What is chronic pain?

Transcription

1 Opioid medicines This brochure gives you information about chronic (long-term) pain and the medicines most commonly used to manage it. You ll learn how these medicines compare and get important information about side effects and safety. You ll also receive self-care tips to help you feel better.

2 What is chronic pain? Chronic pain is pain you have for a long time. Also called long-term pain, it can disrupt your work, hobbies, home life and relationships with friends and family. You may not know the cause of the chronic pain, and it can sometimes last months or years. It is not the same as pain that everyone feels at some time in life. You usually know what caused this type of pain an accident, injury or illness and you know the pain will go away. Chronic pain: Is a real condition. It is not just in your imagination. Lasts over time, but it may be better or worse from day to day. Does not go away when you try to cure it. May make it hard to sleep and may lead to fatigue. May make you depressed or anxious. May make your muscles tense, causing more pain. You can learn to manage chronic pain. Talk to your doctor about it, and always tell your doctor if you have trouble dealing with your pain. More information For more on living with chronic pain, go to and enter D608 in the search box, or select the code from the drop-down menu next to the search box. -2-

3 What can I do to help myself? Pace yourself. Break up large jobs into smaller tasks. Save harder tasks for days when you have less pain. Relax and reduce stress. Try techniques such as deep breathing, meditation, massage or yoga. Keep moving. Gentle, daily exercise, such as walking or swimming, can help reduce pain over the long run. Get enough sleep. Talk with your doctor if you have trouble sleeping because of pain. Cut down on caffeine. If you have trouble sleeping, limit sodas, coffee, tea and chocolate after late afternoon. Do things that you enjoy. Distract yourself instead of focusing on the pain. Your thoughts and attitude can change your pain level. Keep a daily pain diary. Record how your moods, thoughts, sleep patterns, activities and medicine change your pain. Having a record can help you and your doctor find the best ways to treat your pain. Consider counseling. This can help if you feel stressed or depressed because of your pain. -3-

4 Which medicines treat chronic pain? Many types of medicine can treat chronic pain. Your doctor most likely will first suggest medicines you can buy without a prescription, such as acetaminophen (Tylenol), naproxen (Aleve) or ibuprofen (Advil, Motrin). Talk to your doctor before using any of these medicines. Taking too much could cause stomach ulcers or liver damage. If these medicines don t help you, your doctor may prescribe opioids. Opioids are narcotics, and they also are called opiates. Opioids can be short-acting or long-acting. Short-acting opioids give you pain relief for 3 to 4 hours. Long-acting opioids last for 8 hours or longer. Your doctor may give you more than one type of opioid or may combine opioids with other medicines, such as codeine with acetaminophen or aspirin. If one opioid doesn t help your pain, your doctor may prescribe a different one. Opioids may work best when you use them with other types of treatment, such as physical therapy. You may have to try several types of treatment before you find what works best. -4-

5 What are some common opioids? The table below lists some common opioids. Not all opioids are listed. Your doctor may have prescribed an opioid not listed here based on your symptoms and needs. Brand name Generic name Generic available? Duragesic fentanyl Yes Dilaudid hydromorphone Yes Levo-Dromoran levorphanol Yes Dolophine, Methadose methadone Yes Avinza, Kadian, MS Contin, morphine Yes Oramorph SR OxyContin, Roxicodone oxycodone Yes Opana, Opana ER oxymorphone No Darvocet propoxyphene and acetaminophen Yes Tylenol with codeine Roxilox, Tylox Vicodin, Vicodin ES codeine and acetaminophen oxycodone and acetaminophen hydrocodone and acetaminophen Yes Yes Yes All of these medicines are available in different doses and forms, including pills, skin patches, liquids and suppositories. Your doctor will prescribe the best form and dose for you. -5-

6 What are generic medicines? All medicines contain an active ingredient, which is the same as the generic name. The active ingredient is what makes the medicine work. What is a brand name? When drug companies develop a new medicine, they patent it so no one else can make it or sell it for a certain amount of time. The brand name is the name the drug company gives to the medicine. It is the first name most people hear for a medicine because of advertising in magazines and on television. Why is there more than one brand name for some medicines? After a medicine patent expires, other companies can make and sell the medicine. Sometimes these companies call it by the generic name, the name of the active ingredient. But companies also can give it their own brand names. This means a medicine made with one active ingredient can have many names. For example: Morphine is the active ingredient and generic name for one opioid. Avinza and Kadian are both brand names for morphine. -6-

7 Are brand-name medicines better than generic medicines? Generic medicines work the same way brand-name medicines work, but they usually cost less. Your doctor may be able to prescribe a generic medicine if it s available and right for you. A generic medicine may be available for some forms of a medicine, but not for others. -7-

8 Are some opioids better than others? Is one medicine really more effective than another? The Drug Effectiveness Review Project (DERP)* tries to answer that question. Research on codeine, dihydrocodeine, fentanyl, hydromorphone, levorphanol, methadone, morphine, oxycodone and oxymorphone has been reviewed. Some DERP findings are listed below.** There is not enough evidence to say that one long-acting opioid is better than another in reducing pain or improving quality of life. There is not enough evidence to say that one long-acting opioid is better than another when it comes to side effects. There is not enough evidence to say that any long-acting opioid is better than any short-acting opioid in reducing pain or improving quality of life. There is no evidence on how well these medicines work after 6 months of use or how safe they are after 6 months of use. *DERP ( began in 2001 when the state of Oregon started funding research on the effectiveness and safety of comparable drugs. Since then, other states and nonprofits have joined with Oregon to fund and use the research. DERP does not accept funding from drug companies. **All evidence-based DERP reports can be found at DERP has not reviewed the content of this brochure. -8-

9 What do I need to know? Taking opioids There is not enough evidence to say whether one opioid relieves pain better than another. You may want to choose an opioid based on how much its side effects bother you, how often you take it, how easy it is to use and its cost. You may be able to manage your pain better by taking an active role in your treatment. Talk to your doctor about exercises, counseling and other things you can do. Always tell your doctor if you are having trouble dealing with your pain. If you take opioids for more than a few days, they can cause constipation. If you eat more fiber and drink more water, you may avoid this. Talk to your doctor about whether you should take a stool softener or laxative. When you begin taking an opioid, you may feel sick to your stomach and vomit. Lying down may help this feeling pass. If you continue to feel sick to your stomach, talk to your doctor. Other long-term health problems, such as diabetes, can make your pain worse. Talk to your doctor about how to best treat pain along with other health problems. -9-

10 Safety Get emergency help right away if you think you or someone else took too much of an opioid (an overdose). If you take too much of this medicine, you may pass out and could die. Signs of an overdose include being very sleepy, confusion, seizures, slow breathing, pinpoint (very small) pupils or cold and clammy skin. Never take more medicine than your doctor prescribes, whether you are taking an opioid only or an opioid with acetaminophen or aspirin. Do not drink alcohol when using opioids. This can increase side effects of sleepiness and confusion and make it harder to think clearly. Do not drive, use machinery or do anything where you need to be alert until you know how the medicine affects you. Keep all medicines out of the reach of children. -10-

11 Physical dependence and addiction Physical dependence and addiction are not the same thing. Physical dependence means your body is getting used to the medicine. If you are addicted, you crave the medicine and always may be thinking about taking it. You may become physically dependent on opioids if you take them regularly. In this case, if you suddenly stop taking them, you may have withdrawal symptoms. You may feel sick to your stomach, shake, sweat and get chills or diarrhea. This withdrawal is not life-threatening, but it is very unpleasant. You can avoid withdrawal symptoms if you gradually take less of the opioid over a period of time. Your doctor will give you a schedule to do this. If you take opioids as your doctor tells you to, addiction is not likely to happen. Addiction is more of a risk if you have a history of using alcohol or drugs in an unhealthy way (substance abuse) or a family history of addiction. -11-

12 What about side effects? All medicines have side effects. Talk to your doctor or pharmacist about what side effects to expect when you take opioids. Ask if there are any serious side effects you should report to your doctor. Usually the benefits of the medicine are more important than minor side effects. But if side effects continue to bother you and you are wondering whether you should continue to take the medicine, call your doctor. Possible side effects Possible side effects include being constipated, feeling sick to your stomach and vomiting, or feeling faint, sleepy, dizzy or lightheaded. You also may feel itchy, but this is less common. If you take opioids for a long time, your testes (in men) or ovaries (in women) may produce little or none of certain hormones, including testosterone in men and estrogen in women. This could result in a loss of sexual desire, erection problems in men and menstrual changes in women. Serious side effects Get emergency help right away if you think you or someone else took too much of an opioid (an overdose). If you take too much of this medicine, you may pass out and could die. Signs of an overdose include being very sleepy, confusion, seizures, slow breathing, pinpoint (very small) pupils or cold and clammy skin. Call your doctor or 911 right away or go to the emergency room if you have any of the following rare side effects: You have a hard time breathing, get hives, or have swelling of your face, lips, tongue or throat. These are signs of an allergic reaction. -12-

13 How can I manage my medicines? Avoid side effects and interactions Medicines are more likely to interact, cause side effects or harm you if: You are taking high doses. You have another health problem. Your health or a health problem you have is not stable (is changing). You are taking many medicines that your body processes in a similar way. The best way to manage your medicines and help your doctor, pharmacist, or other health care professional is to keep a personal medication record (PMR). The PMR gives you a place to list all the medicines you take, the doses and how they are taken. This includes over-the-counter medicines and dietary supplements. Sharing this list with your health care providers will help you avoid drug interactions. You also can put all your medicines in a bag and take them with you when you see your doctor. Include all supplements, herbs, vitamins and minerals you are taking. Using one pharmacy makes drug interactions less likely. The pharmacist will know which medicines you are taking and watch for interactions. Some pharmacies will keep your PMR up to date for you. -13-

14 Work with your doctor and pharmacist Here are some questions you can ask: What is the name of this medicine? What does it do? What are the side effects? What should I do if I forget to take it? When do I start and stop taking this medicine? How do I take it? How should I store it? At what time do I take this medicine? Should I take this medicine before meals, after meals, with meals or on an empty stomach? Should I avoid certain foods or drinks with this medicine? Will this medicine work safely with other medicines I am taking? Can I do anything instead of or along with taking my medicine to help my symptoms? Is there another medicine I can use? Does it work well, and is it safe? Is there a generic or less expensive medicine I can take? More information Go to and enter Q148 in the search box, or select the code from the dropdown menu next to the search box. You ll get more on working with your doctor and forms to help you manage your medicine. -14-

15 AARP and Walgreens: Knowledge You Can Trust AARP and Walgreens are working together to put adults 50 and over in charge of their medicine, health and lives. Through this alliance, AARP and Walgreens will work together to ensure that Americans 50+ have the tools that they need to take greater control of their health. A primary focus of the alliance will be to help educate the nation s 50+ population about the wise use of medicines. Know Your Rx Options brochures Acid Reflux (GERD) Allergic Rhinitis Chronic Pain Dementia and Alzheimer s disease High Blood Pressure High Cholesterol Insomnia Nausea and Vomiting Osteoarthritis Urinary Incontinence Visit the AARP-Walgreens Alliance Web site at All material contained herein is provided for informational purposes only and should not be construed as medical advice or instruction. Consult your medical provider for advice relating to treatment of a medical problem or condition. Drugs mentioned in this brochure may be trademarks of their respective owners/ companies. -15-

16 AARP is a nonprofit, nonpartisan membership organization that helps people 50+ have independence, choice and control in ways that are beneficial and affordable to them and society as a whole. We produce AARP The Magazine, published bimonthly; AARP Bulletin, our monthly newspaper; AARP Segunda Juventud, our bimonthly magazine in Spanish and English; NRTA Live & Learn, our quarterly newsletter for 50+ educators; and our Web site, AARP.org. AARP Foundation is an affiliated charity that provides security, protection, and empowerment to older persons in need with support from thousands of volunteers, donors and sponsors. We have staffed offices in 50 states, the District of Columbia, Puerto Rico and the U.S. Virgin Islands. Founded in 1901, Walgreen Co. has been a leader in providing innovative, high quality and convenient healthcare services and consumer goods for over 105 years. Today there are over 5,700 Walgreens located across the USA and Puerto Rico, many with Drive-Thru pharmacy service, One Hour photofinishing and printer cartridge refills. Over 1,600 Walgreens are open 24-hours a day, seven days a week to provide service when it s most needed. At Walgreens.com, customers have access to digital photo services, a complete health library, Care Giver resources, online prescription refill ordering and much more. AARP 601 E Street, NW Washington, DC OUR-AARP ( ) Copyright 2007, Healthwise, Incorporated. All rights reserved. This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for your use of this information. 07ST6065