Narcotic pain medications
For severe episodes of low back pain, narcotic pain
medications may be prescribed. Clearly, narcotic agents
are strong and potentially addictive forms of medication
and should only be administered by a physician.
All narcotic agents have a dissociative effect that
helps patients manage pain. It does not actually deaden
the pain, but works to dissociate patients from the
pain. Commonly used narcotics, listed in ascending order
of potency (strength) include:
-
codeine (e.g. Tylenol #3)
-
propoxyphene (e.g. Darvocet)
-
hydrocodone (e.g. Vicodin)
-
oxycodone (e.g. Percocet, Oxycontin)
In general, narcotic medications can be highly effective
in treating back pain for short periods of time (less
than two weeks). After the initial two weeks, the body
rapidly builds a natural tolerance to narcotic medications
and they lose their effectiveness. While some physicians
believe that narcotics can be used long-term at low
doses to treat chronic pain, narcotics are most commonly
used to treat severe acute (short-term) low back pain
or post-operative pain.
Narcotic agents have several major side effects and
potential risks, such as:
-
Impairment of mental function and drowsiness.
Patients taking a narcotic should avoid driving or
operating heavy machinery.
-
Significant constipation. Patients taking
narcotics should take care to include extra fiber
in their diet, and possibly use laxatives, to avoid
constipation.
-
Addiction. Addiction to narcotics is a possible,
but unlikely, event.
-
Drug interaction with acetaminophen. Most
narcotic agents have acetaminophen in them and should
not be taken with additional acetaminophen. Patients
should not take more than the recommended dosage (usually
two every four hours as needed for pain) since this
can lead to dangerous levels of acetaminophen.
In addition to pills, narcotic agents may be taken
in slow release form through a patch (e.g. Duragesic).
Duragesic releases the medication fenatnyl through a
transdermal patch over a 72-hour period. Because it
is slow release it has lower abuse potential and outright
addiction is rare, however it still has the potential
for physical dependence and tolerance. It has all the
potential side effects of any Schedule 2 narcotic (like
morpine), such as altered cognigition and respiratory
depression. Care should be taken not to take too many
other narcotic agents (e.g. short acting pills such
as Vicodin) because of the potential of narcotics overdose.
Duragesic is indicated for use of the treatment of severe
pain, especially in patients with malignant cancer.
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