The Latin word ‘medicatio’ means healing or cure.  But in most cases, pain medication does not heal.  At its best, it helps to reduce pain and relieve suffering, leading to improved function and greater well-being.  At its worst, it leads to harmful side-effects, reduced function, addiction and in the case of opioids to accidental overdose and suicide.  If you need medication for pain, you should use it wisely.

There is growing awareness of a huge social problem that faces Ontario.  This has been focused on the deadly risks of opioids and the widespread misuse and abuse of these drugs.  For some of the patients I treat, opioids are the only drugs that provide relief from pain.  I prescribe them carefully, following guidelines that were written by the best experts in the field.  Opioids are a hot topic, but these are not the only pain medications that can cause harm.  

  • Tricyclic antidepressants increase the risk of obesity, diabetes, heart attack and stroke.  
  • SSRI antidepressants have been linked to the same risks, and they also increase the risk of suicide in the first few weeks of their use.  
  • Sedatives can contribute to falls and dementia.  
  • Antipsychotics are linked to liver damage and cholesterol problems.  
  • Anti-inflammatories, perhaps the worst offenders, can cause heart disease, internal bleeding and kidney problems.
  • most drug classes can cause drowsiness, dizziness and problems with memory and concentration

If you have chronic pain, you have some level of discomfort all the time.  You also get flares of pain when you stress yourself or the affected area.  The need for medications is based on how much discomfort and pain you feel – at baseline and during a flare.

Medication is not the solution for your pain.  If it has not healed on its own, you need to do something about it.  You need to work on your breathing, your posture, your diet and your stress levels.  You also need therapy.  Some of it you can do on your own, like stretching, exercise, meditation or yoga.  Some of it you need to get from a provider, like massage, soft tissue treatment, manipulation and acupuncture.  

These are the solutions.  But you may also need medication to help you get through it all.  If you just can’t take the pain, you may need something to turn down the noise.  Not forever, but for now.  

So you should try different medications.  In most cases, you only need a week to know if a certain dose of a drug will help you.  Some drugs, like antidepressants, take up to 6 weeks to start working.  There are up to 20 different drugs you can try, and if you are feeling unable to cope, you can try all of them.  This may take up to a year, but for some it may be a worthwhile effort.

If a medication makes you feel much better, you can keep using it for the time being.  If you find that it stops working, or that you need higher doses to get the same benefit, there is a problem.  It should probably be stopped or changed.  Many of our patients come to us taking 50 pills a day and feel little relief.  We can usually get them onto a regimen that does more with less.  

In many cases, we can discontinue all medications.  This is usually done all at once, with daily ear acupuncture that hugely improves withdrawal symptoms.  In most cases, they end up with better memory, clearer thinking and more energy.  Their pain ends up being either the same or better.  

Pain medication can sometimes be life-changing, but you should think of them like crutches.  They can help you get around and help you get through the day, but they are not the cure.