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MSWA Bulletin Magazine Winter 2022

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Farewell Sue Shapland | Pain and pain management series: Part 5 | MSWA's Employment Support Service | Tips for staying motivated over winter


PAIN & PAIN MANAGEMENT SERIES Welcome to the final instalment in our series of articles on pain and pain management. Neurological Liaison Nurse Bronwyn Innes, who has a speciality background in pain management, explores medications and pain. If you would like to read the previous articles in our Pain & Pain Management series, all previous editions of Bulletin can be viewed online at PAIN AND MEDICATIONS Pain-relief medications are used as part of a strategy to manage short (acute) or long-term (chronic) pain. They work by targeting the cause of the pain or by reducing the feeling of pain. Medicines include prescription medicines, medicines bought over the counter in pharmacies or supermarkets, and herbal and natural medicines The role of medicines is not to cure pain but to lessen it and improve functionality and quality of life. Even the strongest medicines for pain will not always completely eliminate it, but they can reduce the severity of pain. In this way it is important to view medicines as part of a comprehensive approach to pain management and functional improvement. By making you comfortable, medicines can make it easier to resume normal activities or activities you may have been avoiding, and can help improve quality of life by minimising suffering and maximising function. It is however, important to understand that while medicines can help relieve symptoms, they can sometimes have unpleasant side effects. Often these side effects can be avoided or at least managed with the help of your doctor. All medicine whether prescription, over the counter, herbal or vitamins/ supplements should be used carefully and appropriately because they can interact with each other and cause side effects. It is essential to always tell your doctor about everything you are taking for pain and other conditions. Medicines should always be taken as prescribed by the doctor and if you have any concerns discuss them with your doctor before changing the medicine or the dose. The treatment of pain can be broadly divided into three categories: / Physical (eg physiotherapy) / Psychological (eg relaxation training) / Pharmacological (eg medicines) 32

Because pain is a subjective sensation, treatment can be different from one person to another, even though the diagnosis may be the same. It is best to discuss your treatment with your doctor or healthcare professional. Your overall pain management plan will usually consist of several types of treatment that will complement each other. In this article we will focus on the Pharmacological Interventions. OVER THE COUNTER (OTC) MEDICINES: There are two common types of OTC medicines: Paracetamol – often recommended as the first medicine to try for short term pain. Available as tablets, liquid mixtures, or suppositories. Often is the sole chemical but is also used in combination eg cold and flu tablets, Panadeine, Panadeine Forte. Regular paracetamol at 4mg /day can cause liver damage. If it is not helpful, please stop taking it and see your doctor. Nonsteroidal drugs Anti-Inflammatory (NSAIDS) – a group of medicines that work by reducing swelling and inflammation and relieving pain. These include aspirin, ibuprofen and diclofenac. Available as tablets, some as suppositories, and a few as gels or ointments. They can cause stomach ulcers if taken regularly and need to be taken with food. NB: Please ensure to discuss all medication options with your GP before purchasing any. PRESCRIPTION MEDICINES: Prescription pain medications provide stronger relief than OTC drugs. Types of prescription pain relievers include: 1. Anti-neuropathic medications: These medications are known as coanalgesics and can be prescribed for nerve-related pain. They are often prescribed if you have shooting or burning pain (nerve injury or neuropathic pain). Anti-neuropathic medicines can help reduce or ‘calm down’ nerve activity and reduce pain hypersensitivity associated with conditions like shingles, diabetic pain, sciatica, fibromyalgia, and headaches. 2. Anti-epilepsy drugs: Medications such as Gabapentin or Pregabalin for epilepsy, interrupt pain messages to the brain. These medicines can ease nerve pain and fibromyalgia. Carbamazepine (Tegretol) is the first treatment usually recommended to treat Trigeminal Neuralgia. Treatment with Carbamazepine requires regular blood tests to monitor blood count and liver function, to make sure you are not developing uncommon side effects. 3. Antidepressants: These medications work on chemicals called neurotransmitters in the brain. They work best for chronic pain, including migraines. Serotonin Noradrenaline Reuptake Inhibitors (SNRIs) such as Duloxetine (Cymbalta) and Venlafaxine (Effexor) may be useful for pain, mood, and sleep. Tricyclic Antidepressants (TCAs) such as Amitriptyline and Nortriptyline may be useful for pain and sleep. Some people find that mild side effects (such as dry mouth, blurred vision, or drowsiness) improve the longer they take the medicine. 4. Opioid Pain Medications: Opioids are laboratory made narcotic pain medicines. They change how your brain perceives pain messages. Because they can be addictive, doctors rarely prescribe opioids for chronic pain. Opioids are usually taken for a short time after surgery or traumatic injury. Types of opioids include Buprenorphine patches, Oxycontin, Fentanyl, Methadone, Tapentadol, Codeine, Morphine. 5. Muscle Relaxants: Medications such as Benzodiazepines and Orphenadrine reduce pain by relaxing tight muscles. Baclofen belongs to this group of medicines. It is used to reduce excess tension in muscles which cause spasms. INTRATHECAL PUMPS: Intrathecal pumps offer much lower doses of baclofen because they are designed to deliver the medication directly to the spinal fluid rather than going through the digestive and blood system first. They are often preferred in patients with spasticity, as very little of the oral dose actually reaches the spinal fluid. Besides those with spasticity, intrathecal administration is also used in patients with multiple sclerosis who have severe painful spasms which are not controllable by oral baclofen. 33