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Prescription medications serve as useful tools in helping a physician to control the pain of a chronic pain patient.

Usually, they are used in combinations that often include a high-dose, nonsteroidal, anti-inflammatory drug, a muscle relaxant, and some form of narcotic.

An anticonvulsant and an antidepressant are usually added into the mix when neuropathic pain control is desired.

Narcotics and Opiods as Part of Treatment:

The guidelines that govern the use and prescription of narcotics in this pain management center are the ASIPP (The American Society of Interventional Pain Physicians) guidelines for controlled substances.

This pain management center observes compliance with the state board of medicine regulations and guidelines regarding the use of narcotic prescription for patients.

The use of a narcotic contract, when a narcotic is in employed, is common practice. The objective of this contract is to educate the patient as to the benefits of the controlled substances that are being prescribed for them, as well as to educate the patient to his/her responsibilities during any period which narcotics are prescribed. The primary object of this contract practice is to avoid narcotic abuse during a course of treatment (and also to avoid the unfortunate but necessary diversion of the patient to another treatment facility should abuse occur).

This pain management center incorporates the patient’s agreement to undergo random urine drug screenings as well as blood screenings as part of the requirements set forth for in our narcotic contract.

Most patients go through their needed short-term use of narcotics successfully without any problems.

Solely narcotic-based treatment may, in rare instances (e.g., terminal cancer), be necessary, otherwise, most patients only receive narcotics while other interventional efforts are being made to alleviate the physical cause for their pain.

The philosophy of this pain management center is to lower the amount of narcotics a patient requires, or to completely wean them off of narcotics as soon as pain control is achieved via other interventional methods.

Steroids as Part of Treatment:

Patients are frequently concerned about the use of steroids (specifically, cortisone) in pain management injection procedures.

In the practice of interventional pain management, cortisone is a very commonly injected medication. The central role of cortisone in pain management procedures is anti-inflammation. Cortisone is the strongest anti-inflammatory drug in the medical industry (and it is also the only injectable anti-inflammatory approved by the United States Food and Drug Administration).

Patients are generally concerned about the side effects of steroid (cortisone) injections. Although steroids are naturally occurring hormones that we all produce daily in our bodies, there are side effects of the ingestion (or injection) of large quantities of steroids that have been produced outside of our bodies. When a patient frequently takes oral steroids in large quantities, the side effects can be significant and severe. However, based on years of research, study, and data analysis, it is clear that any side effect is dose related.

In the area of pain management, steroids are used to reduce the inflammation of joints and nerves. Steroids, combined with a local anesthetic mixture, are injected very precisely (and, most importantly, in very small doses) into the inflamed area. In skilled and knowledgeable hands, and because of the precision involved in these injection procedures, the dosages of steroid injected are kept minimal, and therefore, so also are the side effects.

In fact, it can surely be said that skilled steroid use is one of the safest and most effective tools in the pain management physician’s toolbox.

Medications prescribed at this center may include:

ANALGESICS:

Non-narcotic analgesics:

  • Tylenol®
  • Ultracet®
  • Ultram®
  • Other analgesics

Anticonvulsant/antiepileptic:

    • Lamictal®
    • Neurontin®
    • Tegretol®
    • Topamax®
    • Trileptal®
    • Zonegran®
    • Other anticonvulsants

Other antiepileptics

High-dose nonsteroidal anti-inflammatory drugs and COX-2 inhibitors:

  • Arthrotec®
  • Aspirin
  • Bextra®
  • Capsaicin® cream
  • Celebrex®
  • Daypro®
  • Ibuprofen
  • Local anesthetic patch/cream
  • Lidoderm®
  • Lidoderm® cream
  • Lodine®
  • Mobic®
  • Naprosyn®
  • Relafen®
  • Vioxx®

Muscle relaxants:

  • Baclofen®
  • Flexeril®
  • Norflex®
  • Robaxin®
  • Skelaxin®
  • Soma®
  • Zanaflex®

Narcotics:

  • Darvocet®
  • Darvon®
  • Demerol®
  • Fentanyl (Duragesic® patch, Actiq®)
  • Hydrocodone (Lortab®, Lorcet®, Vicodin®, Zydone®, Vicoprofen®)
  • Hydromorphone (Dilaudid®)
  • Oxycodone® (OxyContin®, Percodan® Percocet®, or Tylox®)
  • Methadone
  • Morphine (Avinza™)
  • Stadol®
  • Talwin®
  • Other agents include codeine (Tylenol #2, Tylenol #3, and Tylenol #4)

Antidepressants:

  • Elavil®
  • Doxepin®
  • Pamelor®
  • SSIR (Paxil®, Zoloft®, Prozac®, Celexa®)
  • Trazodone®

Anti-Migraine:

  • Axert®
  • Esgic-plus®
  • Fioricet®
  • Fiorinal®
  • Frova®
  • Imitrex®
  • Midrin®
  • Relpax®
  • Zomig®

Depo Steroids:

  • Aristocort® (triamcinolone acetate)
  • Celestone®
  • Depo-Medrol® (methylprednisolone acetate)

Local anesthetics:

  • Bupivacaine®
  • Lidocaine ®
  • Ropivacaine®
  • Tetracaine®
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