LYMPHEDEMA
PAIN
This
page has been updated,
please see our new Wiki page:
Lymphedema
and Pain Management
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_and_pain_management
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Lymphedema Pain and Pain Management
Coping with Pain from
Lymphedema
PAIN
AND LYMPHEDEMA
Lymphedema is not simply a condition of swollen limbs with occasional
infections
from time to time. It is and can be an excruciatingly painful condition.
Pain is part of our bodies immediate survival defense mechanism.
The signal from our nerves to our brains tells us when something has
gone wrong,
that there is an injury, inflammation, trauma, infection.
Warning pain is a life saver, but chronic unrelenting pain is a
debilitating
experience, both mentally and physically.
Chronic, severe pain drains us of our mental and emotional ability to
cope.
Severe depression can come from unrelenting pain. It can and does put
undue
stress on our bodies and affects our ability to heal from either wounds
or
infections. Because of the stress it can
decrease our immune systems ability to defend the body from disease.
What are the sources of this physical pain from
lymphedema?
1. Compression of and to nerves from the swelling
2. Increased pressure and compression of nerves from fibrosis
3. Chronic inflammations that are all to often with lymphedema
4. Cellulitis, lymphangitis and other infections
5. Over exertion of areas of the body as it attempts to cope with
the excess strain and weight over an oversized limb
6. Wounds and those weeping sores we all get from time to time
These are only some of the sources of pain associated with lymphedema.
When our
pain becomes chronic and severe, it needs to be treated. You may find
it
necessary to seek a referral to a pain clinic and learn different types
of pain
management.
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Pain
Management
Patients with lymphedema may experience pain caused by the swelling and
pressure
on nerves; loss of muscle tissue and function; or scar tissue causing
shortening
of muscles and less movement at joints. Pain may be treated with
medications,
relaxation techniques, and/or transcutaneous electrical nerve
stimulation
(TENS), however, the most successful treatment is to decrease the
lymphedema.
www.nci.nih.gov/cancerinfo/pdq/supportivecare/lymphedema/patient
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Pain in the
lymphedematous arm following treatment of breast cancer -
evaluation and treatment
NLN Newsletter
http://www.lymphovenous-canada.ca/paincan.htm
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International
Association for the Study of Pain
http://www.halcyon.com/iasp
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Pain
Terminology
International Association for the Study of Pain
http://www.iasp-pain.org/terms-p.html
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COPING WITH
PAIN
http://facial-neuralgia.org/coping/pain/pain.html
Pain
management is unfortunately a constant for facial neuralgia patients
and their
families. Drugs and surgery are the usual forms of treatment for these
conditions but these treatments are not always 100% effective and
people must
learn to cope with pain in their lives. There are many resources
available on
the Internet for the treatment of and coping with pain. Here are a few
starting
points.
PainNet.
Probably the best net site in this field.
Wellness Web
Pain Management Center
Discussion of what pain is, how to cope, links to
other pain sites.
Chronic
Pain: Hope Through Research
National Institute of Neurological Disorders and Stroke,
presents an excellent general discussion of chronic pain, its causes,
treatments and problems.
Chronic Pain Study
Although commissioned by the Workers Compensation Board of Nova Scotia,
this study presents an excellent discussion of chronic pain and its
unique problems as opposed to acute pain.
Coping
Skills
Suggestions on coping with chronic pain from the Invisible
Disabilities Association of Canada
National Chronic Pain Outreach Center
Publishes a quarterly journal, LIfeline and serves as a clearing house
for information on all kinds of chronic pain.
IASP Home Page.
International Association for the Study of Pain.
Virtual Pocket
Dictionary of Pain Terms
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COPING WITH
PAIN OR CHRONIC ILLNESS
http://www.helphorizons.com/care/topic.asp?topic=22
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AMERICAN
ACADEMY OF PAIN MANAGEMENT
http://www.aapainmanage.org/
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Pain.com
http://www.pain.com/frameindex.cfm
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From
CancerBacUp - UK
Series of Articles Regarding Pain
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What is pain?
Pain is defined as an
uncomfortable and unpleasant
sensation and emotional experience that occurs when tissues in the body
are
damaged. Pain is felt when particular nerves within the nervous system
are
stimulated by pressure such as that caused by a tumour, by external
things such
as extreme heat or cold, or by damage to the surrounding tissue.
The nervous system is made
up of the brain, the spinal
cord, and a complicated network of nerves that thread throughout the
body. The
brain is the control centre for the entire body.
The brain uses the
information it receives from nerves
to co-ordinate our actions and reactions. Nerves carry nerve impulses
back and
forth between all the areas of the body and the brain. Nerves known as
sensory
nerves send messages from the body to the brain via the spinal cord
inside the
spine. Nerves known as motor nerves carry messages out from the brain
to all the
muscles and glands in the body.
Nerves are made up of nerve
cells. Nerve cells are also known as neurons. Neurons are very thin.
Some are very small, and some can be three feet long. They are all
shaped a bit like flat stars that have been pulled at each end so that
they have long fingers. The fingers of one nerve cell almost reach to
the next neuron, but there is a gap between them.
When a nerve cell is
stimulated - by heat, cold, touch, sound vibrations or some other
message - it begins to create a tiny electrical pulse in the cell that
travels the full length of the neuron. When the electrical impulse
reaches the end of the cell, it triggers the release of chemicals that
carry the electrical impulse to the next nerve cell. In this way
messages can be sent from nerves anywhere in the body to the spinal
cord and then up to the brain where the sensation is felt (perceived).
In the same way messages can also be sent in the opposite direction
from the brain to any part of the body.
Pain can be acute, which
means that it is short term and caused by an injury such as a burn,
cut, or sprain. Acute pain gets better after a short time as the injury
heals, and is helpful in drawing attention to an injury. One example
is, if you sprain your ankle, the pain prevents you walking on the
injury, so it makes you rest and gives the sprain a chance to heal. If
you have a headache caused by stress, it may make you think about ways
of reducing stress, so that you don't get headaches.
In cancer, pain can be
chronic, which means that the pain is constant, and is often not
relieved by resting. It may need specialist treatment to control it.
Content
last reviewed: 01 April 2003
Page last modified: 11 August 2004
**link no longer valid**
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What causes pain?
http://www.janssen-cilag.com/bgdisplay.jhtml?itemname=pain_causes
http://painresourcecenter.com/main_b_howpaindevelops.asp
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Describing pain
http://painresourcecenter.com/main_e_howtodescribepain.asp
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Painkillers - Comparison Chart
http://www.vaughns-1-pagers.com/medicine/painkiller-comparison.htm
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Realistic Levels of pain control
http://www.medscape.com/viewarticle/587545
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Facts about painkilling drugs
http://www.macmillan.org.uk/Cancerinformation/Livingwithandaftercancer/Symptomssideeffects/Pain/Factsaboutpainkillers.aspx
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***Note before using any of these medicines, you should check with your
physcian
as many have are contraindictory for lymphedema patients***
Other helpful medicines
http://www.nhs.uk/ipgmedia/national/macmillan%20cancer%20support/assets/controllingpain-otherwaystocontrolpain(cb).pdf
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Other methods of pain control
http://www.macmillan.org.uk/Cancerinformation/Livingwithandaftercancer/Symptomssideeffects/Pain/Othermethodsofpaincontrol.aspx
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What you can do for yourself
http://www.ciap.health.nsw.gov.au/nswtag/publications/guidelines/PainManagement41202.pdf
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Acetaminophen
Why is this medication
prescribed?
Acetaminophen is used to relieve mild
to moderate pain and
to reduce fever. It does not relieve the stiffness, redness, and
swelling of
arthritis.
This medication is sometimes
prescribed for other uses; ask
your doctor or pharmacist for more information.
How should this medicine
be used?
Acetaminophen comes as a tablet,
chewable tablet, capsule,
liquid, drops, and granules (to be dissolved in water) to take by mouth
and a
suppository to use rectally. Acetaminophen is available without a
prescription.
Follow the directions on the package label carefully. If your doctor
prescribes
it for you, the prescription label will tell you how often to take it.
Follow
the directions on the package or prescription label carefully, and ask
your
doctor or pharmacist to explain any part you do not understand. Take
acetaminophen exactly as directed. Do not take more or less of it or
take it
more often than prescribed by your doctor.
Do not crush, chew, or open the
capsules: swallow them
whole.
To insert an acetaminophen suppository
into the rectum,
follow these steps:
- Remove the wrapper.
- Dip the tip of the suppository in water.
- Lie down on your left side and raise your right knee to
your chest. (A left-handed person should lie on the right side and
raise the left knee.)4. Using your finger, insert the suppository into
the rectum, about 1/2 to 1 inch in infants and children and 1 inch in
adults. Hold it in place for a few moments.
- Stand up after about 15 minutes. Wash your hands thoroughly
and resume your normal activities.
Adults should not take acetaminophen
for pain for more than
10 days (5 days for children) without talking to a doctor.
Acetaminophen should
not be taken by adults or children for high fever, for fever lasting
more than 3
days, or for recurrent fever without a doctor's supervision. Do not
give a child
more than five doses in 24 hours unless directed to do so by a doctor.
What special precautions
should I follow?
Before taking acetaminophen,
- tell your doctor and pharmacist if you are allergic to
acetaminophen or any other drugs.
- tell your doctor and pharmacist what prescription and
nonprescription medications you are taking, especially carbamazepine
(Tegretol), phenobarbital, phenytoin (Dilantin), rifampin (Rifadin,
Rimactane), sulfinpyrazone (Anturane), and vitamins.
- tell your doctor if you have or have ever had liver disease
and if you have a history of alcohol abuse.
- tell your doctor if you are pregnant, plan to become
pregnant, or are breast-feeding. If you become pregnant while taking
acetaminophen, call your doctor.
- if you drink 3 or more alcohol beverages every day, ask
your doctor if you should take acetaminophen. You should not drink
alcohol beverages while taking acetaminophen.
What special dietary
instructions should I follow?
To prevent stomach upset, take
acetaminophen with meals or
milk.
What should I do if I
forget a dose?
If your doctor prescribes
acetaminophen on a regular basis,
take the missed dose as soon as you remember it. However, if it is
almost time
for the next dose, skip the missed dose and continue your regular
dosing
schedule. Do not take a double dose to make up for a missed one.
What side effects can this
medication cause?
Although side effects from
acetaminophen are not common,
they can occur. Tell your doctor if this symptom is severe or does not
go away:
Ifyou experience the following
symptom, call your doctor
immediately:
What storage conditions
are needed for this medicine?
Keep this medication in the container
it came in, tightly
closed, and out of reach of children. Store it at room temperature and
away from
excess heat and moisture (not in the bathroom). Throw away any
medication that
is outdated or no longer needed. Talk to your pharmacist about the
proper
disposal of your medication.
In case of
emergency/overdose
In case of overdose, call your local
poison control center
at 1-800-222-1222. If the victim has collapsed or is not breathing,
call local
emergency services at 911.
What other information
should I know?
Before taking other nonprescription
pain relievers or cold,
cough, and allergy products, read their labels to be sure that they do
not
contain acetaminophen. An overdose of acetaminophen can have serious,
life-threatening consequences.
Ask your pharmacist any questions you
have about
acetaminophen.
Last Revised - 01/01/2003
http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a681004.html
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Acetaminophen
(a see ta MIH no fen)
Anacin-3 Maximum Strength, Childrens Tylenol, Tylenol, Tylenol Caplet,
Tylenol
Caplet Extra Strength, Tylenol Extended Release, Tylenol Extra
Strength, Tylenol
Gelcap Extra Strength, Tylenol Suspension
What
is the most important information I should know about acetaminophen?
|
|
• |
Use acetaminophen for up to 3 days for fever or up to
10 days for pain (or up to 5 days to treat a child's pain). If the
symptoms do not improve, or if they get worse, stop using acetaminophen
and see a doctor. |
|
• |
Avoid alcohol during treatment with acetaminophen.
Together, alcohol and acetaminophen can be damaging to the liver. |
|
• |
Be aware of the acetaminophen content of other
over-the-counter and prescription products. Care should be taken to
avoid taking more than the recommended amount of acetaminophen per dose
or per day. |
|
• |
Acetaminophen is a pain reliever and a fever reducer. |
|
• |
Acetaminophen is used to treat many conditions such as
headache, muscle aches, arthritis, backache, toothaches, colds, and
fevers. |
|
• |
Acetaminophen may also be used for purposes other than
those listed in this medication guide. |
What
should I discuss with my healthcare provider before taking
acetaminophen?
|
|
• |
Do not take acetaminophen without first talking to your
doctor if you drink more than three alcoholic beverages per day or if
you have had alcoholic liver disease. You may not be able to take
acetaminophen, or you may require a lower dose or special monitoring. |
|
• |
Before taking acetaminophen, tell your doctor if you
have kidney or liver disease. You may not be able to take
acetaminophen, or you may require a dosage adjustment or special
monitoring during treatment if you have either of these conditions. |
|
• |
Acetaminophen is in the FDA pregnancy category B. This
means that it is unlikely to be harmful to an unborn baby. Do not take
acetaminophen without first talking to your doctor if you are pregnant. |
|
• |
Acetaminophen passes into breast milk. It appears to be
safe for use during breast-feeding but should be avoided if possible.
Talk to your doctor before taking acetaminophen if you are
breast-feeding a baby. |
|
• |
If you are treating a child, read the package carefully
and use a pediatric form of the medication if possible. Talk to a
doctor first if the child is younger than 2 years of age. |
How
should I take acetaminophen?
|
|
• |
Take acetaminophen exactly as directed by your doctor
or follow the instructions on the package. If you do not understand
these instructions, ask your pharmacist, nurse, or doctor to explain
them to you. |
|
• |
Take each oral dose with a full glass of water. |
|
• |
Acetaminophen can be taken with or without food. |
|
• |
Wash your hands before and after using the rectal
suppositories. Run the suppository under cold water or put it in the
refrigerator for a few minutes before using it. Remove any wrapping
from the suppository and moisten the suppository with cold water.
Squat, stand, or lie down with one leg straight and the other bent, in
a comfortable position that allows access to the rectal area. Use your
finger, or the applicator if one is provided, to deposit the
suppository as far as it will comfortably go into the rectum. Insert
the narrow end first. Close your legs and lie still for a few minutes.
If the applicator will be reused, take it apart and wash it with warm
water and mild soap, then dry it completely. Avoid having a bowel
movement for at least 1 hour after inserting the suppository. |
|
• |
To ensure that you get a correct dose, measure the
liquid forms of acetaminophen with a special dose-measuring spoon or
cup, not with a regular table spoon. If you do not have a
dose-measuring device, ask your pharmacist where you can get one. Shake
the liquid well before measuring. |
|
• |
Never take more acetaminophen than is directed. The
maximum amounts for adults are 1 gram (1000 mg) per dose and 4 grams
(4000 mg) per day. Taking more acetaminophen could be damaging to the
liver. If you drink more than three alcoholic beverages per day, talk
to your doctor before taking acetaminophen. |
|
• |
Use acetaminophen for up to 3 days for fever or up to
10 days for pain (or up to 5 days to treat a child's pain). If the
symptoms do not improve, or if they get worse, stop using acetaminophen
and see a doctor. |
|
• |
If you are treating a child, read the package carefully
and use a pediatric form of the medication if possible. Talk to a
doctor first if the child is younger than 2 years of age. |
|
• |
Store acetaminophen at room temperature away from heat,
moisture, and the reach of children. The rectal suppositories can be
stored at room temperature or in the refrigerator. |
What
happens if I miss a dose?
|
|
• |
If you are taking acetaminophen on a regular schedule,
take the missed dose as soon as you remember. Wait the prescribed
amount of time or as directed in the package labeling before taking
another dose. Do not take a double dose. |
|
• |
If you are taking acetaminophen on an as-needed basis,
missing a dose is not usually a problem. Take the dose as soon as you
remember, and do not take another dose for the amount of time
prescribed or as directed in the package labeling. |
What
happens if I overdose?
|
|
• |
Seek emergency medical attention. |
|
• |
Symptoms of an acetaminophen overdose include nausea,
vomiting, diarrhea, abdominal pain, sweating, seizures, confusion, and
an irregular heartbeat. |
What
should I avoid while taking acetaminophen?
|
|
• |
Avoid alcohol during treatment with acetaminophen.
Together, alcohol and acetaminophen can be damaging to the liver. |
|
• |
Be aware of the acetaminophen content of other
over-the-counter and prescription products. Care should be taken to
avoid taking more than the recommended amount of acetaminophen per dose
or per day. |
What
are the possible side effects of acetaminophen?
|
|
• |
If you experience any of the following rare but serious
side effects, stop taking acetaminophen and seek emergency medical
attention or contact your doctor immediately: |
|
· |
an allergic reaction (difficulty breathing; closing of
the throat; swelling of the lips, tongue, or face; or hives); |
|
· |
liver damage (yellowing of the skin or eyes, nausea,
abdominal pain or discomfort, unusual bleeding or bruising, severe
fatigue); |
|
· |
blood problems (easy or unusual bleeding or bruising). |
|
• |
Other, less serious side effects are not known to occur. |
|
• |
Side effects other than those listed here may occur.
Talk to your doctor about any side effect that seems unusual or that is
especially bothersome. |
What
other drugs will affect acetaminophen?
|
|
• |
Be aware of the acetaminophen content of other
over-the-counter and prescription products. Care should be taken to
avoid taking more than the recommended amount of acetaminophen per dose
or per day. |
|
• |
Acetaminophen may cause false urine glucose test
results. Talk to your doctor if you have diabetes and you notice
changes in your glucose levels while taking acetaminophen. |
|
• |
Other medications may interact with acetaminophen. Talk
to your doctor and pharmacist before taking any prescription or
over-the-counter medicines, including herbal products while taking
acetaminophen. |
Where
can I get more information?
|
|
• |
Your pharmacist has additional information about
acetaminophen written for health professionals that you may read. |
• |
Remember, keep this and all other medicines out of the
reach of children, never share your medicines with others, and use this
medication only for the indication prescribed. |
|
• |
Every effort has been made to ensure that the
information provided by Cerner Multum, Inc. ('Multum') is accurate,
up-to-date, and complete, but no guarantee is made to that effect. Drug
information contained herein may be time sensitive. Multum information
has been compiled for use by healthcare practitioners and consumers in
the United States and therefore Multum does not warrant that uses
outside of the United States are appropriate, unless specifically
indicated otherwise. Multum's drug information does not endorse drugs,
diagnose patients or recommend therapy. Multum's drug information is an
informational resource designed to assist licensed healthcare
practitioners in caring for their patients and/or to serve consumers
viewing this service as a supplement to, and not a substitute for, the
expertise, skill, knowledge and judgment of healthcare practitioners.
The absence of a warning for a given drug or drug combination in no way
should be construed to indicate that the drug or drug combination is
safe, effective or appropriate for any given patient. Multum does not
assume any responsibility for any aspect of healthcare administered
with the aid of information Multum provides. The information contained
herein is not intended to cover all possible uses, directions,
precautions, warnings, drug interactions, allergic reactions, or
adverse effects. If you have questions about the drugs you are taking,
check with your doctor, nurse or pharmacist. |
© 1996-2003 Cerner Multum, Inc. Version: 7.02. Revision date:
3/10/03.
http://www.drugs.com/acetaminophen.html
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Non
Steroidal
Anti-Inflammatory Drugs
http://www.medinfo.co.uk/drugs/nsaids.html
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Nonsteroidal
anti-inflammatory drugs (NSAIDs)
From MayoClinic.com
Special to CNN.com
NSAIDs (en-SEDS) are most effective for mild to moderate pain
accompanied by
swelling and inflammation. These drugs relieve pain by inhibiting an
enzyme in
your body called cyclooxygenase (si-klo-OX-suh-juhn-ays). This enzyme
makes
hormone-like substances called prostaglandins, which are involved in
the
development of pain and inflammation.
NSAIDs are especially helpful for arthritis and pain resulting
from muscle
sprains, strains, back and neck injuries or cramps.
Over-the-counter
NSAIDs include:
- Aspirin
- Ibuprofen (Advil, Motrin, others)
- Ketoprofen (Orudis)
- Naproxen sodium (Aleve)
NSAIDs available
only by prescription include:
- Diclofenac potassium (Cataflam)
- Diclofenac sodium (Voltaren)
- Etodolac (Lodine)
- Flurbiprofen (Ansaid)
- Indomethacin (Indocin)
- Ketorolac (Toradol, Acular)
- Nabumetone (Relafen)
- Naproxen (Anaprox, Naprelan, Naprosyn)
- Oxaprozin (Daypro)
- Piroxicam (Feldene)
- Sulindac (Clinoril)
When taken as directed, NSAIDs are generally safe. But if you
take more than
the recommended dosage — and sometimes even the recommended dosage —
NSAIDs
may cause nausea, stomach pain, stomach bleeding or ulcers. Large doses
of
NSAIDs can lead to kidney problems and fluid retention. Your risk
increases with
age. If you regularly take NSAIDs, talk to your doctor so that he or
she can
monitor you for side effects.
NSAIDs have a so-called ceiling effect, or limit to how much
pain they can
control. This means that beyond a certain dosage, they don't provide
additional
benefit. If you have moderate to severe pain, exceeding the dosage
limit may not
help relieve your pain.
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Naproxen sodium
How does it work?
Naproxen
sodium belongs to a group of medicines called non-steroidal
anti-inflammatory drugs (NSAIDs).
It works by blocking the action of a substance in the body called
cyclo-oxygenase. Cyclo-oxygenase is an enzyme that is involved in the
production of various chemicals in the body, some of which are known as
prostaglandins. Prostaglandins are produced in response to injury or
certain diseases and cause pain, swelling and inflammation. As naproxen
stops the production of prostaglandins, it is effective at relieving
pain and inflammation.
All the medicines in this group reduce inflammation caused by the
body's own immune system and are effective pain killers.
What is it used for?
- A form of
arthritis affecting the joints of the spine (ankylosing spondylitis)
-
- Abdominal
pain associated with menstrual periods (dysmenorrhoea)
- Acute
gout
- Disorders of
the muscles and skeleton, such as tendon inflammation (tendinitis),
sprains, strains, dislocations, fractures
- Inflammatory
disease of the joints (rheumatoid arthritis)
- Osteoarthritis
- Pain following
childbirth
- Pain following
insertion of an intrauterine contraceptive device (coil or IUCD)
- Pain following
surgery
- Pain
relief in migraine
Warning!
- This medicine
may reduce your ability to drive or operate machinery safely. Do not
drive or operate machinery until you know how this medicine affects you
and you are sure it won't affect your performance.
- This medicine
is not recommended for use in children under 16 years of age.
- If you have
cirrhosis of the liver, heart failure or kidney disease, you are on a
low sodium diet, or you are taking diuretic medicines, you should have
your kidney function assessed before and during treatment with this
medicine.
- If you
experience any disturbances in your vision during treatment with this
medicine you should have an eye test.
Use with caution in
- Blood clotting
disorders
- Decreased
kidney function
- Decreased
liver function
- Elderly people
- Heart
failure
- History
of allergies
- History
of asthma
- History of
diseases of the stomach or intestines
- People on a
low salt (sodium) diet
Not to be used in
- Allergy
to aspirin or other medicines in this class (NSAIDs)
- Bleeding from
the stomach or intestines
- People in whom
aspirin or other medicines in this class (NSAIDs), cause attacks of
asthma, itchy rash (urticaria) or nasal inflammation (rhinitis)
- Peptic
ulcer or a history of this
This medicine should not
be used if you are allergic to one or any of its ingredients. Please
inform your doctor or pharmacist if you have previously experienced
such an allergy.
If you feel you have experienced an allergic reaction, stop using this
medicine and inform your doctor or pharmacist immediately.
Pregnancy
and Breastfeeding
Certain
medicines should not be used during pregnancy or breastfeeding.
However, other medicines may be safely used in pregnancy or
breastfeeding providing the benefits to the mother outweigh the risks
to the unborn baby. Always inform your doctor if you are pregnant or
planning a pregnancy, before using any medicine.
- This medicine
is not recommended for use in pregnancy, particularly in the first and
third trimesters, unless considered essential by your doctor. Seek
medical advice from your doctor.
- This medicine
passes into breast milk. It is recommended that mothers should avoid
using this medicine while breastfeeding. Seek medical advice from your
doctor.
Label warnings
- Take this
medication with or after food.
Side effects
Medicines and
their possible side effects can affect individual people in different
ways. The following are some of the side effects that are known to be
associated with this medicine. Because a side effect is stated here, it
does not mean that all people using this medicine will experience that
or any side effect.
- Headache
- Abdominal pain
- Difficulty in
sleeping (insomnia)
- Swelling of
the legs and ankles due to excess fluid retention (peripheral oedema)
- Blood disorders
- Abnormal
reaction of the skin to light, usually a rash (photosensitivity)
- Seizures
(convulsions)
- Balance
problems involving the inner ear (vertigo)
- Nausea and
vomiting
- Sensation of
ringing, or other noise in the ears (tinnitus)
- Inflammation
of the liver (hepatitis)
- Severe
blistering skin reaction affecting the tissues of the eyes, mouth,
throat and genitals.(Stevens-Johnson Syndrome)
- Concentration
difficulties
- Ulceration or
bleeding of the stomach or intestines
- Hypersensitivity
reactions such as narrowing of the airways (bronchospasm), swelling of
the lips, throat and tongue (angioedema), itchy blistering rash or
anaphylactic shock
- Kidney
disorders
The side effects listed
above may not include all of the side effects reported by the drug's
manufacturer.
For more information about any other possible risks associated with
this medicine, please read the information provided with the medicine
or consult your doctor or pharmacist.
How can this
medicine affect other medicines?
Naproxen may
increase the blood levels of the following medicines, resulting in an
increased risk of side effects:
- lithium
- methotrexate
- phenytoin.
There may rarely be an increased risk of seizures if this medicine is
taken with quinolone-type antibiotics such as ciprofloxacin.
Probenecid may increase the blood level of naproxen, resulting in an
increased risk of side effects.
Naproxen may reduce the effectiveness of the following medicines for
high blood pressure:
- diuretics such as furosemide (frusemide)
- ACE inhibitors such as captopril
- beta-blockers such as propranolol.
There may be an increased risk of kidney problems if this medicine is
taken with any of the following:
- diuretics
- ACE inhibitors
- ciclosporin.
NSAIDs such as naproxen should not be taken within 8-12 days of taking
mifepristone.
Naproxen should not be taken with any other NSAID, eg ibuprofen, as
this increases the risk of adverse effects.
There may be an increased risk of bleeding if naproxen is taken with
the following:
- blood-thinning or anticoagulant medicines such as warfarin
- corticosteroids such as prednisolone.
This medicine may affect the results of certain laboratory tests, eg
adrenal function tests. If you are due to have any blood tests, ask
your doctor if you need to stop taking this medicine beforehand.
Other
medicines containing the same active ingredients
|
Last updated 8.7.2004
http://www.netdoctor.co.uk/medicines/100004608.html
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Ibuprofen
Why is this medication
prescribed?
Ibuprofen is used to relieve the pain,
tenderness,
inflammation (swelling), and stiffness caused by arthritis and gout. It
also is
used to reduce fever and to relieve headaches, muscle aches, menstrual
pain,
aches and pains from the common cold, backache, and pain after surgery
or dental
work.
This medication is sometimes
prescribed for other uses; ask
your doctor or pharmacist for more information.
How should this medicine
be used?
Ibuprofen comes as a tablet and liquid
to take by mouth. It
usually is taken three or four times a day for arthritis or every 4-6
hours as
needed for pain. Follow the directions on the package or prescription
label
carefully, and ask your doctor or pharmacist to explain any part you do
not
understand. Take ibuprofen exactly as directed. Do not take more or
less of it
or take it more often than directed by the package label or prescribed
by your
doctor. If you think that you need more medication to relieve your
symptoms,
call your doctor.
If you obtained ibuprofen without a
prescription, do not
take it for more than 3 days for fever or 10 days for pain without
talking to a
doctor.
If you are taking ibuprofen for pain
and the painful area
becomes red or swollen, call your doctor.
What special precautions
should I follow?
Before taking ibuprofen,
- tell your doctor and pharmacist if you are allergic to
ibuprofen, aspirin or other medications for pain or arthritis, or any
other drugs
- tell your doctor and pharmacist what prescription and
nonprescription medications you are taking, especially anticoagulants
('blood thinners') such as warfarin (Coumadin), aspirin, atenolol
(Tenormin), carteolol (Cartrol), cyclosporine (Neoral, Sandimmune),
digoxin (Lanoxin), diuretics ('water pills'), labetalol (Normodyne,
Trandate), lithium (Eskalith, Lithobid), medications for arthritis or
diabetes, methotrexate, metoprolol (Lopressor), nadolol (Corgard),
phenytoin (Dilantin), probenecid (Benemid), and vitamins. Do not take
aspirin or acetaminophen when using ibuprofen unless directed to do so
by your doctor.
- tell your doctor if you have or have ever had liver, heart,
or kidney disease; high blood pressure; any stomach problems; or any
other gastrointestinal disease.
- tell your doctor if you are pregnant, plan to become
pregnant, or are breast-feeding. If you become pregnant while taking
ibuprofen, call your doctor.
- if you are having surgery, including dental surgery, tell
the doctor or dentist that you are taking ibuprofen.
- you should know that this drug may make you drowsy. Do not
drive a car or operate machinery until you know how this drug affects
you.
- if you drink 3 or more alcohol drinks every day, ask your
doctor if you should take ibuprofen. You should not drink alcoholic
beverages while taking ibuprofen.
What special dietary
instructions should I follow?
Ibuprofen may cause an upset stomach.
Take ibuprofen with
food or milk.
What should I do if I
forget a dose?
If your doctor prescribes ibuprofen on
a regular basis, take
the missed dose as soon as you remember it. However, if it is almost
time for
the next dose, skip the missed dose and continue your regular dosing
schedule.
Do not take a double dose to make up for a missed one.
What side effects can this
medication cause?
Although side effects from ibuprofen
are not common, they
can occur. Tell your doctor if any of these symptoms are severe or do
not go
away:
- headache
- dizziness
- nervousness
- upset stomach
- stomach pain or cramps
- vomiting
- constipation
- diarrhea
- gas
If you experience any of the
following symptoms, call
your doctor immediately:
- bloody vomit
- bloody diarrhea or black, tarry stools
- ringing in the ears
- blurred vision
- swelling of the hands, feet, ankles, or lower legs
- skin rash
- itching
What storage conditions
are needed for this medicine?
Keep this medication in the container
it came in, tightly
closed, and out of reach of children. Store it at room temperature and
away from
excess heat and moisture (not in the bathroom). Throw away any
medication that
is outdated or no longer needed. Talk to your pharmacist about the
proper
disposal of your medication.
In case of
emergency/overdose
In case of overdose, call your local
poison control center
at 1-800-222-1222. If the victim has collapsed or is not breathing,
call local
emergency services at 911.
What other information
should I know?
Keep all appointments with your doctor
and the laboratory.
Your doctor may order certain lab tests to check your response to
ibuprofen.
Do not let anyone else take your
medication. Ask your
pharmacist any questions you have about refilling your prescription.
Last Revised - 01/01/2003
http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682159.html
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Chronic
Pain Medicines
What drugs can treat
chronic pain?
Many medicines can decrease pain, including the ones
listed below. Each one may have side effects. Some side effects can be
serious. It's important to listen to your family doctor carefully when
he or she tells you how to use your pain medicine. If you have
questions about side effects or about how much medicine to take, ask
your doctor or your pharmacist.
Acetaminophen
Acetaminophen (one brand name: Tylenol) helps many kinds
of chronic pain. Remember, many over-the-counter and prescription pain
medicines have acetaminophen in them. If you're not careful, you could
take more acetaminophen than is good for you. Taking too much
acetaminophen could cause liver damage. If you often have to take more
than 2 acetaminophen pills a day, tell your doctor.
Nonsteroidal
Anti-inflammatory drugs (NSAIDs)
Other drugs that help with pain are called nonsteroidal
anti-inflammatory drugs, or NSAIDs. Examples include aspirin, ibuprofen
(two brand names: Motrin, Advil) and naproxen (two brand names: Aleve
[over the counter], Naprosyn [prescription]). These medicines can be
taken just when you need them, or they can be taken every day. When
these medicines are taken regularly they build up in the blood to
levels that fight the pain of inflammation (swelling) and also give
general pain relief. Many of these medicines are available in low-dose
forms without a prescription.
If your doctor wants you to take an NSAID, always take
it with food or milk because the most common side effects are
related to the stomach. If you are taking other pain medicines, don't
take NSAIDs without first talking to your doctor.
Narcotics
Narcotics can be addictive, so your family doctor will
be careful about prescribing them. For many people with severe chronic
pain, these drugs are an important part of their therapy. If your
doctor prescribes narcotics for your pain, be sure to carefully follow
his or her directions. Tell your doctor if you are uncomfortable with
the changes that may go along with taking these medicines, such as
inability to concentrate or think clearly. Do not drive when taking
these medicines.
When you're taking narcotics, it's important to remember
that there is a difference between "physical dependence" and
"psychological addiction." Physical dependence on a medicine means that
your body gets used to that medicine and needs it to work properly.
When you don't have to take the pain medicine any longer, your doctor
can help you slowly and safely decrease the amount of medicine until
your body no longer "needs" it.
Psychological addiction is the desire to use a drug
whether or not it's needed to relieve pain. Using a narcotic this way
can be dangerous and may not help your pain. If you have a
psychological addiction to a narcotic, your doctor may give you another
drug to help with your psychological problems. Or your doctor might
recommend that you talk to a counselor. Your doctor might also change
the medicine that you are addicted to by lowering the dose, changing to
another drug or stopping the medicine altogether.
Narcotic drugs often cause constipation (difficulty
having bowel movements). If you are taking a narcotic medicine, it's
important to drink at least 6 to 8 glasses of water every day. Try to
eat 2 to 4 servings of fresh fruits and 3 to 5 servings of vegetables
every day. Be sure to tell your doctor if constipation becomes a
problem for you. He or she may suggest taking
laxatives to treat or prevent it.
Other medicines
Many drugs that are used to treat other illnesses can
also treat pain. For example, carbamazepine (one brand name: Tegretol)
is a seizure medication that can treat some kinds of pain.
Amitriptyline (one brand name: Elavil) is an antidepressant that can
also help with chronic pain in many people. Your doctor may want you to
try one of these medicines to help control your pain. It can take
several weeks before these medicines begin to work well.
Remember -- if you are taking any pain medicine, be sure
to ask your doctor or pharmacist before you take any other medicine,
either prescription or over-the-counter.
Are drugs the only
way to treat chronic pain?
No. Many other treatments can also decrease pain. They
can actually change the body's chemicals that produce pain. Almost
anything we do to relax or get our minds off our problems may
help control pain. It's important to add relaxing activities to your
daily life, even if you are already taking medicine for pain. You might
have to use stress reduction methods for several weeks before you
notice a decrease in pain. Your doctor can give you tips about stress
reduction and relaxation methods.
|
Reviewed/Updated:
03/03
Created: 9/00
|
|
|
This article provides a general
overview on this topic and
may not apply to everyone. To find out if this article applies to you
and to get
more information on this subject, talk to your family doctor.
http://familydoctor.org/122.xml
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Prescription Pain Relievers
What Are the Different Kinds of Prescription Pain
Relievers?
For many years, the most widely used prescription
pain relievers have been narcotics. Narcotics are drugs that relieve
pain and cause drowsiness or sleep. In addition, they all have similar
side effects. Historically, these drugs came from the opium poppy. They
are also called opioids or opiates. Today, many
narcotics are synthetic, that is, they are chemicals manufactured by
drug companies. Frequently used opioid pain relievers include the
following:
- codeine
- hydromorphone (Dilaudid)
- levorphanol (Levo-Dromoran)
- methadone (Dolophine)
- morphine
- oxycodone (in Percodan)
- oxymorphone (Numorphan)
You can get these pain relievers only with a
doctor’s written prescription. They may be taken by mouth (orally or
PO), by injection (intramuscularly or IM), through a vein
(intravenously or IV), or by rectal suppository. There are also other
methods of giving pain medicines for more continuous pain relief. Not
all narcotics are available in each of these forms. Another group of
prescription pain relievers is similar to ibuprofen (in large doses,
ibuprofen requires a prescription). They are called nonsteroidal
anti-inflammatory drugs (NSAIDs). Included in this group of pain
relievers are Motrin, Naprosyn, Nalfon, and Trilisate. They are useful
for moderate to severe pain. They may be especially helpful in treating
the pain of bone metastasis. Because NSAlDs are not narcotics, their
use does not result in drug tolerance or physical dependence. These
drugs are used alone or with nonprescription pain relievers to treat
moderate to severe pain. Some are more effective than others in
relieving severe pain.
How Do I Decide Which Pain Medications To Use?
This is not something you should decide alone.
Discuss this with your doctor, nurse, or pharmacist before you use any
drugs for pain. Medications that worked for you in the past or that
helped a friend or relative may not be right for you at this time.
Never take someone else’s medicine! Only one doctor should prescribe
your pain medicine. If a consulting doctor changes your medicine, be
sure the two doctors discuss your treatment. Otherwise, you may take
too much or too little. Let your doctor or nurse know whether your pain
medication gives you relief. Work together to find the medication or
pain-relief program that is best for you. Remember, your need for pain
medicine may change as your cancer treatment changes. It is important
to record the name and amount of pain medication you take. You can then
give precise information to the doctor or nurse about its effect on
your pain.
Will I Become Addicted if I Use Narcotics for Pain
Relief?
No. Narcotic addiction is defined as dependence on
the regular use of narcotics to satisfy physical, emotional, and
psychological needs rather than for medical reasons. Pain relief is a
medical reason for taking narcotics. Therefore, if you take narcotics
to relieve your pain, you are not an “addict,” no matter how much or
how often you take narcotic medicines. If you and your doctor decide
that narcotics are a proper choice for your pain relief, use them as
directed. Addiction is a very common fear of people who take narcotics
for pain relief. Narcotic addiction is an emotionally charged subject.
You may hear people use the term “addiction” very loosely without
understanding exactly what it means - the compulsive use of
habit-forming drugs for their pleasurable effects. Drug addiction in
cancer patients is rare. Generally, when narcotics are used under
proper medical supervision the chance of addiction is very small. Most
patients who take narcotics for pain relief can stop taking these drugs
if their pain can be controlled by other means. It is important to
remember that if narcotics are the only effective way to relieve pain,
the patient’s comfort is more important than any possibility of
addiction. If you take narcotics for several weeks or more, be prepared
for someone to express a concern about addiction. Most people with
prolonged pain who take narcotics have faced this problem. Remind
yourself that other people’s concerns about addiction are often due to
lack of information. If you have concerns about addiction, share them
with those who are caring for you. These fears should not prevent you
from using narcotics to effectively relieve your pain.
What Is Drug Tolerance?
When certain drugs are taken regularly for a
length of time, the body doesn’t respond to them as well as it once
did, and the drugs at a fixed dose become less effective. Larger or
more frequent doses must be taken to obtain the effect that was
achieved with the original dose. People who take narcotics for pain
control sometimes find that over time they will need to take larger
doses. This either may be due to an increase in the pain or the
development of drug tolerance. Increasing the doses of narcotics to
relieve increasing pain or to overcome drug tolerance is not addiction.
Can Taking Narcotics Be Dangerous?
All medicines can be dangerous if they are not
taken properly. The risks of improperly taking narcotics include
overdose, drug interactions, and accidents resulting from drowsiness.
Overdose: Too large a dose of a narcotic may cause
breathing to slow down or stop (respiratory depression). Doses required
for good pain relief are rarely, if ever, large enough to cause death.
Doctors carefully adjust the doses of narcotic pain relievers so that
pain is relieved with little effect on breathing. You may have heard of
addicts dying from narcotic overdose. This usually is due to taking the
narcotic with other drugs that interact with it, or to taking a much
higher dose than would be necessary for pain relief, or to impurities
in illegally obtained narcotics. The first sign of narcotic overdose is
a feeling of unusual sleepiness or difficulty in waking up. If you have
either of these problems, someone should contact your doctor or nurse
as soon as possible.
Drug Interactions: Combinations of narcotics,
alcohol, and tranquilizers can be dangerous. If you drink alcohol or if
you take tranquilizers, sleeping aids, antidepressants, antihistamines,
or any other drugs that make you sleepy, tell your doctor how much and
how often. Even small doses might cause problems. The use of alcohol or
any of these drugs with narcotics can lead to overdose symptoms such as
weakness, difficulty in breathing, confusion, anxiety, or more severe
drowsiness or dizziness. These drug interactions may result in
unconsciousness and death. Tell your doctor about any medicine or
combination of medicines that makes you drowsy or sleepy.
Accidents: Narcotics often cause drowsiness or
dizziness. If you are aware of this, you can be extra careful to avoid
accidents. Sometimes it may be unsafe for you to drive a car or even to
walk up or down stairs. Avoid operating equipment such as saws or
drills, or performing activities that require alertness. Be aware of
the effect narcotics have on you so that you can take necessary
precautions.
How Much Narcotic Pain Reliever Is Safe for Me To
Take?
The amount of pain reliever you take should be
determined by your doctor. Analgesics affect different people in
different ways. A very small dose may be effective for you, while
someone else may need to take a much larger dose to obtain pain relief.
You need to ask these questions:
- How much should I take? How often?
- If my pain is not relieved, can I take more?
- If the dose should be increased, by how much?
- Must I call the doctor before increasing the dose?
- What if I forget to take it or take it late?
Your doctor will try to prescribe the amount of
narcotic that will be both safe for you and effective for your pain.
Take the medicine as your doctor or nurse has prescribed but tell them
at once if your pain is not controlled or if you have severe side
effects such as extreme drowsiness or difficulty in breathing. If you
do not need as much narcotic as has been prescribed, your doctor or
nurse will tell you how to reduce the dose or frequency.
What if the Medicine That Has Been Recommended
Doesn’t Relieve My Pain?
Tell your doctor or nurse as soon as you can if
you are not getting effective pain relief. Don’t wait for your next
appointment! They need to know:
- How much, if any, pain relief you get.
- How long the pain is relieved.
- Any side effects that occur or do not occur,
especially drowsiness.
- How pain interferes with your normal activities
such as sleep, work, eating, or sex.
With your doctor’s help, you can usually get good
pain relief. When the medicine does not give you enough pain relief,
the doctor may increase the dose or the frequency or prescribe a
different drug. Some narcotics are stronger than others, and you may
need a stronger one to control your pain. If your pain relief is not
lasting long enough, ask your doctor about long acting forms of
medicine. Morphine is now available in a tablet form that releases it
over a long period of time (MS Contin or Roxanol SR). You may have
developed drug tolerance if you have taken narcotics for a long time.
As a result, doses that may have been too large for you a few weeks
before may be safe now. The desired effect is pain relief with as few
side effects as possible, regardless of the size of the dose. Some
doctors are reluctant to prescribe large enough doses or stronger
narcotics for pain control. However, with careful medical observation,
the doses of strong narcotics (by mouth or injection) can be safely
raised enough to ease severe pain. Do not increase the dose of your
pain medicine on your own. Remember, you are the best judge of whether
your pain is relieved. If you still have pain and your doctor does not
seem to be aware of other alternatives, ask to see a specialist in
cancer pain management.
What Are the Side Effects of Narcotics?
Although not everyone has side effects from
narcotics, some of the more common ones are drowsiness, constipation,
and nausea and vomiting. Some people also might experience dizziness,
mental effects (nightmares, confusion, hallucinations), a moderate
decrease in rate and depth of breathing, or difficulty in urinating.
You should always discuss side effects with your doctor or nurse. Side
effects from narcotic pain relievers can usually be handled
successfully.
What Can I Do About Drowsiness?
At first, narcotics cause some drowsiness in most
people, but this usually goes away after a few days. If the narcotic is
giving you pain relief for the first time in a long time, your
drowsiness might be the result of the decrease in pain, allowing you
much needed rest. This kind of drowsiness will go away after you “catch
up” on your sleep. Drowsiness will also lessen as your body gets used
to the medicine. Call your doctor or nurse if you feel you are too
drowsy for your normal activities after you have been taking the
medicine for a week. If you are drowsy, be very careful to avoid
situations in which you might hurt yourself as a result of not being
alert such as cooking, climbing stairs, or driving. Here are some ways
to handle drowsiness:
- Wait a few days and see if it disappears.
- Check to see if there are other reasons for the
drowsiness. Are you taking other medicines that can also cause
drowsiness?
- Ask the doctor if you can take a smaller dose more
frequently.
- If the narcotic is not relieving the pain, the
pain itself may be wearing you out. In this case, better pain relief
may result in less drowsiness. Ask your doctor what you can do to get
better pain relief.
- Sometimes a small decrease in the dose of a
narcotic will still give you pain relief but no drowsiness. If
drowsiness is severe, you may be taking more narcotic than you need.
Ask your doctor about lowering the amount you are presently taking.
- Ask your doctor if you can take a mild stimulant
such as caffeine, or your doctor can prescribe a stimulant such as
dextroamphetamine (Dexedrine) or methylphenidate (Ritalin).
- If drowsiness is severe or if it suddenly occurs
after you have been taking narcotics for a while, notify your doctor or
nurse right away.
What Can I Do About Constipation?
Narcotics cause constipation in most people. The
stool does not move along the intestinal tract as fast as usual and
becomes hard because more water is absorbed. Your doctor will probably
prescribe a stool softener and a laxative. After checking with your
doctor or nurse, you can try the following:
- Eat foods high in fiber or roughage such as
uncooked fruits and vegetables and whole grain breads and cereals.
Adding 1 or 2 tablespoons of unprocessed bran to your food adds bulk
and stimulates bowel movements. Keeping a shaker of bran handy at
mealtimes makes it easy to sprinkle on foods. A dietitian can suggest
other ways to add fiber to your diet.
- Drink plenty of liquids. Eight to ten 8-ounce
glasses of fluid each day will help keep your stools soft.
- Exercise as much as you are able.
- Eat foods that have helped relieve constipation in
the past.
- Try to use the toilet or bedside commode when you
have a bowel movement, even if that is the only time you get out of bed.
- Plan your bowel movements for the same time each
day, if possible. Set aside time for sitting on the toilet or commode,
preferably after a meal.
- Have a hot drink about half an hour before your
planned time for a bowel movement.
- If you have difficulty eating enough bran or other
foods high in fiber, check with your doctor, nurse, or pharmacist about
using a bulk laxative such as Metamucil.
Be sure to check with your doctor or nurse before
taking any laxative or stool softener on your own.
What Can I Do for Nausea and Vomiting?
Nausea and vomiting caused by narcotics usually
will disappear after a few days of taking the medicine. The following
suggestions may be helpful:
- If your nausea occurs mainly when you are walking
around (as opposed to being in bed), remain in bed for an hour or so
after you take your medicine. This type of nausea is like motion
sickness. Sometimes the doctor will tell you to use medicines (such as
Bonine or Dramamine) that can be bought without a prescription to
counteract this type of nausea. Do not take these medicines without
checking with your doctor, nurse, or pharmacist.
- If pain itself is the cause of the nausea, using
narcotics to relieve the pain usually makes this nausea go away.
- Medicine (such as Compazine, or Torecan by mouth
or by rectal suppositories) can sometimes be prescribed.
- Ask your doctor or nurse if some other medical
condition or other medications you are taking such as steroids,
anticancer drugs, or aspirin might be causing your nausea.
Some people mistakenly think they are allergic to
narcotics if the narcotic causes nausea. Nausea and vomiting alone
usually are not allergic responses. But nausea and vomiting accompanied
by a rash or itching may be an allergic reaction. If this occurs, stop
taking the drug and notify your doctor at once.
I’ve Heard That Some People Who Stop Taking
Narcotics Have Withdrawal Effects. Is This True?
You should not stop taking narcotic pain relievers
suddenly. People who stop taking narcotic medicine usually are taken
off the drug gradually so that any withdrawal symptoms will be mild or
scarcely noticeable. If you stop taking narcotics suddenly and develop
a flu-like illness, excessive perspiration, diarrhea, or any other
unusual reaction, tell your doctor or nurse. These symptoms can be
treated and tend to disappear in a few days to a few weeks.
If My Pain Becomes Severe, Will I Need Shots for
Pain Relief?
Probably not. Intramuscular injections or “shots”
are rarely used for relieving cancer pain. Narcotic rectal
suppositories can be effective, and new methods of giving narcotic pain
relievers have been developed. Long-acting morphine tablets are now
available, and some narcotics provide quick pain relief when they are
given under the tongue (sublingually). One narcotic drug, fentanyl, is
now available as a skin patch which continuously releases the medicine
through the skin for 48 to 72 hours. If you and your doctor have not
been able to find a way to get good pain control with medicine you take
by mouth, some kinds of pain medicine can be given intravenously. You
may want to ask about patient-controlled analgesia. With this method, a
portable computerized pump containing the medicine is attached to a
needle that is placed in a vein. Whenever pain relief is needed, the
patient presses a button on the pump that delivers a preset dose of
pain medicine into the vein. A new simple, safe, and effective method
of pain control is called continuous subcutaneous infusion. A small
electronic pump dispenses the drug automatically through a small needle
placed under the skin. Another way of treating cancer pain is to inject
pain medicine into the spinal cord (intrathecal) or into the space
around the spinal cord (epidural). Your doctor or a pain specialist can
give you more information about these advances in pain treatment.
Is It True That Severe Pain Can Only Be Relieved
by Heroin?
No. That is not true. Some newspaper and magazine
articles have suggested that heroin is the only way to relieve severe
pain, but the reported success with heroin was due more to how the drug
was given (in a preventive way) than to the effects of the drug itself.
Strong narcotics such as morphine and Dilaudid usually can relieve very
severe pain. In fact, the body converts heroin to morphine. Heroin is
available in England and has been used there to treat pain in cancer
patients. However, even in England, morphine now is being used
routinely because it has been shown to be just as effective as heroin.
In the United States, heroin is not legally available.
What Other Prescription Medicines Are Used To
Relieve Cancer Pain?
Several different classes of drugs can be used
along with (or instead of) narcotics to relieve cancer pain. They may
have their own pain-relieving action or they may increase the
pain-relieving activity of narcotics. Others lessen the side effects of
narcotic pain relievers. The following classes of non narcotic drugs
might be prescribed by your doctor to help you get the best pain relief:
- Antidepressants such as Elavil, Tofranil, or
Sinequan are used to treat the pain that results from surgery,
radiation therapy, or chemotherapy.
- Antihistamines such as Vistaril or Atarax relieve
pain, help control nausea, and help patients sleep.
- Antianxiety drugs such as Xanax or Ativan may be
used to treat muscle spasms that often go along with severe pain. In
addition they are helpful for treating the anxiety that some cancer
patients feel.
- Dextroamphetamine (Dexadrine) increases the
pain-relieving action of narcotic pain relievers and also reduces the
drowsiness they cause.
- Anticonvulsants such as Tegretol or Klonopin are
helpful for pain from nerve injury caused by the cancer or cancer
therapy.
- Steroids such as prednisone or Decadron are useful
for some kinds of both chronic and acute cancer pain.
- NSAIDs such as Motrin decrease inflammation and
lessen post surgical pain and the pain from bone metastases.
Related Articles:
Pain Control: Dispelling The Myths
Pain: What Is It?
How To Relieve Pain Without Medicine
Nonprescription Pain Relievers
Dealing with Pain, sponsored by the Connecticut
Division, Inc., of the American Cancer Society and the Yale
Comprehensive Cancer Center, New Haven, Connecticut, was the basis of
the first edition of Questions and Answers About Pain Control: A Guide
for People with Cancer and Their Families. Since that time, new
advances in pain control have taken place. This guide reflects many of
those advances. We wish to thank the many reviewers, people who work
with cancer patients daily, for their helpful comments and their
assistance in revising Questions and Answers About Pain Control.
|
http://www.hospicenet.org/html/prescription.html
........................................
N S A I D
Information
-
- - - -
NSAID
Use Increases Renal Failure Risk,
Especially in Hypertension or Heart Failure
By Michelle Rizzo
NEW YORK (Reuters Health) Mar 31 - The risk of developing
acute renal failure
(ARF) is increased among nonsteroidal anti-inflammatory drug users
compared to
non-users in the general population, according to report from Spain.
The risk is
heightened in patients with hypertension or heart failure.
Dr. Consuelo Huerta, from Centro Espanol de Investigacion
Farmacoepidemiologica, Madrid, and colleagues used the General Practice
Research
Database from the United Kingdom to assess the risk for nonfatal ARF
associated
with NSAID use in a nested case-control study.
As reported in the March issue of the American Journal of
Kidney Diseases,
the analysis included a total of 103 patients confirmed as idiopathic
cases of
ARF, compared with 5000 matched controls.
"We found that the incidence of nonfatal ARF was 1 per 10,000
person-years in persons with no prior history of renal impairment," Dr.
Huerta told Reuters Health. "This risk increased threefold among users
of
NSAIDs." The risk declined after treatment was discontinued. Long-term
and
high daily doses were associated with slightly increased risks.
The investigators found that a history of heart failure,
hypertension,
diabetes, and hospitalizations in the previous year were associated
with a
greater risk for ARF. "The increased risk associated with NSAIDs was
potentiated among patients with a history of hypertension or congestive
heart
failure," Dr. Huerta explained.
The risk for ARF was increased with the use of selected
cardiovascular drugs,
especially diuretics. The relative risk of ARF with concomitant use of
NSAIDs
and diuretics was 11.6, and for NSAIDs and calcium channel blockers it
was 7.8.
"Our study adds to the existing evidence that NSAIDs should be
used with
special caution in patients with a low circulating plasma volume and/or
renal
function already compromised, in particular patients with congestive
heart
failure or hypertension," Dr. Huerta concluded.
Am J Kidney Dis 2005;45:531-539.
-
- - - -
Alert Center:
NSAIDs and Cardiovascular Effects
Updated April 4, 2005
Emerging information is creating debate about whether the
benefits of COX-2
inhibitors ("coxibs") outweigh their cardiovascular risks. In
addition, possible adverse effects of standard NSAIDs on the
cardiovascular
system are under scrutiny. Physicians as well as patients are uncertain
about
the optimal use of these agents. This Alert Center provides links to
articles
and/or policy statements that update the evidence in this important
therapeutic
area. This Center is not intended to be a definitive source on the
subject.
http://www.medscape.com/pages/editorial/public/alertcenters/coxib
- - - - -
Medscape Editorial Note, January 18, 2005
The Pulse of Current Cardiovascular
Concern: Anti-inflammatory Medications CME
Co-Chairs: Thomas F. Lüscher, MD,
FRCP; Carl J. Pepine, MD; Faculty: Jeffrey S. Borer, MD; R. Preston
Mason, MBA, PhD; Wayne A. Ray, PhD; Frank Ruschitzka, MD; Lee S. Simon,
MD
Disclosures
Release Date: December 22, 2004;
As noted above, this activity is a symposium presented on November 8,
2004.
On December 17, 2004, the National Institutes of Health (NIH) announced
suspension of the use of the COX-2 inhibitor celecoxib (
Celebrex;Pfizer,
Inc.) for all participants in a large colorectal cancer prevention
clinical trial (Adenoma Prevention with Celecoxib [APC]). This action
was based on an analysis by an independent Data Safety and Monitoring
Board that showed a 2.5-fold increased risk of major fatal and nonfatal
cardiovascular events for participants taking the drug compared with
placebo.
However, according to a Pfizer spokesperson, data from another ongoing
study assessing whether celecoxib can prevent colon cancer -- the
Prevention of Colorectal Sporadic Adenomatous Polyps (PreSAP) trial --
"revealed no greater cardiovascular risk than placebo."
[1]
The PreSAP trial used the same cardiovascular measures and the same
Data Safety and Monitoring Board as the APC trial.
The NIH, which sponsors over 40 studies using celecoxib for the
prevention and treatment of cancer, dementia, and other diseases, will
conduct a full review of all supported studies involving this drug
class.
On the basis of suspension of celecoxib in the APC study, the US Food
and Drug Administration (FDA) issued a statement noting that although
these findings were important, "at this point FDA has seen only the
preliminary results of the studies. FDA will obtain all available data
on these and other ongoing
Celebrex trials as soon
as possible and will determine the appropriate regulatory action."
[2]
Further information from the FDA about celecoxib is available on its
Celecoxib
Information Page: http://www.fda.gov/cder/drug/infopage/celebrex/default.htm
In addition, on December 23, 2004, the FDA issued an alert for
healthcare providers regarding naproxen, in which it stated, "Based on
emerging information from a long-term prevention trial, the risk of
cardiovascular and cerebrovascular events may increase among patients
taking naproxen. FDA will be analyzing all available information from
these studies to determine whether additional regulatory action is
needed."
The
Naproxen Alert, which includes prescribing
information
, is available at:
http://www.fda.gov/downloads/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm124311.pdf
Further information from the FDA is available on its
Naproxen
Information Page: http://www.fda.gov/downloads/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/UCM164733.pdf
The FDA also approved a new label with upgraded warnings for valdecoxib
(
Bextra;Pfizer, Inc.). The FDA announced on December
9, 2004 that "a 'boxed' warning, strengthening previous warnings about
the risk of life-threatening skin reactions and a new bolded warning
contraindicating the use of
Bextra in patients
undergoing coronary artery bypass graft surgery, will be added to the
label."
The
Bextra labeling announcement
is available at:
Information from the FDA on nonsteroidal anti-inflammatory drug
products (NSAIDs), including rofecoxib, celecoxib, valdecoxib, and
naproxen, is available in a
Public Health Advisory on NSAIDs,
released December 23, 2004.
A regularly updated comprehensive collection of information related to
NSAIDs is available in the
Medscape
NSAID Alert Center
References
- Pfizer. Investor news
release. December 17, 2004. Available at: http://www.pfizer.com/are/investors_releases/2004pr/mn_2004_1217.cfm
- US Food and Drug
Administration. FDA statement on the halting of a clinical trial of the
Cox-2 inhibitor Celebrex. Available at: http://www.fda.gov/bbs/topics/news/2004/new01144.html
- - - - -
Daily Living: Understanding The Risks Of
Common Painkillers...
|
At some point,
most people dealing with Chiari or syringomyelia have reached into
their
medicine chests for an over-the-counter painkiller to help them get
through the
day. And if they're like 30 million other people in the
world, they chose
an NSAID, or non-steroidal anti-inflammatory.
NSAID's are a widely used
group of drugs that
have analgesic, anti-inflammatory and antipyrectic action. They are
very similar
to aspirin and are used extensively in treating everything from
post-operative
pain, arthritis, inflammation, back pain, sciatia, and migraines to
pain
associated with menstruation. There are many brand names in the NSAID
family,
including: Advil (ibuprofen), Aleve (naproxen), Excedrin IB, Celebrex
(Cox-2),
Haltran, Naprosen, and Vioxx to name a few.
Despite the drugs' popularity,
many users are unaware
of the side effects that NSAID's can cause and the serious risks using
them
every day can entail. It it well documented in the medical
literature -
but not commonly discussed in the doctor's office - that daily use of
NSAID's
can result in gastro-intestinal problems, lead to sudden bleeding, and
cause
life-threatening health problems. It's a little known fact
that thousands
of people die every year from complications due to NSAID use.
A recent study, published in
the August, 2004 issue of
the journal Gastroenterology, drives home the risks of using these
"everyday" type drugs. The study examined the rates of ulcer
formation in 1,615 osteoarthritis patients who took a standard daily
dose of
either a placebo, low-dose aspirin, rofecoxib (Vioxx) combined with
aspirin, or
ibuprofen, over a 12 week period.
The trial was administered to
a select group of
patients, aged 50 and over, with a confirmed diagnosis of
osteoarthritis. Each
patient had to meet strict health standards and be without ulcers or
erosive
esophagitis (verified by endoscopy) to be included in the study. The
trial was
conducted by Loren Laine of the University of S. California School of
Medicine,
and a team from Merck Research Laboratories in West Point,
Pennsylvania, led by
Eric S. Maller.
The patients were randomly
split into four groups and
given the average daily dosage of each specific drug, with one group
taking a
placebo, one group taking 81 mg of enteric-coated aspirin a day, one
group
taking 25 mg rofecoxib combined with the aspirin every day,
and one group
taking 800 mg of ibuprofen a day. Repeat endoscopies were performed at
6 weeks
and 12 weeks. Patients who developed ulcers were discontinued from the
study and
received ulcer treatment.
The results were striking and
clearly show the inherent
risk of using NSAID's on a daily basis. Low-dose aspirin did
not
significantly increase ulcer incidence; in fact, after 12 weeks, only
27 of the
patients had ulcers greater than 3mm. But with the addition of 25 mg.
of Vioxx,
the number jumped to 58. In the ibuprofen group, 62 people -
about 15% -
developed ulcers after only 12 weeks of use.
A peptic ulcer is a sore that
forms in the lining of
the stomach or the beginning of the small intestine, the duodenum.
Ulcers can
cause a gnawing, burning pain in the upper abdomen, accompanied by
nausea,
vomiting, a loss of appetite and weight loss. NSAID's work by affecting
chemicals in the body that cause inflammation, the prostaglandins.
Unfortunately, this same group of chemicals is also involved in the
activity of
the stomach. Thus, NSAID's interfere with the stomach's
ability to protect
itself from the acid used to digest food and tend to cause indigestion,
and in
some cases, even ulcers.
Normally the stomach has three
defenses against
digestive juices: the mucus that coats the stomach lining to protect it
from
acids, the chemical bicarbonate which neutralizes these acids, and
blood
circulation to the stomach lining that aids in cell renewal and repair.
NSAID's
hinder all of these protective mechanisms, and with the stomachs
defensives
down, the natural digestive juices frequently cause the problems seen
in this
study.
It should be noted that the
harmful effects of NSAID's
can occur quickly. In this study, most of the increase in the
number of
erosions actually had occurred by the week 6 check-up. It
should also be
noted that while aspirin caused less problems than ibuprofen, it did
cause
significantly more problems than the
placebo.
Although NSAID's can work well
as pain-relievers, their
benefits should be carefully weighed against their side
effects. The
finding in this study is in line with other estimates which state that
15%-30%
of long term NSAID users develop peptic ulcers. That's a
significant
number when you consider that peptic ulcers can involve
life-threatening
complications, such as bleeding and perforation.
The risks of NSAID's don't
stop with ulcers either.
NSAID's can affect medical conditions such as asthma and high blood
pressure,
and can even impact the liver and kidneys. In fact, just
before this issue
was posted, Merck voluntarily pulled their blockbuster drub, Vioxx, off
the
market due to concerns about side effects involving the heart (see
Merck Pulls Vioxx Off The Market)
Despite the lack of awareness
regarding the risks of
NSAID's, the research is clear. Given this, it is important
to discuss
NSAID use - especially daily, long-term use - with your doctor, so that
together
you can evaluate the potential benefits and risks and make an informed,
intelligent healthcare decision.
-- Julie
Carter
Sources:
-
Ulcer Formation With Low-Dose Enteric-Coated
Aspirin and the Effect of COX-2 Selective Inhibition: A Double-Blind
Trial. Laine L. et al. Gastroenterology, August 2004; 127;
395-402
-
Digestive Diseases A-Z: NSAIDs and Peptic
Ulcers
-
National Digestive Diseases Information
Clearinghouse
-
NIH Publications No. 02-4644, February 2002
-
www.nlm.nih.gov/medlineplus/print/druginfo/medmaster/a699046.htm
-
Astrazeneca Press Release
- - - - -
After
Vioxx: The Pros and Cons of Other Anti-Inflammatory Drugs
All
pain relievers have risks as well
as benefits. Get the pros and cons of anti-inflammatory medicines here.
WebMd
http://my.webmd.com/content/Article/95/103425.htm?pagenumber=1
The Pros and Cons of Older Anti-Inflammatory
Drugs
http://my.webmd.com/content/Article/95/103425.htm?pagenumber=2
The Pros and Cons of Other Analgesics
http://my.webmd.com/content/Article/95/103425.htm?pagenumber=3
==================================================
See
Also:
Cellulitis,
Lymphangitis
http://www.lymphedemapeople.com/thesite/lymphedema_cellulitis_lymphangit.htm
Deep
Venous Thrombosis
http://www.lymphedemapeople.com/thesite/lymphedema_deep_venous_thrombosis.htm
Fibrosis
http://www.lymphedemapeople.com/thesite/lymphedema_fibrosis.htm
Immunodificient
Limb
http://www.lymphedemapeople.com/thesite/lymphedema_immunodificient_limb.htm
Pleural
Effusions
http://www.lymphedemapeople.com/thesite/lymphedema_pleural_effusions.htm
Wounds
http://www.lymphedemapeople.com/thesite/lymphedema_wounds.htm
================================================
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Subscribe: |
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Pat O'Connor
Lymphedema People
/ Advocates for Lymphedema
=======================================================
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Lipodema Lipoedema
No matter how you spell it, this is another very little understood and
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......................
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About Lymphangiectasia
Support group for parents, patients, children who suffer from all forms
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......................
Lymphatic
Disorders Support Group @ Yahoo Groups
While we have a number of support groups for lymphedema... there is
nothing out
there for other lymphatic disorders. Because we have one of the most
comprehensive information sites on all lymphatic disorders, I thought
perhaps,
it is time that one be offered.
DISCRIPTION
Information and support for rare and unusual disorders affecting the
lymph
system. Includes lymphangiomas, lymphatic malformations,
telangiectasia,
hennekam's syndrome, distichiasis, Figueroa
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......................
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===========================
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===================================================
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Reviewed. 15, 2012