Prevention of Neuropathy with Pain Medicines
Pain medicines used for neuropathy are powerful and each has a risk-vs-benefit profile that is individualized for each patient. There are many pitfalls that can emerge in using them, and prevention of the ill-effects of pain medication is just as much a part of therapy as the beneficial effects of the pain relief they provide.
Pitfalls in Using Pain Medication
Monotherapy (one medication at a time) simply presents concern for side effects and dosing. When multiple medications are used, the drug-drug interaction between/among them can prove fatal if not monitored very closely. There is value to what is called rational polypharmacology, tweaking several medication dosages and combinations of them to get a “designer” effect for an individual patient; such personalized protocols develop over time as the physician and patient sort out the benefits vs. the side effects.
Preventing the Pitfalls in Using Pain Medication
- Any sedating drugs will be potentiated by narcotics, including the antidepressants and anticonvulsants used for neuropathic pain. Mixing a narcotic with alprazolam, for example, can be fatal if not supervised scrupulously. This particular combination is especially noteworthy due to the fact that both the narcotic and the short-acting alprazolam are very addictive. In patients in which this poses danger, a longer-acting anxiety benzodiazepine should be used, because the rapid-acting ones give the brain a surge of the neurotransmitter dopamine which increases its addictive properties.
- Methadone causes cardiac rhythm disturbances, so chronic use requires intermittent ECGs to monitor heart rate and rhythm.
- The acetaminophen in combination with an opioid augments the pain relief of both, which is a benefit purposely designed in these drugs. Oxycodone/acetaminophen, hydrocodone/acetaminophen, and other combinations require arithmetic to ensure the acetaminophen total per day does not exceed 2,000 mg, which can cause liver toxicity.
- Switching a patient from one narcotic to another must take into account the potency equivalence of each so that under-treatment or overdose won’t occur.
- Rather than taking many short-acting opioids on a chronic basis, a longer-acting one is safer in regards to addiction. As with the benzodiazepines, shorter-acting opioids give a “rush” due to a spike in dopamine, which can provoke addiction in predisposed individuals. The short-acting opioids, with chronic use, should be reserved for “breakthrough” pain that occasionally occur with long-term opioid maintenance.
- It makes no sense to use two short-acting opioids. It only increases the addictive potential. If one opioid is needed for maintenance and another for breakthrough pain, it should be a regimen of long-acting with short-acting, respectively.
- Drug screens are seen as obtrusive. Even insulting to patients but they are necessary to prevent the dangerous behaviors that they readily identify. It is not for law enforcement, but for patient safety and well-being.