Drug Therapies Typically Used For Treating CRPS
DRUG THERAPIES For CRPS, Complex Regional Pain Syndrome
DRUG THERAPIES ARE NOT A CURE BUT THEY CAN OPTIMIZE PAIN CONTROL AND PROVIDE THE RELIEF NECESSARY TO REGAIN FUNCTION AND ALLOW THE PATIENT TO PARTICIPATE IN PHYSICAL THERAPY.
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 simply give some of the basic medication types, an example, and what they are typically used for.
Lately there has been a lot of talk, especially out of Washington, DC, regarding the need to add even more legislation to "safeguard" those of us who use medications to treat chronic pain. 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 is trying to push the FDA into enacting legislation to protect ALL users of medications from what they see as the obvious abuse that is occurring.
However, according to the study "Fewer than five percent of patients 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 of how 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). Dependency does NOT mean addiction! Please understand that there is a significant difference between dependency and addiction!
"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."
Information provided by an article titled "Painkillers Not As Addictive As Feared".
Definitely read the article in its' entirety and pass it along to your own Drs if necessary.
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.
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. These are broken down into three types; CODEINE-BASED MEDICATIONS; the OXYCODONE BRANCH (Oxycontin CR and IR, Percocet, Percodan, etc.); and the HYDROCODONE BRANCH of OPIODS (MS Contin, Vicodin, Lortab, Lorcet, Methadone, and Kadian, for example).
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.
So what is the difference then between the OXYCODONE Branch and the HYDROCODONE Branch?
If you search the Internet here is what most of the double-blind studies show: Oxycodone and Hydrocodone are similar in analgesic effect, but Oxycodone is generally as effective at 66% of the dosage of Hydrocodone. This means you generally need less Oxycodone to achieve the same result. 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 is FENTANYL, 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 about FENTANYL HERE.
OPIATES & ADDICTION? IS THERE A DIFFERENCE BETWEEN ADDICTION AND TOLERANCE?
For more information go to ADDICTION VERSUS TOLERANCE article.
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 cautious because there have been studies showing that some teens placed on antidepressants have developed an increased rate of suicidal thoughts and there has been a link to increased suicide rates as well.
* 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. Examples include Tegretol, Topamax, Lyrica, and Neurontin ( Gabapentin).
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 Zanalfex. Sometimes a Dr may prescribe a benzodiazepine for this; these can include Klonopin, Valium, and Xanax.
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!
TO READ ABOUT THE SCHEDULES OR CLASSES OF PRESCRIPTION DRUGS, CLICK HERE
TO READ ARTICLES ABOUT MEDICATIONS, PLEASE VIST OUR MEDICATION ARTICLES SECTION HERE