MEDICATION: (in current frequent use)
- OPIATES(e.g. morphine, pethidine, methadone, tramadol etc.):171=54%
- ANTI-INFLAMMATORY(e.g. Brufen,Mobic,Naproxen,Vioxx etc.) :144=45
- ANTIDEPRESSANT(commonest amitriptyline; also prozac etc) : 90=28
- ANTICONVULSANT (e.g. Tegretol; Neurontin;Vigabatrin): 84=26%
- MUSCLE RELAXANT:(e.g.Baclofen;Robaxin;Dantrolene;Zanaflex):34=11%
- BENZODIAZEPINE(e.g. diazepam,clonazepam,nitrazepam,etc.):39=12%
- DIURETICS(for fluid retention): 17=5%
- INA(intraspinal narcotic agents= "the pump") :8=2% incl. CLONIDINE: 2
- SCS(spinal cord stimulator): 2
- STEROIDS : 4 (1 via portal implant)
- QUININE(for muscle cramps): 3
- MEXETIL: 1
- AXSAIN CREAM (topical capsaicin):1
- OXYBUTININ(for bladder muscle instability): 1
- BETHANECOL( for urinary retention): 1
- ETIDRONATE (for prevention of bone loss in osteoporosis): 1
- RITALIN: 1 (for epilepsy)
- PARAMAX(=paracetamol+metoclopramide): 1
- SINEMET(for Parkinson's):1
- BETAHISTINE(for Meniere's disease): 1
- NONE: 10=3% PARACETAMOL/ASPIRIN ONLY : 4
- TENS: 2
? Note low percentage on no medication or simple analgesia; generally, for respondents who were not on medication, this was due to inability to tolerate stronger medication due to side-effects or adverse reactions.
? Most cases in the survey involved polypharmacy, with a combination of opiates with antidepressant and/or anticonvulsant being common. Anti-inflammatory medication (NSAIDS) usage was common despite a considerable number of respondents stating that they had had to discontinue use due to adverse gastric effects(e.g. gastric/duodenal ulcer, heartburn, gastric bleed), which are well-known with this type of medication.
? Antidepressant medication is used at a subtherapeutic dose as regards treating depression(i.e. say 25mg amitriptyline rather than 75-150mg) it is useful for neurogenic pain. Tricyclic antidepressants are most effective, whereas SSRIs (newer type) such as Prozac are often poorly effective. Of course, in some cases, full antidepressant dose may be given to combat any depressive features compounding the physical problems.
? Anticonvulsant medication is useful for neurogenic pain.
? Benzodiazepines: a group of drugs including valium: used either as a muscle relaxant or to combat anxiety, or perhaps as sleeping tablets.
? Both opiates and benzodiazepines are known to cause physical and psychological dependence (though the latter is not as marked in usage for analgesia as compared with recreational use) and tolerance to opiates may necessitate increasing doses for the same therapeutic effect.
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