies. Most pain relievers only decrease pain by 30% to 50% and therefore it is important to consider additional treatment methods other than medications alone.

In rare cases, long-term use of pain medications like opioids can cause the nervous system to become more “switched on”, causing you to become more sensitive to pain. If you experience the below symptoms when taking pain relief medication, it is important to see your GP or pharmacist.

  • Become more sensitive to pain
  • Pain continues even after doses of pain relievers are increased
  • Experience a change in pain sensations and previously non-painful sensation feel painful

As your pain experience changes, your pain relievers may need to change too. Depending on the medication, it can be best to gradually reduce the dose when changing to something else. With any change, doing this with the support of your GP and pharmacists is always recommended. Having your medications reviewed every three to six months by your pharmacist is important to maintain safety and effectiveness at all times.

What medications are used to treat chronic pain?

Non-prescription pain-relievers

Non-prescription pain-relievers can include paracetamol, anti-inflammatory pain relievers, combination products, complementary medicines, topical analgesic creams and specially compounded products.

Prescription pain relievers

If your pain is not controlled by a non-prescription pain reliever, your doctor can prescribe other pain relievers and medicines to suit your type of pain.

Click here for more information about Paracetamol, NSAID and Opioids

Paracetamol
Paracetamol provides effective, temporary relief of mild to moderate pain and fever. It has analgesic properties (blocks transmission of the pain message to the brain) and antipyretic properties (reduces fever), but little or no anti-inflammatory effect. Before taking paracetamol, check carefully what dose is recommended. Avoid using more than one product containing paracetamol at the same time, as taking too much paracetamol can cause liver damage.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) contain anti-inflammatory (reduces pain and inflammation), analgesic (pain reliever) and antipyretic (reduces fever) properties. There are many NSAIDs available on the market including:

  • Ibuprofen
  • Naproxen
  • Mefenamic acid
  • Diclofenac
  • Aspirin

Some NSAIDs, such as ibuprofen, are available over the counter, but others such as celecoxib and meloxicam are only available on prescription.

These medicines are effective in relieving pain, fever and inflammation (at least in the short term) but can cause unwanted side effects. They should be used at the lowest dose that improves your symptoms and only for a short time.

NSAIDs come in various forms (tablets, capsules, liquid and topical gel) so it is important to find out from your GP or pharmacist, which product will give you the best results. Most NSAIDs should be taken after food or milk to reduce irritation to the stomach. These medicines may not be suitable for people with stomach troubles, heart problems, kidney problems, high blood pressure or asthma again check with your GP or pharmacist to work out what’s right for you.

Opioids
One prescription medication used to treat severe acute pain are a group of medications called Opioids. Opioids are commonly used to relieve severe acute pain or cancer pain but are generally not effective at reducing chronic pain that is not caused by cancer, particularly in the long term. Prescription opioids can include:

  • Buprenorphine
  • Fentanyl
  • Morphine
  • Oxycodone
  • Tramadol
  • Tapentadol
  • Codeine in higher doses

Side effects
Whilst relatively effective for severe acute and cancer pain, opioids can be addictive and may have side effects such as nausea, vomiting and constipation. Around 80% of patients who take opioids long term will experience side effects. Because of their sedative effect, your ability to drive might be affected. If you are taking opioids, do not drink alcohol and be aware of other sedatives – these can further impair your ability to function and lead to accidental overdose and death. The longer you take opioids, the greater the risk of experiencing problems, which can include:

    • Hormone changes
    • Chronic dry mouth causing tooth decay
    • Bone weakness, loss and fractures from minor accidents
    • Chronic constipation
    • Altered sleep
    • Dependence
    • Risk of overdosing

If you suffer from any of these problems, please discuss it with your pharmacist and see your GP for regular monitoring.

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Unsure if what you’re currently taking has paracetamol? Speak with your TerryWhite Chemmart pharmacist who can help you manage your medications.
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Click to find your nearest pharmacy

What pain medication is right for me?

Unsure if you should continue with your current pain relief medication?  Speak with your GP or TerryWhite Chemmart pharmacist who can advise on what pain medication is right for you. When you discuss this with a health professional, make sure to ask the following questions:

  • What are my options to treat chronic pain?
  • How likely are they to help?
  • When should I expect them to start working?
  • What level of pain relief should I expect?
  • If they don’t completely take the pain away, how do I know if they are helping?
  • What goals should I be achieving by taking this medication?
  • How long do I need to take them?
  • How much and how often do I take the medicine?
  • Do I need to take the medicine with anything or avoid things when I take the medicine?
  • What are the possible side effects? What should I do if I have them?
  • How do I safely start and stop chronic pain medicines?
  • Are there alternative forms of treatment, besides medicine, that can treat chronic pain?
  • What else could I be doing to help my pain?
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– Tim Siv’s TerryWhite Chemmart Clare, Tim Siv

terrywhite-chemmart-chester-pass-albany-brad

– TerryWhite Chemmart Chester Pass Albany Pharmacist, Brad Smithson

Pharmacist Tips: Chronic pain symptoms not subsiding from over-the-counter products or prescription pain relivers?

Palmitoylethanolamide (PEA)

At selected TerryWhite Chemmart pharmacies throughout Australia, our pharmacists’ compound PEA (Palmitoylethanolamide); a drug that to tone down pain by reducing inflammatory substances that amplify pain. PEA has shown promising results in our patients, particularly in those who suffer from nerve related back pain, osteoarthritis, fibromyalgia, sciatic pain and migraine, amongst other chronic pain conditions.

Do I need a script?

No – you do not require a script to get PEA. Simply visit your local TerryWhite Chemmart and let your pharmacist know you would like to purchase this product. Your pharmacist will then have a short consultation with you to review your current and previous pain management plan and existing conditions to determine if PEA is suitable for you. Please note, this is only available at selected TerryWhite Chemmart pharmacies.

Medicines alone are not the answer to chronic pain. Complete all modules to learn how to manage your chronic pain better.

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