Prescriptions for Pain List

C.S. Lewis, the famous author and Christian apologist, once wrote an essay entitled 'The Problem of Pain.' His approach was a philosophical one. I, however, am not a philosopher, but a pharmacist. His approach was to grapple with the existence of pain, my approach is to grapple with the treatmentof pain. Regardless of how one approaches the 'problem' of pain, it is clear from any angle that pain IS a problem. Dr. Kathryn Weiner, the director of the American Academy of Pain Management, describes our national chronic pain situation as "silent epidemic" effecting upwards of 50 million Americans.

"Pain" treatment is a broad category. For the purposes of this article I will be focusing primarily on the prescription narcotic pain relievers available at a retail pharmacy which are used to treat a variety of "pain" conditions which include, but are not limited to:

• Cancer Pain
• Chronic Back Pain
• Surgical Pain

The goal of this article is (1) to provide a resource for those currently looking for options to treat their pain, and (2) provide information for those looking to understand a little more about the particular pain medication which has been prescribed for them.

Many drugs have been developed to treat very specific painful conditions, and are generally limited to those conditions. Fore example, the injectable biological drugs like Enbrel for rheumatoid arthritis or the oral drug allopurinol for gout. These specific types of pain relievers are beyond the scope of this article. Click this link for an article specifically on the prescription drugs for Migraine Headaches which I have written.

For the sake of convenience and organization, I will divide and discuss these Prescriptions for Pain under 3 categories:

• Long Acting Narcotic Prescriptions for Pain
• Short Acting Narcotic Prescriptions for Pain
• Non-Narcotic Prescriptions for Pain

Long-acting narcotic prescriptions are an important weapon in our war against against pain. They allow for once or twice daily dosing, as opposed to taking tablets every 3-4 hours. These prescriptions for pain are generally used to treat chronic conditions like cancer or injuries that will require an extended recovery time. As a general rule, long-acting products should never be crushed, broken or chewed. They must be swallowed whole.

I will group these by their active ingredient of: (1) Oxycodone, (2) Morphine, (3) Fentanyl, or (4) Methadone.

(1) OXYCODONE containing products:

• Oxycontin (currently not available as a generic, Schedule 2 controlled substance). Oxycontin tablets come in a variety of strengths and are taken every 12 hours.

(2) MORPHINE (or morphine-like) containing products:

• Avinza (Schedule 2 controlled substance). Avinza is an extended release form of morphine in capsule form available in a variety of strengths. They may be swallowed whole, or opened an sprinkled on applesauce. They must not be crushed, chewed or dissolved. Full prescribing information is available by clicking HERE.
• MS Contin (Schedule 2 controlled substance). MS Contin is a 12-hour release (taken twice daily) form of morphine and comes in a variety of strengths and is available generically.
• Opana ER (oxymorphone, Schedule 2 controlled substance). Opana ER is available as a tablet, and comes in a variety of strengths. Oxymorphone is a more potent form of morphine. Patients on morphine will likely require much smaller dosages of oxymorphone for comparable effects. Opana lasts 12 hours and is therefore dosed twice daily. For more information on Opana ER click HERE.
• Oramorph SR (Schedule 2 controlled substance). Oramorph SR uses a unique mechanism to slowly release morphine into the body over 12 hours. Oramorph SR comes in several strengths and is manufactured by Xanodyne pharmaceuticals in Cincinnati.
• Kadian (Schedule 2 controlled substance). Kadian is a slowly released morphine capsule designed to be taken once or twice daily. The capsules can be opened, and the contents sprinkled on applesauce, but the pellets must not be chewed or dissolved. For information on financial assistance for Kadian click here.
• Embeda (Schedule 2 controlled substance). Embeda is a unique product containing morphine in an extended release tablet. Embeda ALSO contains a substance known as "naltrexone." The purpose of the naltrexone is to prevent Embeda from being abused by those who may be tempted to crush it, chew it, dissolve it...in order to get a "high" from the morphine content. If altered, the naltrexone is released and will produce very uncomfortable withdrawl symptoms. For more information on "naltrexone" read THIS ARTICLE.

(3) FENTANYL containing products:

Duragesic (Schedule 2 controlled substance). Duragesic is a patch containing fentanyl and is applied topically to the skin. The patch is designed to release the medication steadily over 3 days (72 hours). After 3 days the patch is to be removed, properly disposed of, and a new patch is applied (altering locations to avoid the development of skin irritation or a rash). Duragesic is available in a generic formulation. For information on Duragesic click HERE.

(4) METHADONE containing products:

Methadone: (Schedule 2 controlled substance). Methadone tablets come generically and in a variety of brand name forms such as Methadose and Dolophine. Methadone is generally dosed every 6 to 8 hours. Methadone is an effective pain reliever, but carries significant risks related to toxicity. For example, the following warning is attached to the prescription drug Dolohone: "Deaths, cardiac and respiratory, have been reported during initiation and conversion of pain patients to methadone treatment from treatment with other opioid agonists." This is serious medication! It must be used very carefully. For some statistics on the rising use of Methadone across the country, click HERE.

For an academic article, written by medical professionals, reviewing the uses of Methadone Treatment for pain CLICK HERE.

Short acting narcotics generally are taken every 2-4 hours. They are commonly used for pain conditions that do not require 24 hour pain control, for relief of temporary or short-term pain, or to treat "break through" pain (pain experienced while currently being treated with other long-acting pain relievers, generally in between doses). There are many short acting narcotic pain relievers on the market. Some contain just a single ingredient (like morphine or oxycodone) and some contain two ingredients (like Percocet which contains oxycodone and acetaminophen). Because this is such an extensive category, I am simply going to list some of the many options available. I will list the ingredients next to the brand name, indicate if it is available generically, and provide website links to more information where it is available.

SINGLE INGREDIENT SHORT ACTING NARCOTICS:

• Actiq (fentanyl oral lozenges, available generically): Actique has a unique delivery system. Fentanyl is basically sucked and absorbed through the cheeck and gums from the end of the delivery stick. Actique is ONLY prescribed for breakthrough pain in patients currently being treated with other opioids for pain. Click HERE for an explanation of how to use Actique.
• Codeine (codeine tablets are generically available)
• Dilaudid (hydromorphone, available generically)
• Demerol, Meperitab (meperidine, available generically)
• Nucynta (tapentadol, NOT available generically)
• Onsolis (fentanyl buccal film, NOT available generically)
• Opana (oxymorphone, now available generically)
• Roxanol (morphine solution, 20mg/ml)
• Roxicodone, OxyIR (oxycodone, available generically)

TWO INGREDIENT SHORT ACTING NARCOTICS:

• Combunox (oxycodone and ibuprofen, available generically)
• Endocet, Percocet, Roxicet (oxycodone and acetaminophen tablets, available generically)
• Endodan, Percodan (oxycodone and aspirin)
• Hycet (Hydrocodone and acetaminophen solution)
• Magnacet (oxycodone and acetaminophen, NOT available generically)
• Tylox (oxycodone and acetaminophen capsules, available generically)
• Vicoprofen (hydrocodone and acetaminophen)

Effective pain relief IS possible without narcotic ingredients. Below I will list several prescription products currently being used to treat a variety of painful conditions that do NOT contain any narcotic ingredients.

Celebrex (celecoxib): Celexbrex belongs to a family called "NSAIDs" which stands for Non-Steroidal Anti-inflammatory Drugs. Celebrex has a lower incidence of stomach related side-effects than other NSAIDs. Celebrex is approved for the treatment of arthritis and comes in 50mg, 100mg, 200mg and 400mg capsules. Celebrex is dosed once or twice daily.

Lidoderm patches ( 5% lidocaine): Lidoderm patches are applied topically for 12 hours and then removed for 12 hours. Lidoderm is FDA approved for the treatment of pain due to shingles (known as post-herpetic neuralgia).

Ryzolt (tramadol extended release tablets): Ryzolt is an extended release form of tramadol which comes in 100mg, 200mg, and 300mg tablets. This product is taken once daily and should not be crushed or chewed. The most common side-effects of Ryzolt are nasea, constipation and dizziness. Ryxolt is NOT available generically.

Ultram & Ultram ER (tramadol immediate release and extended release): Ultram is available generically.

Voltaren gel (1% diclofenac gel): Voltaren gel is approved for arthritis pain and is applied 4 times daily to the affected areas. The gel should be measured out with the dosing cards supplied.

Narcotic drugs, according to the DEA (Drug Enforcement Administration), are those medications which are derived from specific plant species or are derivatives of specific chemical substances which have the potential for addiction or abuse.  For these reasons, some patients are reluctant to take narcotic pain relievers, and some physicians are reluctant to prescribe them.  These are reasonable concerns.  Here are a few thoughts to bear in mind:

1. Some narcotics have a higher potential for addiction and abuse than others.  The DEA assigns them a "controlled substance schedule" to indicate those products with a greater or lesser degree of potential for dependence, addiction or abuse.  Schedule 2 drugs (such as Oxycontin or Duragesic) have the highest potential for these problems.  Drugs in schedules 3, 4 or 5 have a relatively lesser potential.
2. It is very important to follow the dosing schedule prescribed by your doctor.  Make sure you discuss this with your doctor and that you clearly understand how to take this medication.  Never take more than has been prescribed without express authorization from your doctor. 
3. Never share your pain medication with someone else.  These medications are strong, and can be harmful to others for whom they were not prescribed.
4. After proloned use, never stop your medication abruptly.  Your doctor will generally work out a tapering approach so that your body adjusts to not having this medication.
5. Never take additional, non-prescribed, pain medication along with your narcotics unless specifically instructed to do so.  Often prescription narcotics contain tylenol (acetaminophen) or ibuprofen, which is also available over-the-counter, and could be harmful if overdose.

It would be impossible to provide, in the space of a short article, a comprehensive list of all the medications used to treat pain.  I hope this summary has provided some basic information to help you.  Here are some links to other helpful articles on the subject of pain management:

Muscle Relaxer Medications

Migraine Headache Medications