People in pain have difficulty getting relief


Doctors are dismayed by the opioid epidemic sweeping the nation. Over the past year, the drumbeat of headlines about opioid overdoses and deaths has scared a lot of physicians into cutting back on prescribing drugs such as hydrocodone and oxycodone.

Unfortunately, that means many people who are still in pain have been left without relief. Consequently, physicians are searching for other drugs they can prescribe instead of narcotics. They may settle on tramadol (ConZip, Ultram) or the gabapentinoids (gabapentin and pregabalin).

Gabapentin (Neurontin) and pregabalin (Lyrica) both are used to treat nerve pain. Doctors prescribed these medications three times more often in 2015 than they did in 2002, despite no radical change in the number of patients with neuropathic pain (JAMA Internal Medicine, online, Jan. 2, 2018). The author advises his colleagues to use these drugs cautiously “given the lack of proven long-term efficacy and the known and unknown risks of gabapentinoid use.”

Gabapentin can cause depression, dizziness, fatigue, drowsiness, digestive-tract upset, trouble with balance, cognitive difficulties and visual problems. The official prescribing information warns: “Antiepileptic drugs [AEDs], including gabapentin, increase the risk of suicidal thoughts or behavior in patients taking these drugs for any indication. Patients treated with any AED for any indication should be monitored for the emergence or worsening of depression, suicidal thoughts or behavior and/or any unusual changes in mood or behavior.”

Pregabalin also can cause adverse reactions. They include dizziness, unsteadiness, fatigue, dry mouth, edema, blurred vision, cognitive difficulties, depression and possibly suicidal thoughts, among other problems.

The other popular substitute for opioid pain relievers is tramadol. It initially was presented to doctors as a nonnarcotic all-purpose pain reliever. But this medication can cause quite serious side effects and has potentially deadly interactions. Not only that, but it triggers nasty symptoms if people stop taking it abruptly.

What are tramadol’s side effects? Many people experience vertigo, unsteadiness, dizziness or trouble with coordination. Itching, dry mouth, digestive upset and headache also are common. Tramadol also can cause seizures, life-threatening allergic reactions, serious skin reactions and serotonin syndrome.

While many patients can benefit from tramadol or one of the gabapentinoids, experts suspect that the push to move away from narcotics is leading doctors to overprescribe these alternatives. Unfortunately, there aren’t many other drug options for managing severe, chronic pain.

NSAIDs (nonsteroidal anti-inflammatory drugs) such as celecoxib, diclofenac, ibuprofen, meloxicam and naproxen are not that effective against chronic pain. They also carry a number of serious side effects including bleeding ulcers, irregular heart rhythms, heart attacks and strokes.

Some pain patients tell us that the only way they can function is with an opioid such as hydrocodone. But scary headlines and regulations have made it very difficult for health professionals to prescribe such medicines. If there is one message to researchers, drug companies and clinicians, it is that we desperately need better and safer alternatives for controlling severe, chronic pain.

2018 King Features Syndicate Inc.

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