A Pain Med Primer

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As an extremely old and cranky individual (some find it charming, I keep telling myself), I frequently complain about my various aches and pains.  It stands to reason that my minor issues with discomfort at present will be multiplied by the increased workload demands of a power-down situation.  Try lugging a full 5 gallon bucket of water from your local natural water source to your home a few times; I think you’ll get the idea.  Any person who hasn’t considered providing for pain issues in times of trouble is not medically prepared. Therefore, it’s a good idea to have a working knowledge of the actions and uses of various pain medications.
Pain Types and Medical Preparedness
Pain is extremely variable; it can be sharp, dull, throbbing or numbing.  It can be major or minor, and might or might not be a sign of something serious.  It can improved or worsened by various factors; as such, the exact same injury in two different individuals may elicit different levels of pain.  Pain relief is referred to as “analgesia“.
If we characterize pain by the kind of damage that it is caused by, we can group it into two or perhaps three categories.  Pain is most commonly caused by tissue damage (“nociceptive” pain).  The damage may be due to trauma or may be due to disease, such as tissue destruction from cancer.  Even certain medical treatments such as radiation may cause tissue damage that could lead to pain.  This type of pain is often described as “sharp”, “stabbing”, “achy”, or worsens with movement (“it only hurts when I laugh”).
Another category is pain caused by nerve damage (“neuropathic” pain).  Nerves transmit pain signals from the damaged area to the brain.  If the nerve is damaged, the sensation you feel may be very different from what you would expect.  You might feel burning where there is no burning, for example.  You might even feel pain in a limb that is no longer there, due to amputation.  This pain is more likely to be chronic than pain from tissue damage. Besides burning, this type of pain is described as prickling, “pins and needles”, or similar to an electric shock.

Pain Medications

Some feel that pain is “psychogenic”, or “all in the mind”.  Although fear, depression, anxiety and other emotions may play a part in someone’s pain, there is most often some physical origin.  Never dismiss a group member’s complaints of pain without fully evaluating them by physical exam.
Pain medications are used to, well, relieve pain.  As pain is variable, there are many different types of drugs available that have different mechanisms of action:
Non-steroidal anti-inflammatories:  Also known as NSAIDS, these drugs act on agents that cause inflammation
and fever as well as pain.  The most popular NSAIDs are Ibuprofen and Aspirin.  Naproxen is the other NSAID available without a prescription.  For quick relief from pain, the shorter acting Ibuprofen or Aspirin is superior to Naproxen.  Naproxen may not have an effect until you have taken a couple of doses, but works well for long-term relief.  These drugs are especially useful in injuries associated with swelling or other signs of inflammation. There are various prescription versions of NSAIDS on the market, such as Meclomen, Ponstel, Toradol, and many others.  Are they better than the non-prescription versions?  Despite pharmaceutical company claims to the contrary, there is no proven evidence that these expensive medications are much more effective.  Your experience may vary.  NSAIDS are associated with bleeding from the stomach lining, usually from long-term use.
Acetaminophen:  This drug relieves pain by changing the body’s sensitivity to things that cause pain (its “pain threshold”), and also lowers fever.  This drug is often as effective as NSAIDS for pain and has fewer side effects (unless you have liver disease).  Acetaminophen has no anti-inflammatory action, however.
Steroids:   Corticosteroids exert their effect upon pain by a very strong anti-inflammatory action.  The most common steroids used for inflammation are Prednisone and Cortisone.  They can be taken orally or are sometimes injected directly into damaged and inflamed joints.
Muscle Relaxants:  Drugs that relax tense and damaged muscles and also have a sedative effect.  A common one is Flexeril.  These are especially helpful for back strains or other injuries that cause muscle spasms.
Opioids:   Narcotics are used for pain in severe cases, and act by modifying pain signal transmission in the brain.  If you have had surgery, you likely have been given these medication for pain relief in the immediate aftermath.  Opioids are classified in “schedules” by the U.S. government.  Vicodin, for example, is “Schedule III”.  Others are “Schedule II”,  such as Demerol, which cannot be simply called in by the doctor to the pharmacy; it must be presented in person.  Tramadol, as it is less addictive, is “Schedule IV”.  Besides the risk of addiction, narcotics have a strong sedative as well as analgesic effect, and must be used with extreme caution during manual work or driving a car.
Anti-anxiety and anti-depressant agents:  Drugs such as Xanax or Prozac may have an effect on pain by relieving “psychogenic” factors such as anxiety or depression; this allows the patient to better deal with their pain issues.  They work by adjusting level of certain chemicals in the brain tissue.
Anti-Seizure Medication:  Some anti-convulsant drugs, such as Tegretol, used for epilepsy are useful to calm damaged nerves, and are possible options for “neuropathic” pain described earlier.
Combination Drugs:  Some pain medications are combinations of different drugs. Percocet, for example, is Acetaminophen and Oxycodone (an opioid).  Some are used alternatively during the day; An NSAID may be prescribed between doses of an opioid.
Most of these drugs are by prescription only, and it will be unlikely that you’ll be able to stockpile large quantities of any but the non-prescription versions.  As such, it will be important to know about all the natural alternatives you have for pain relief.
Dr. Bones
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