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>> Types of Traffic Accident Injuries >> Chronic
Pain
This is a stressful time for people who take
strong medicines for their pain. The withdrawal of two COX-2
non-steroidal anti-inflammatory (NSAID) medications and the
more stringent, FDA-mandated warnings on all NSAIDS have created
fear and confusion about what’s safe and effective for
treating pain.
You may feel overwhelmed and confused. You may
ask yourself, “What’s safe? What medications can
I take? What can I do now that I can no longer take this medication?
What things can I do to improve my quality of life?”
The important thing to remember is that you
are not alone. Millions of Americans suffer from chronic pain
and there are many organizations working to address this serious,
life-altering, and profoundly difficult problem. Now, more
than ever, is the time to educate yourself about your treatment
options and empower yourself by doing what you can to care
for yourself physically, emotionally, and spiritually.
The American Chronic Pain Association, the American
Pain Foundation, and the National Pain Foundation have prepared
this guide cooperatively to help people with pain and their
families better understand the current situation and to regain
a sense of control over the critical and very personal decisions
involved in managing chronic pain.
You can learn more about the resources offered
by these organizations at the following web sites:
- Find a knowledgeable health care provider
who understands pain and work with him or her to decide
what’s best for you. See the links below for help
in finding a provider.
- Take care of the things you can control.
Part of being an active participant is caring for your body.
Get adequate rest, eat a healthy diet and engage in physical
activity—all vitally important to maintaining function
and health. Ask your physician which exercises are safe
for you.
- In addition to a healthy diet and exercise,
relaxation techniques such as meditation, visualization,
hypnosis, and biofeedback may help you feel better. Your
health care provider can help you decide which techniques
may be beneficial for you.
- Pay attention to your emotional health. Taking
care of the emotional aspects of chronic pain is necessary
to treat your overall pain condition. Your physician may
want to prescribe medication for depression, anxiety, and
sleep disturbances and, in addition, may suggest cognitive
behavioral therapy (e.g., relaxation techniques, coping
strategies, psychological therapy).
- Share your thoughts and feelings with loved
ones and allow them to share their feelings with you. People
cannot read your mind—just as pain is an invisible
disease, emotions can be difficult to discern.
- Avoid isolation and loneliness by joining
a support group. Rebuilding a life devastated by chronic
pain is easier with the support and help of those who have
been there and can help you find the way back. A good support
group does not dwell on symptoms or losses, but rather focuses
on positive actions you can take to improve the quality
of your life—with a little help from your friends.
See the Questions and Answers below to learn more.
Medications such as NSAIDs and selective NSAIDs
(COX-2 inhibitors) are important tools in the management of
chronic pain, but they are not the only tools available to
help you. NSAIDs work by decreasing inflammation and pain.
Traditional NSAIDs, such as ibuprofen and naproxen, tend to
irritate the stomach and can lead to ulcers and bleeding.The
COX-2 NSAIDs have become popular because they are less likely
to cause ulcers and bleeding.
News that another NSAID has been withdrawn from
the market and the fact that all NSAIDs will now have additional
warnings on their labels can be frightening and disheartening.
The first step in determining if NSAIDs and COX-2 NSAIDs are
still an option for you is to speak with your doctor. You
and your doctor are the only people who can determine whether
a specific medication is the right choice for you.
If you are taking NSAIDs for pain, be sure your
doctor knows your medical history, including any history of
heart problems, high blood pressure, ulcers, and medication
allergies. Be sure your doctor knows about all the medications
you currently take, including medications prescribed by other
doctors, over-the-counter medications, and supplements. This
information will help you and your doctor weigh the overall
risk-benefit of a medication.
It is up to you to educate yourself about your
health and your treatment options. There are many options
for your pain, including:
- prescription and over-the-counter NSAIDs;
- prescription medications such as opioids,
anti-anxiety medications, anticonvulsants, antidepressants,
muscle relaxants, and more, depending on your pain condition;
- complementary and alternative therapies,
such as biofeedback, meditation, relaxation techniques,
yoga, acupuncture, and more;
- physical therapy; and
- interventional treatments (eg, for arthritis,
injections at the pain site containing a pain reliever and
corticosteroid, or for back and neck pain, spinal cord stimulators
and intrathecal drug pumps).
Talk with your doctor. Developing an open and
trusting relationship with your pain specialist is important
to helping you determine which treatment options are best
for you.
Is it important to see a pain specialist?
Many primary care physicians are well informed about treating
pain and can be relied on to provide excellent care. But if
you and your primary doctor agree, a pain specialist might
be appropriate in your case. Pain specialists, like neurologists,
cardiologists, and other specialists, have additional training
and experience that you may find valuable.
To learn more, you may wish to visit these sites
of organizations that serve pain specialists:
- American Academy of Pain Medicine
- American Academy of Pain Management
- American Academy of Neurology
- American Board of Pain Medicine
- American Medical Association
- American Pain Society
- American Society of Interventional Pain Physicians
What should I consider in selecting
a doctor or pain program?
There are physicians who prescribe medications only for pain,
physicians who do only functional restoration without medications,
physicians who do only cognitive behavioral pain therapy,
physicians who perform only blocks or do surgeries for pain,
and physicians who might do combinations of these therapies.
Some physicians, in an interdisciplinary fashion, provide
expertise in all of the above interventions to patients in
pain. You should know the type of pain clinic that you have
chosen to visit. Choose wisely!
You may also want to consider a multidisciplinary
pain management clinic or program. The American Chronic Pain
Association has guidelines for selecting a pain management
program at http://www.theacpa.org/pf_02_05.asp.
My doctor is not responsive to my questions
and needs. How can I find another?
You have a right to be treated with respect and to have your
concerns taken seriously. If your current provider does not
measure up to your expectations, find
another.
Many professional physician organization web
sites have listings of their members available to the public.
These directories can help you locate an appropriate pain
medicine physician in your area. Print the directory and share
it with your primary care physician to identify the best physician
for your particular needs. You can call American Pain Foundation
at 1-888-615-7246 (pain) for a list of pain specialists in
your state or visit these sites for help:
Where can I go to learn more about the
medications I’m taking?
The American Chronic Pain Association offers a guide to medications
currently used for pain treatment, including prescription
and OTC drugs. It’s also available in Spanish. To download
it, visit: www.theacpa.org/pf_03_01.asp.
What are the risks posed by NSAIDS
and Cox 2 inhibitors?
Research has indicated a greater risk of cardiovascular (heart)
problems with these drugs, along with possible gastro-intestinal
(stomach and intestine) side effects. While problems do not
arise with everyone taking these medications, the FDA has
determined that they should be used with care and that stronger
warnings should be placed on their labels.
You can learn more about the issues related
to COX-2 inhibitors and other NSAIDs at the Food and Drug
Administration’s web site at www.fda.gov.
What should I ask my doctor about the
medications I’m taking?
Doctor visits can seem rushed and it’s hard to remember
all your questions when you are under stress. Good communication
is at the heart of sound medical care and it’s up to
you as the consumer to set a tone for open discussion of your
issues. Make a list of your questions before you leave for
your appointment. If your doctor does not have the time to
talk with you, ask to see someone else in the practice who
can answer your questions. Many health care providers have
patient education specialists, physician assistants, and well-informed
nurses who are trained to help.
For more information about preparing for your
doctor appointment and tools to create an inventory of your
treatments, medications, and other health related issues,
visit these pages:
Will my doctor and/or pharmacist tell
me about any side effects?
Most physicians and pharmacists will offer to discuss your
medications with you. But to be sure that you know as much
as you can about any medication you are taking, you should
ask. Medical professionals respect your need to be an informed
consumer. Don’t be shy when it comes to your health.
In addition, all prescriptions have package
inserts that describe the warning signs of possible side effects.
Your pharmacist will review this with you if you ask. You
also can visit the National Library of Medicine’s site
at www.nlm.nih.gov/medlineplus/druginformation.html.
Is dependency on a medication the same
as addiction?
No. Dependency occurs when your body becomes accustomed to
a medication and reacts negatively to its absence or a reduction
in dosage. For example, a diabetic will react negatively to
stopping insulin or an individual with depression to not taking
an antidepressant, but these individuals are not considered
addicted to their medications.
Addiction is a neurobiologic disease characterized
by behaviors that include a lack of control over use of the
drug, compulsive use, continued use despite harm, and craving.
What is tolerance?
Tolerance is a state of adaptation in which the use of a drug
brings about changes in the body that result in a lessening
of one or more of the drug's effects over time. That’s
why it’s important to review your medications with your
doctor on a regular basis.
For more information about dependency, addiction,
and tolerance, visit these web sources:
How can I find out more about my condition
and treatment options?
The National Pain Foundation web site has information about
eight common pain conditions. You can find information about
arthritis, back and neck pain, cancer pain, complex regional
pain syndrome, fibromyalgia, headache, pelvic pain, and issues
related to chronic pain and your mental health at www.nationalpainfoundation.org/MyPain.
In addition, the American Chronic Pain Association
has links to many condition-related web sites. Link to the
list at www.theacpa.org/pf_03_03.asp
or go to www.theacpa.org,
click on People With Pain and Their Families, then Resources,
and find Health Conditions under the Links of Interest menu.
The American Pain Foundation also offers links
to topic-related web sites at www.painfoundation.org/page.asp?menu=1&item=6&file=Links/Index.htm
Finally, you can find condition-specific information
at many web sites, including:
Are there alternative therapies that
can help me reduce my suffering?
As we have learned more about the connection between mind
and body, the role of alternative therapies in treating chronic
conditions has grown. Many people with pain find that therapies
such as massage, yoga, tai chi, relaxation training, biofeedback,
acupuncture, and more can help reduce the impact pain has
on their lives. These therapies can be a helpful addition
to, not a replacement for, traditional medical treatment.
Discuss with your doctor what might be useful.
To learn more, visit:
There also is information on alternative
medications in the American Chronic Pain Association’s
Medication Supplement at www.theacpa.org/pf_03_01.asp.
Where can I learn pain management techniques
that I can use on my own?
There are many ways to reduce your sense of suffering and
improve the quality of your life in spite of pain. A key step
is getting involved in your care and regaining control of
your life by learning good pain management skills. Here are
some good places to start:
Are there support groups for people
with chronic pain?
Rebuilding a life devastated by chronic pain is easier with
the support and help of those who have been there and can
help you find the way back. A good support group does not
dwell on symptoms or losses, but rather focuses on positive
actions you can take to improve the quality of your life—with
a little help from your friends. The American Chronic Pain
Associations has groups across the country. Visit www.theacpa.org/aa_03.asp
to find a group near you or visit the American Pain Foundation’s
PainAid at www.painaid.painfoundation.org
or the National Pain Foundation’s My Community at www.nationalpainfoundation.org/MyCommunity
to join an online group.
What role can families and friends
play?
When pain strikes one member of a family or social group,
everyone suffers. As a caregiver, family member, or friend
of someone with pain, you also have needs. The American Chronic
Pain Association has a manual designed to address the needs
of families who live with or care about people with pain.
You can read more about it at www.theacpa.org/catalog.asp.
In addition, these links can help you keep a
healthy balance in your life while appropriately supporting
the person with pain.
How can I find out more about the Food
and Drug Administration?
Visit their web site at www.fda.gov.
How can I find out more about the Drug
Enforcement Administration?
The Drug Enforcement Administration web site is http://www.usdoj.gov/dea
I want decision makers to know how I
feel about this issue. How can I make my voice heard?
There are many ways you can play a role in shaping public
policy on pain management. You can contact your elected federal
and state officials and ask them to make pain care a priority.
Find out how by visiting your state’s Internet home
page or these national links:
You can ask your member of the House of Representatives
to support HR 1020, the National Pain Care Policy Act of 2005.
For more information about the bill and what you can do to
support it, visit the American Pain Foundation’s online
advocacy center www.painfoundation.org
and click on the TAKE ACTION! button.
For a guide to having September declared Pain
Awareness Month in your state or community, download the Partners
for Understanding Pain Proclamation Tool Kit at www.theacpa.org/documents/Proclamations%20Process%20Guide%20Tool%20Kit6.pdf.
To help you create awareness in your communities
about the far reaching implications pain has on an individual’s
life, go to www.nationalpainfoundation.org/NationalPainAwareness/default.asp.
Finally, there is a Pain Advocacy Tool Kit available
for those who want to play a more active role at www.partnersagainstpain.com/painadvocacycommunity.
If believe you have chronic pain
as a result of a traffic accident, it is important to visit
a qualified doctor to evaluate your injuries. Trying to "heal
yourself" could cause your body more harm.
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