(Originally published as an article for Imbue Pain Relief Patch)

The increase in Americans’ use of oral pharmaceutical drugs over the past several decades is nothing short of mind-blowing. I always ask my patients what drugs they’re taking – if any – and I routinely have people hand me a list of ten or more prescription medications that they take every day. Often, these lists are 15 or 20 items long.

In the case of pain, there really aren’t a lot of biomedical treatment options without significant drawbacks, and unfortunately, pain is exceedingly prevalent. The Centers for Disease Control report, “Health, United States, 2006,” featured a special section on pain. Here are some of the statistics:

– In 1999-2002, 26% of Americans age 20 and older said they had a problem with pain persisting over 24 hours at some time in the previous month.

– Nearly 60% of adults age 65 and older who reported pain indicated that it lasted for one year or more

– In 2002–2003, ambulatory medical care or prescribed medicine expenses for headaches alone totaled more than $4 billion – not including self-treatment, over-the-counter drugs, and inpatient hospital expenses. I don’t need to tell you that’s a lot of money.

Pain, especially chronic pain, has a wide range of repercussions on our quality of life.  The longer the duration of a pain disorder, the more common anxiety and depression become.  These also make treating the pain more difficult because they make us prone to irritability and a heightened sensitivity to stimuli.  Any of an individual’s interpersonal relationships may be affected.  A recent study showed 77% of migraine sufferers missed work because of their pain.  When pain causes missed work, a person’s sense of purpose and usefulness may be diminished.  Additionally, there are obvious broader social and economic impacts.

While oral analgesic drugs (pain killers) may improve the pain, they have basically no chance of rectifying its origin.  Thus, unless the cause is somehow resolved, the drugs will need to be taken indefinitely, and many of them have potential side effects.  In my opinion, it seems reasonable to bear some unpleasant side effects while undergoing a therapy with a real chance of actually correcting the underlying problem; otherwise, they shouldn’t be tolerated.

Following are common drugs used for pain and some of their potential side effects:

– Acetaminophen (Tylenol): liver toxicity, kidney toxicity

– Aspirin: gastrointestinal irritation, bleeding, and ulceration, Reye’s syndrome in children, salicylate poisoning

– NSAIDs (non-steroidal anti-inflammatory drugs – these include aspirin, and also ibuprofen [Advil], naproxen [Aleve] and others): gastrointestinal bleeding, kidney toxicity, exacerbation of congestive heart failure

– COX-2 inhibitors (a class of NSAID; includes Celebrex and the now-outlawed and dangerous Vioxx): possible increased risk of heart attack, gastric irritation and ulceration

– Opioids (morphine, codeine, tramadol, methadone, oxycodone, hydrocodone, others): sedation, constipation, addiction, nausea/vomiting

– Carbamazepine (CBZ): bone marrow suppression, impaired coordination, drowsiness, upset stomach, others

– Gabapentin (Neurontin): sedation, dizziness, ataxia (a lack of voluntary coordination of muscle movements), weight gain, depression, increased risk of suicide

– Tricyclic antidepressants: elevated risk of heart attack, drowsiness, urinary retention, dizziness, impaired sexual functioning, disorientation or confusion, weight gain

Several of these drugs may be paradoxical in their effect.  While they can diminish perception of pain enough to allow someone to be more functional, their sedating and disorienting effects can impede one’s ability to engage in meaningful activity.

As a result of these drawbacks, many patients give up on biomedical treatment.  The CDC study showed that a large number of patients, especially those over age 65, underreport their pain, possibly because of skepticism about their treatment options.

In addition to the downsides of the drugs themselves, they must be increasingly scrutinized in the context of drug interactions.  With the growing problem of polypharmacy – the simultaneous use of multiple drugs by an individual – experts acknowledge that it is impossible for a doctor to know what the total effect of these various interacting substances is in the body. In the last 10 years, the percentage of people over 60 who take five or more medications has jumped from 22 percent to 37 percent. Why add a pain medication to this mix, especially when a topical analgesic can do the job?

Despite the apparently huge number of doctors who don’t have a problem with prescribing half a dozen or more drugs simultaneously, it’s often the patients who sense there’s something wrong with this practice.  One unexpected sector of the population that has embraced Imbue is people with celiac disease (gluten intolerance), irritable bowel syndrome, and inflammatory bowel disease.  These folks have an acute awareness of the tendency for oral drugs to mess with their digestive tract and many have written us to say they appreciate having an effective pain reliever they don’t have to worry about using.  In Japan, and increasingly throughout Asia, natural pain patches are now used more frequently than oral pain killers.  We expect (and hope) this trend to grow widely in the next few years, especially in the United States, where, despite the fact that we are embracing oral pharmaceuticals like they’re going out of style, there is also a burgeoning interest in doing things naturally.

 

Copyright 2012 by Peter Borten. No reproduction allowed in any form without permission.