The Dangers of Mixing Pain Medication

September 12, 2016 / Thomas Cohn, MD

The Food and Drug Administration came out with a new warning this week, stating that mixing drugs that are opioids and either benzodiazepines or barbituates (anti-anxiety) can be especially dangerous and may result in coma or death. The recognition of the dangers of mixing these two classes of drugs is becoming increasingly evident. Both types of drugs – opioids and anti-anxiety drugs – have addictive natures. The use of these drugs is additive, and both can suppress the respiratory drive. When used together, one could easily “pass out” and stop breathing.

The FDA is ordering that some 400 products now carry a “black box warning.” This is one of the most severe categories of risk, indicating that these products have serious health risks and are potentially fatal. The products of concern are anxiety medications such as Valium (diazepam), Ativan (lorezepam), Xanax (alprazolam), Klonipin (clonazepam), Restoril (temazepam), Soma (carisoprodol), and phenobarbital. All these drugs make one relax and often fall asleep. Drugs in this class are also used as part of anesthesia to control anxiety during procedures. All these medications can decrease the ability to breathe. However, in a medical setting, they can be reversed with an IV medication flumazenil, but they can not be easily reversed often when taken orally or outside of medical settings. These are the same type of medications that are part of the cocktail used for putting a person to death with drugs for the death penalty.

Why Mixing Medications Is Dangerous

Opioid addiction and abuse has been a major problem, becoming worse over the last ten years. Death rates have skyrocketed and now are about 30,000 people each year in the US, putting it in the same range as the number of people killed in motor vehicle accidents. A person can die just from overdosing on an opioid. The illegal use of narcotics makes death especially easy since the dose of drug is often uncontrolled. Prince died due to such an illegal mixture of oxycodone and fentanyl. The only good thing is that the drug naloxone (Narcan) can reverse most opioids rapidly and prevent death. Examination of those dying from opioid overdoses has found a disturbing trend that many of those people have had both opioids and benzodiazepines in their bodies. Furthermore, just giving naloxone may not rescue an overdose victim.

Patients with chronic pain are often dependent on medications to control symptoms. When pain is not well managed, and there is no successful treatment, many doctors resort to the use of opioid medications. For select patients, these drugs may be very helpful to manage symptoms. With chronic pain, the brain also tends to show changes, and the central receptors for painful sensations become overly active. These regions in the brain are right next to the same regions responsible for depression and anxiety. Patients with chronic pain often develop depression and anxiety, possibly related to the fact that the centers in the brain involved in pain and anxiety are next to each other. Treating chronic pain patients who have anxiety with both opioids and benzodiazepines now has become especially dangerous, and potentially fatal.

The bottom line for chronic pain patients is that if you have pain and anxiety, do not mix opioids and anxiety medications. If as a patient, opioids are felt to be necessary, try to find an alternative treatment. Long-term management with opioids for pain is often unsuccessful, and using other options may be more beneficial. Anxiety is a form of depression. If you also have pain, do not use an anxiety drug. Instead, work with a professional to treat the symptoms and the depression. There are many anti-depressant medications that may help along with working with a psychology management team.

The mixing of medications when one has pain can be highly dangerous. A good pain provider will want to know all the medications a patient is taking such that they can reduce the risks of serious interactions.

Pain Doctors Looking To The Painless For Possible Solutions

June 22, 2015 / Thomas Cohn, MD

If you’re a James Bond fan, you may remember the 1999 film, The World is Not Enough. The movie’s villain is a Russian terrorist named Renard who suffers from a rather unique condition. During an encounter with British agent 009, Renard gets shot in the head. However, like most bad guys in the movies, the oft-would-be kill shot doesn’t end up being a fatal blow. Renard’s doctor saves his life, but he is unable to remove the bullet, as doing so would kill the man. Eventually, the bullet will claim Renard’s life, but until that time, its presence in his medala oblong gata renders him almost senseless, dulling his ability to smell, taste and even feel pain.

Although the events leading up to Renard’s condition are unique, the inability to feel pain is not. Many people are unable to sense pain, which may sound appealing, but it can actually be very dangerous. After all, pain is one of the quickest ways our body tells us that something is wrong.

Inability to Feel Pain

The inability to feel pain is known in the medical community as congential insensitivity to pain. It is part of a larger set of disorders known as hereditary sensory and autonomic neuropathy.

As we mentioned above, it may sound cool to feel “invincible,” but it can leave you open to injury. For example, let’s say you have the condition and you set your hand on a hot stove. You’ll still suffer the burns, but you won’t realize you’re being burned. See how this could be an issue?

Interestingly, it’s the pain-free that the pain community are turning to to address the problem of chronic pain. Researchers at Cambridge University have recently pinpointed the exact gene responsible for the pain-free condition, and they’re trying to replicate its expression to help find new pain management avenues.

According to researchers, knowing the underlying mechanisms of pain sensations are critical to controlling and reducing pain, especially because some current methods are ineffective or addictive.

“We are very hopeful that this new gene could be an excellent candidate for drug development, particularly given recent successes with drugs targeting chromatin regulators in human disease,” said Dr. Ya-Chun Chen, the study’s first author.

Obviously the treatment strategy is in the beginning stages, but it’s encouraging for the future of pain management. The key here will be to find a delicate balance between helping people achieve chronic pain relief without dulling the senses so much that the individual is in danger.

Related Source: Medical Daily

Do Pain Medications Cause Kidney Stones?

February 5, 2014June 24, 2014 / Thomas Cohn, MD

Kidney stones are tiny pieces of mineral or salt in the urine that are incredibly painful when passed. Pain meds are often used to ease discomfort during stone passage. But can these pain medications also cause kidney stones?

What are Kidney Stones?

Kidney stones are considered one of the most painful acute conditions. They are caused by a variety of things such as:

How the body metabolizes various compounds (calcium, for example).
Not drinking enough water
Other medical conditions like gout
Genetic predisposition

As stones are passed from the kidney through the ureters to the bladder, they can be extremely painful. Stones are often as small as a grain of sand. As they are passed from the kidney they irritate the structures on the way out of the body.

Identifying & Preventing Kidney Stones

Stones are often suspected when there is blood in the urine without any additional signs of infection. In most cases, once you have a kidney stone you have no choice but to pass it. The only thing you can do is take pain meds to manage the pain during passage. In more severe cases, surgical procedure may be necessary to remove the stone. Analysis of the stone after it is passed can determine a prevention strategy moving forward.

Pain Medications & Kidney Stones

Pain medications are often used to control the extreme pain caused during the passage of a kidney stone. It is common that people when passing a stone have such severe pain that they go to a hospital. Powerful opioid and narcotic medications are useful to control the severe discomfort.

Pain medications themselves have not been known to cause kidney stones. They have been used as an essential tool in the treatment of acute passing of stones. Treatment is usually only necessary for a few hours to several days with opioid medications. In rare cases with people who have recurrent stones, frequent use of opioid medication on a temporary basis is necessary. This should only be a temporary solution until a renal specialist can develop a more definitive management strategy.

How do Pain Medications Impact your Dreams?

January 21, 2014June 24, 2014 / Thomas Cohn, MD

Many medications used in pain management have been known to cause weird dreams. Medications that tend to have some effect on the brain can also have an effect on sleep and dreams.

Antidepressants & Muscle Relaxers

The most common medications that impact dreams and sleep are probably antidepressant drugs, followed by muscle relaxers. These medications have direct actions on the brain and nervous system, and change the balance of brain chemicals that can lead to very odd cognition and disturbing dreams.

The older tricyclic antidepressants have a positive effect on pain but have had a significant reputation for bad dreams. Newer antidepressants impact the neurotransmitter chemical balance in the brain, and can make emotions, depression, and sleep worse if they are not the right medication for the individual. Muscle relaxers are compounds that have similar structures to drugs used for anxiety. They can cloud thinking and negatively impact sleep.

Neuropathic Medications

Neuropathic medications are drugs often used to treat pain. These drugs include many different classes of chemical and all directly affect the central nervous system and the brain in a variety of different ways. For most people, if prescribed with a degree of caution these drugs can be highly effective for pain. However, as with any medication that acts on the brain, the side effects can include an alteration of cognition and weird dreams.

At this time, it is very difficult to know if a drug will cause bad dreams without trying it. If you have had a problem with a medication, similar drugs may cause the same type of problem and should be monitored closely. Sudden or rapid changes in drug levels can cause some of the problems tolerating certain medications. Often, if a new drug is started at the lowest available dose, and slowly increased, side effects can be minimized. It is also equally important to not suddenly stop these drugs to prevent side effects. Working with an experienced physician with regards to medications is always advisable. If a problem does occur, ask the prescribing physician to check if there are medications interacting with each other and causing problems.

Pain Medication Tolerance vs. Addiction

January 8, 2014June 24, 2014 / Thomas Cohn, MD

Pain medications such as opioids and narcotics can be very helpful at relieving and managing pain. However, if these pain drugs are used in excess they can lead to tolerance and addiction. This article will investigate the similarities and differences of drug tolerance and addiction. Are they the same? Does one lead to the other? Read on to learn more.

Pain Medication Tolerance

Drug tolerance is a state that occurs when a medication dose ceases to be effective for a person who previously found the same dose to have a therapeutic effect. A higher dose is then required to achieve the same previous effect. Tolerance is a common phenomenon with many medications, especially opioids and narcotics.

Enzymes that metabolize a drug become more active over time as the presence of a drug becomes routine. These enzymes clear the drug out of the body faster and, as a result, it takes more of the drug to achieve the same previous therapeutic level.

Addiction to Pain Meds

Addiction to a drug is a physical and psychological state in which a person has a loss of control in their behavior and is unable to limit the intake of a drug despite negative consequences. In addiction, the drug provides a positive, pleasurable reward to the brain. An addict will seek out the drug even if it is ruining their health or involves illegal activity.

Addiction is a disease of the brain. It occurs with many drugs that stimulate the dopamine reward centers and is also seen with opioid medications and alcohol.

Dependence is usually coupled with addiction. When a person is dependent on a drug, they can function normally with the medication in their system, but experience a physical disturbance when the drug is removed. Opioid withdrawal can cause:

Nausea
Vomiting
Diarrhea

Dependence occurs with many medications, which is why many drugs have warnings not to suddenly stop taking the medication.

The Difference Between Tolerance & Addiction

The difference between tolerance and addiction is the psychological desire for the medication that occurs with addiction. Many drugs can develop tolerance effects. Sometimes changing the medication to a slightly different drug that is similar or changing the dose can overcome this issue.

Addiction is an abnormal craving for the drug since it gives the person some sort of psychological pleasure, and that the person will do anything to get the drug despite the consequences. Those who are tolerant (and not addicted) can be withdrawn from the drug and do not crave it once it is no longer available.

Tolerance to a medication does not equate to addiction. However, a person who is tolerant to a medication can also have addiction problems to the same medication. If you have questions, you should talk directly with your physician and be evaluated.