ACPA Resource Guide 2014 FINAL

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  ACPA Resource Guide To Chronic Pain Medication & Treatment 2014 Edition American Chronic Pain Association P.O. Box 850 Rocklin, CA 95677 Tel 800-533-3231 Fax 916-632-3208 E-mail ACPA@theacpa.org  Web Site http://www.theacpa.org  Copyright 2014 American Chronic Pain Association, Inc.  All rights reserved. No portion of this book may be reproduced without permission of the  American Chronic Pain Association, Inc.    2 American Chronic Pain Association Copyright 2014 Table of Contents I NTRODUCTION &   A DVICE FROM THE ACPA  ............................................................................................................. 6   P AIN T REATMENT O VERVIEW ...................................................................................................................................... 8   P AIN T YPES &   C HRONIC P AIN C LASSIFICATION  ......................................................................................................... 8   P AIN IN C HILDREN  ...................................................................................................................................................... 9   P AIN IN O LDER P ERSONS  ............................................................................................................................................ 9   C LINICAL T RIALS  ..................................................................................................................................................... 10   M EDICATIONS I N G ENERAL  ....................................................................................................................................... 11   M EDICATIONS AND C HRONIC P AIN  .......................................................................................................................... 11   H OW M EDICATIONS C AN H ELP &   H ARM  ................................................................................................................. 12   I F M EDICATIONS A RE NOT W ORKING  ....................................................................................................................... 14   D ETOXIFICATION AND W EANING O FF OF O PIOID M EDICATIONS  .............................................................................. 15   W ARNING A BOUT I  NTERNET M EDICATION P URCHASES  ........................................................................................... 18   M EDICATION P ICTURES  ............................................................................................................................................ 19   M EDICATION S IDE E FFECTS ,   D RUG A LLERGIES ,   &   D RUG I  NTERACTIONS  ................................................................ 19   O FF -L ABEL M EDICATION U SE  .................................................................................................................................. 21   C LASSES OF M EDICATIONS FOR THE TREATMENT OF P AIN  ...................................................................................... 23   N ON -P RESCRIPTION P AIN R  ELIEVERS  ....................................................................................................................... 24   O VER  -T HE -C OUNTER (OTC)   P AIN R  ELIEVERS  ........................................................................................................ 24   A CETAMINOPHEN S PECIAL C OMMENTS  .................................................................................................................... 27   H ERBAL M EDICINES ,   S UPPLEMENTS ,   &   V ITAMINS  ................................................................................................... 30   T OBACCO ,   A LCOHOL ,   M ARIJUANA ,  AND I LLICIT SUBSTANCES  ................................................................................. 33   N ON -O PIOID P AIN R  ELIEVERS  ................................................................................................................................... 38    N ON -O PIOID P AIN R  ELIEVERS (  NON -  NARCOTIC ) ...................................................................................................... 38   G ASTROINTESTINAL (GI)   P ROTECTIVE M EDICATIONS  .............................................................................................. 40    N ON -O PIOID A  NALGESIC D RUGS &   T HEIR U SES  ...................................................................................................... 42   O PIOID (N ARCOTIC )   P AIN R  ELIEVERS AND THEIR S AFE U SE  ................................................................................... 44   O PIOID A  NALGESIC P AIN R  ELIEVERS  ....................................................................................................................... 44   W HAT ARE O PIOIDS ? ................................................................................................................................................ 46   O PIOID D ELIVERY  .................................................................................................................................................... 47   S HORT - ACTING AND L ONG - ACTING O PIOID A GONISTS  ............................................................................................. 47   ALERT:  PROPOXYPHENE (D ARVON ®,   D ARVOCET ®)    –    D ISCONTINUED FOR S ALE IN THE USA .............................. 53   G ENERAL O PIOID A DVERSE S IDE E FFECTS  ............................................................................................................... 54   D EFINITION OF T ERMS REGARDING O PIOIDS  ............................................................................................................ 57   T HE E VIDENCE FOR O PIOID U SE  ............................................................................................................................... 61   K  EY S TEPS T O U SE O PIOIDS S AFELY  ....................................................................................................................... 62   O PIOIDS &  THE G OALS OF P AIN M ANAGEMENT  ....................................................................................................... 63   M ONITORING Y OUR M EDICATION U SE ..................................................................................................................... 64   O PIOID T REATMENT A GREEMENT  ............................................................................................................................ 65   U RINE D RUG T ESTING (UDT)   /   U RINE D RUG S CREENING (UDS)............................................................................. 66   O THER M EDICATIONS THAT CAN A FFECT P AIN  ........................................................................................................ 67   A  NTIDEPRESSANTS  ................................................................................................................................................... 67   A LERT :   M IXING A  NTI - MIGRAINE A GENTS &   C ERTAIN A  NTIDEPRESSANTS  .............................................................. 73   A  NTICONVULSANT (A  NTIEPILEPTIC )   D RUGS  ............................................................................................................ 75   S ODIUM C HANNEL B LOCKING &   O RAL A  NTI -A RRHYTHMIC A GENTS  ...................................................................... 77   T OPICAL P AIN R  ELIEVERS  ........................................................................................................................................ 78   C OMPOUNDED M EDICATIONS  ................................................................................................................................... 81   S EDATIVES AND A  NTI -A  NXIETY M EDICATIONS  ....................................................................................................... 83    3 American Chronic Pain Association Copyright 2014 M USCLE R  ELAXANTS  ............................................................................................................................................... 85   A  NTI -P SYCHOTIC M EDICATIONS  .............................................................................................................................. 86   A  NTI -H YPERTENSIVE M EDICATIONS  ........................................................................................................................ 86   B OTULINUM T OXINS ................................................................................................................................................. 87    NMDA   I  NHIBITORS  .................................................................................................................................................. 89   A DRENERGIC D RUGS ,   B ISPHOSPHONATES ,   T HALIDOMIDE ,   &   C ALCITONIN  .............................................................. 90   A CTIVATING M EDICATIONS ( CENTRAL NERVOUS SYSTEM S TIMULANTS ) ................................................................. 92   M IGRAINE H EADACHE T REATMENT  ......................................................................................................................... 94   I  NTRA -A RTICULAR S TEROID I  NJECTIONS  ................................................................................................................. 96   V ISCOSUPPLEMENTATION  ......................................................................................................................................... 96   S PINAL C ORD S TIMULATION (SCS) .......................................................................................................................... 96   I MPLANTED T ARGETED I  NTRATHECAL D RUG D ELIVERY S YSTEMS (P AIN P UMPS ) ................................................... 99   E PIDURALS ,    N ERVE &   F ACET B LOCKS ,   &   R  ADIOFREQUENCY A BLATION (R  HIZOTOMY ) ....................................... 102   C OMPLEMENTARY AND A LTERNATIVE M EDICINE (CAM)  ..................................................................................... 104   P ASSIVE T HERAPIES &   P HYSICAL M ODALITIES  ..................................................................................................... 105   H YPERBARIC O XYGEN ............................................................................................................................................ 105   A CUPUNCTURE  ....................................................................................................................................................... 105   M ANIPULATION &   M OBILIZATION  ......................................................................................................................... 106   E LECTRICAL S TIMULATION D EVICES ( EXTERNAL ) ................................................................................................. 106   T RIGGER P OINT I  NJECTIONS  ................................................................................................................................... 107   A CTIVE I NTERVENTIONS -   M ONOTHERAPIES  .......................................................................................................... 108   E DUCATION  ............................................................................................................................................................ 108   E XERCISE (A CTIVE T HERAPY ) ................................................................................................................................ 108   T AI C HI  .................................................................................................................................................................. 109   Y OGA  ..................................................................................................................................................................... 109   G RADED M OTOR I MAGERY  .................................................................................................................................... 110   P SYCHOLOGICAL &   B EHAVIORAL A PPROACHES  .................................................................................................... 112   M IND -B ODY I  NTERVENTIONS  ................................................................................................................................. 114   A CTIVE I NTERVENTIONS -   I NTERDISCIPLINARY ....................................................................................................... 116   F UNCTIONAL R  ESTORATION P ROGRAMS &   A PPROACHES  ...................................................................................... 116   F INAL C OMMENTS  .................................................................................................................................................... 118   R  EFERENCES :   L INKS T O C HRONIC P AIN S ITES &   R  ESOURCES  .............................................................................. 119    4 American Chronic Pain Association Copyright 2014 Authors, Contributors & Reviewers Written, reviewed & updated yearly by Senior Author Steven Feinberg, M.D., M.P.H., with Co- authors Michael Leong, M.D., Jennifer Christian, M.D., M.P.H., Chris Pasero, M.S., R.N.-B.C., F.A.A.N., April Fong, Pharm.D., and Rachel Feinberg, D.P.T, P.T. Steven Feinberg, M.D., M.P.H., ( http://www.FeinbergMedicalGroup.com ) is a practicing pain medicine physician in  Palo Alto, California, and is an Adjunct Clinical Professor at Stanford University School of Medicine. He is a former  Board member and Past President of the American Academy of Pain Medicine. He is a member of the ACPA Board of Directors. He served as an Associate Editor of the American College of Occupational and Environmental Medicine (ACOEM) Chronic Pain Guidelines 2008 Chapter update and is a Medical Advisor to the Occupational Disability Guidelines (ODG).  Michael Leong, M.D., Ph.D., ( http://med.stanford.edu/profiles/Michael_Leong/  ) is a Stanford School of Medicine Clinical Associate Professor in the Department of Anesthesia and Clinic Chief of the Stanford Pain Management Center. He has worked in academic medicine, private practice with a clinical research center and been a medical director at several pharmaceutical companies developing compounds and devices for pain relief. Dr. Leong is also a member of the American Academy of Pain Medicine (AAPM) and the International Association for the Study of Pain (IASP) and currently serving as a scientific committee member for the AAPM and other pain medicine organizations.  Jennifer Christian, M.D., M.P.H., is board certified in occupational medicine with specialization in work disability  prevention and management. She chairs the Work Fitness & Disability Section of the American College of Occupational & Environmental Medicine. She is President of Webility Corporation, a training and consulting company ( www.Webility.md  ). Webility offers Maze-Masters, a structured, guided, non-medical self-help service delivered by phone and over the Internet to develop and  strengthen the individual’s ability to cope with their medical conditions and improve the quality of their everyday lives. Chris Pasero, M.S., R.N.-B.C., F.A.A.N., is a pain management educator and clinical consultant from El Dorado Hills, California. She is the co-founder and past president of the American Society for Pain Management Nursing.  April Fong, Pharm.D., is an ICU pharmacist at Stanford Hospital & Clinics.  Rachel Feinberg, DPT, PT, is Chief Physical Therapist and Director of the Feinberg Medical Group Functional  Restoration Program in Palo Alto, California.  Donna Kalauokalani, M.D., M.P.H., (  http://www.folsompainmanagement.com/  ) is an educator, consultant and  practicing pain medicine physician in Folsom, California. She is President of the ACPA Board of Directors.  Mel Pohl, MD, FASAM is a Board Certified Family Practitioner. He is the Medical Director of Las Vegas Recovery Center (LVRC). Dr. Pohl was a major force in developing LVRC’s Chronic Pain Recovery Program. He is certified by the American Board of Addiction Medicine (ABAM) He is the author of A Day without Pain, revised edition (Central Recovery Press, 2011).
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