Discussion Guide for Talking to Your Health Care Provider About Your Pain Relief Needs
News over the last year has left many people in pain concerned and confused. It's hard to weigh the benefits and risks of pain medicines. As anyone in pain knows, finding one that works for you is a big part of living well.
Below is a list of questions. You may find them helpful when you visit your health care provider. Talk them over. Together, you and your health care provider can decide the right choice for you.
I have been dealing with arthritis or joint pain for a long time. How can I
get relief?
There are many ways to manage your pain. You should talk to your health care provider about what
might be appropriate for you. Ways to help control arthritis and joint pain may include:
- Different kinds of medications: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs); prescription nonselective NSAIDs; COX-2 inhibitors; acetaminophen; opioids; and more
- Physical therapy or exercise
- Weight loss
- Herbal remedies
- Alternative therapies like acupuncture
- Joint surgery
You may want to think about what has worked for you in the past. Think about what type of medication has given you pain relief. Ask yourself which one you've been able to take without stomach upset or other side effects.
I've seen a lot of news on medications called NSAIDs. What should I know about these drugs?
There are different types of NSAIDs. Some you can get by prescription. Others are over-the-counter —
that is, you can buy them without a prescription. Ibuprofen and naproxen are common NSAIDs that are
available both over-the-counter and by prescription.
NSAIDs work by blocking an enzyme in the body that's responsible for pain and inflammation. That enzyme is called COX-2. But NSAIDs also block an enzyme called COX-1 that protects the lining of the stomach. There is a type of NSAID called COX-2 inhibitors. These drugs were developed to target the COX-2 enzyme but not affect COX-1.
The news you've seen is most likely about data that has come out on this whole class of NSAID drugs. The Food and Drug Administration (FDA) has advised that all NSAIDs should have stronger warnings to alert people to the potential risks of heart, stomach, and skin problems. This includes both over-the-counter and prescription drugs.
All drugs can have both potential risks and benefits. For many, NSAIDs are good choices for relief from pain and inflammation. If you are not sure whether you're taking an NSAID, ask your health care provider. We urge you to talk with him or her about your own health and what you need for pain relief.
How do I know if I am at risk for heart attack or stroke? How does that affect my choice of
pain relievers?
Talk to your health care provider about your health. You may have an increased risk for a heart attack
or stroke if you have had:
- high blood pressure
- high cholesterol
- previous heart attack
- stroke
- heart surgery
Some medicines may increase your personal risk for heart attack and stroke. The FDA has advised that all NSAIDs should have stronger warnings to alert people to the potential risks of heart attack or stroke. This includes both over-the-counter and prescription drugs.
Prescription NSAIDs:- may have increased risk with longer use and in people with heart disease
- should never be used right before or after the heart surgery called coronary artery bypass graft (CABG) — known as "bypass surgery"
- may carry risk if they are used longer than 10 days, as stated on the label
How do I know if I am at risk for stomach bleeding? How does that affect my choice of pain
relievers?
Prescription and over-the-counter NSAIDs may cause serious stomach or intestinal side effects.
Stomach complications from using over-the-counter and prescription NSAIDs have sent over 100,000
people to the hospital each year. And over 16,000 people have died. Yet, few know of the risks
to the digestive system linked with these drugs.
It is true that some people may have only mild stomach upset with the use of NSAIDs. But others may be at risk for more serious side effects. Two major dangers are bleeding and ulcers. Risk factors for an ulcer or bleeding in the stomach or intestines include:
- older age
- taking drugs such as corticosteroids (used for inflammation) or anticoagulants (used to keep blood from clotting)
- use of NSAIDs over a long period of time
- smoking
- drinking alcohol
- having poor health
Please note that you may have none of these risk factors and still have stomach bleeding or other stomach problems. NSAIDs can cause ulcers. They can cause bleeding in the stomach and intestines at any time during treatment. It can happen without warning. It may cause death. You should talk to your health care provider about what pain drug may be right for you.
How long can I use an over-the-counter pain reliever to treat my pain?
You should not use over-the-counter pain medicines for more than 10 days without talking to your
health care provider. This includes acetaminophen and NSAIDs, such as ibuprofen or naproxen. If you
are taking one of these on a regular basis, you should talk to your health care provider. He or she
can work
with you to set up a treatment plan that's right for you.
Also, if you take medicine for colds or allergies, check the labels. Some of these drugs have NSAIDs or acetaminophen. If you take them with your daily pain reliever, you might be taking a higher dose than you realize. That could place you at higher risk for side effects.
What do I need to know about opioid medication choices?
Opioids can give good pain relief. But they must be used the right way and under the close watch
of a health care provider. Like all drugs, they have both potential risks and benefits. Side
effects can include being constipated and drowsy.
Some people worry about addiction. For most people, the risk of addiction is low. The chance of developing an addiction depends on family and personal history and other factors.
Should I not take any medication at all to treat my pain?
You should be aware that being in pain can be a health risk. It may limit your activity. This can
have an impact on your overall health. Being inactive can increase the risk for heart disease and
other health problems.
Many people find that they need pain medicine along with healthy food and exercise to help manage pain. Many may find relief with other types of treatments and do not use pain drugs. In either case, it's important that you talk to your health care provider. Only then can you make the right choice about what treatment is appropriate for you.
Where can I find more information about pain relief?
You should talk to your health care provider about what you need for pain relief. Ask what
type of treatment plan may be appropriate for you.
There are also organizations that you can contact to help make sense of pain relief:
American Chronic Pain Association:http://www.theacpa.org/
1-800-533-3231
American Pain Foundation:
http://www.painfoundation.org/
1-888-615-7246
National Pain Foundation:
http://nationalpainfoundation.org/
1-866-590-PAIN (7246)
