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Chronic Pain

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Part 1 – Introduction and background

This article is to help you become aware of what you need to know about your medications and how you can access all necessary information about the drug you have been prescribed

People have always looked for cures and experimented with substances that promote healing. Written reports on Sumarian clay tablets from about 5000 years ago tell us how they used herbs for cures, as did the ancient Aegyptians, and the Chinese still use some of the herb recipes the Red Emperor had compiled into a textbook about 5000 years ago.

Ancient cultures, and up to fairly recent times, also used concoctions that make our hairs rise, containing animal parts and fats, grated bones and metals, ochre, spiders webs, roots, barks and seeds.

We may find this amusing, horrifying or rubbish it. But the humbling point about it is that modern research has found that many of these strange applications actually contain chemicals that were beneficial to the healing process they were aimed at.

For example:

• cabbage leaves and spiders webs used for wound healing do contain an antibiotic-like substance

• animal livers used for night blindness contain vitamin A

• pomegranate roots used to eliminate roundworms are a potent vermifuge

• poppy seeds or the juice made out of, were used for pain relief and are still a strong analgesic, opium, now used as a purified alkaloidal extract we call morphine

This tells us a little about how medications and their applications developed over time and how many modern drugs have their pre-cursers in ancient healing practices.

Until the middle of the last century drugs were made of plant extracts to be used in exact dosages. Today many drugs are synthetic compounds that mimic the original effects of plants. An example would be Digitalis used for a particular heart malfunction. Until the 1970s the small plant with pale blue flowers was harvested and processed into tablets but is now synthetically produced.

The development and changes in medications continues at a faster rate than ever. New drugs flood the market and sometimes research on current drugs in circulation shows that they have unforeseen and undesired long term side effects, or prove effective for unexpected purposes or need to be taken off the market altogether. For example most people would know of Valium as a psychotherapeutic drug, but it is also used as a muscle relaxant after injury.

This means when you are on a particular medication it is important to understand the exact purpose you are prescribed the drug.

The continued research into drugs and rapid changes in application and combinations make information about medications a tricky subject. Information about individual drugs could easily be obsolete even as you are reading this.

There are basic principles that apply for safe drug administration.

Medical assessments and advice on medications is always left to medical professionals.

 Part 2 - Principles

Knowing what the medication is for. You may have several prescribed medicines. It is therefore important to be aware of the purpose of each medication in order to observe its effect. It is best to clarify what each medicine's purpose is at the time it is prescribed.

What side effects it may have
All medications have several effects beside the desired one. It is important to know what the side effects may be. Furthermore, not all people react the same way to the same medication. Even if side effects seem mild, the prescriber needs to be informed to decide whether you can safely continue with the medication or whether the dosage or the medicine needs to change

At what time medication has to be taken and why it is important to take it at the correct time
The time of day or night medication needs to be taken is important eg vitamins are energizing so you need to be taken in the morning; sedating medication in the evening. Some medicines need to be swallowed BEFORE meals, others WITH food or AFTER a meal to be most effective because of the way the chemicals react to food
Some medications require specific foods to be avoided for as long as you have to be taken, the most commonly known being antibiotics and alcohol

What to do if a medication is taken at a wrong time, or if a dosage has been missed
Most medications have an information sheet that includes what to do if a medicine has been taken at the wrong time or a dose has been missed. It is not the same for all medicines. If there is no information, a pharmacist or the prescriber will be able to advise
This may be very important because of the speed at which a swallowed medicine is absorbed

Does the medicine have to be swallowed whole or can tablets be broken up
This is usually advised on the package. It is important to adhere to the advice as it has to do with the absorption and uptake of the chemical into the blood stream and a constant level of medicine. If a tablet or a capsule, meant to be swallowed whole, is broken up or pulverised, it creates an overdose in the stomach and a constant level of medicine in the blood cannot be maintained. This may also create stomach problems and decreases the desired effect
Problems with swallowing tablets or capsules may be solved by administering the medication in fluid form, patches or injections

What to do if the prescribed dosage differs from the recommended dosage information in the medication packet
It is advisable to ALWAYS check and query this with the prescriber. It can be an oversight or there may be a valid reason for it, such as other drugs taken at the same time

What to do if the wrong dosage has been taken
It will depend on the medication and may be very important. The prescriber or a pharmacist should be asked for advice immediately. For some medication the effect could be severe and the person who took the wrong dosage best stay put until advised

How to safeguard taking the correct dosage at the correct time
There are different ways to safeguard correct dosage and correct time eg
• A time + dosage table stuck to the fridge door
• Count out each medicine for the day into different and labelled containers
• Buy a medicine dispenser box

Medication affecting clear thinking after reducing or increasing medication doses
Always follow instructions on the medication packet. Don’t drive or operate machinery if it advises. It may not be noticeable to you that your mind has slowed down

Reducing or increasing medication doses
A prescribed medication dosage must be followed.
Reduce or increase medication dosages ONLY after discussion and with agreement of the prescriber. This should be in writing

Why the prescribing doctor needs to be informed about over-the-counter or herbal medicines taken at the same time, including vitamins and vitamin complexes
Originally all medicines were made from herbs. Today most are synthetically mimicking their effects. By taking herbal medicines without discussion with the medical prescriber, a person may double dose or take a herbal medicine that is counteractive. A counteractive example would be a person taking medication to control high blood pressure and taking a herbal medicine containing ginseng

What to do if you run out of prescribed medication
This is a question of organisation eg
• Purchase the next lot while there are still some left
• If there are for example 30 tabs in a bottle or packet, write a note for the next purchase and stick it on the fridge door
• Note it on the calendar or in the diary
• If you are travelling, take contact details of your prescribing doctor with you

Does a course of medicine have to be finished
Unless the prescriber instructs differently the answer is YES
eg antibiotics need the full prescribed course in order to not just eliminate the symptoms but also destroy the hearth of the infection

Expiry dates
No medicine should be taken beyond its expiry date. Some chemicals change after the expiry date and the medicine becomes ineffective or causes adverse reactions

Every person has the right and the responsibility to request information from the prescriber regarding dosage or medication changes if the prescribed medication is not effective
If the prescriber does not offer information on a new medication it may be helpful for both parties to write questions down to be answered over the phone rather than wait for the next visit
Better still, write down a set of questions like the above 1 – 14 and take them to visits to the doctor in case new medicines are prescribed

Stigma
This may occur when people are on central nervous system dampening medication like painkillers or psychotropics (mood affecting drugs).
Being open and informative to family and close others is a start.
Where schoolchildren are involved, as the medicated person or of a family member on medication, informing/educating the teacher to create awareness and understanding may help
If schoolchildren are being bullied by classmates because you or their parents are on medication, teachers can be asked to address the issue with an educative class talk
The same goes for work bosses and colleagues. Well informed people are more likely to be understanding

Some useful resources

• Medicines Line 9am – 6pm EST Mon – Fri - Local call cost 1300 888 763 www.nps.org.au/consumers
• Medicines Talk – newsletter for consumer information and hints on managing medicines www.nps.org.au
• NSW Health – NSW Therapeutic Assessment Group www.ciap.health.nsw.gov.au/nswtag
• National Prescribing Service www.nps.org.au

• Poisons Information is available 24 hours a day 7 days a week throughout Australia on 13 11 26

Chronic Pain Australia

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-Chronic Pain Australia

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