Patient Education for Opiate Use
- No pain medication is guaranteed to make all of your pain go away. Sometimes partial improvement in pain is the best that can be done.
- The goals of pain management are to help you feel better and be able to lead a more active life. This usually takes more than medications, including regular stretching, core-muscle exercises, physical therapy, etc.
- When used to treat pain, opioid pain medications rarely cause addiction, which is an emotional need for medication. However, physical dependence or habituation may occur and your body may react physically if you stop taking these medications suddenly. Do not stop your medications on your own. Stopping the medications gradually is the only safe way to accomplish this. Please contact our office if you wish to stop your medication for any reason.
- As with any medication there can be side effects from opiates. These include:
- Sleepiness, confusion, difficulty thinking/concentrating
- Nausea, vomiting, constipation
- Difficulty breathing, shortness of breath, wheezing
- Rash, itching, allergic reactions
- Hormonal Imbalances (chronic opiate use can cause low testosterone)
- Potential for interaction with other medications
- Potential for dose escalation and tolerance (the need for higher doses of medication to achieve the same pain relieving effects)
- Potential for dependence (the body physically adjusts to the medications and they cannot be stopped without experiencing physical symptoms)
- Potential for withdrawal (stopping medications abruptly may cause nausea, vomiting, abdominal pain, sweating, aching, abnormal heartbeat, and other symptoms that can be life-threatening)
- Potential for addiction (compulsive drug use, not related to pain relief)
- Potential for impaired judgment and motor skills (ex. Driving is impaired)
- Some side effects (such as nausea and itching) can be managed. Some side effects (such as itching and drowsiness) will last only a few days. Constipation is one effect that does not go away, but can be managed with constipation prophylaxis. Please let us know if you are experiencing any side effects.
- Safety Tips:
- Never take a prescription painkiller unless it has been prescribed for you
- Do not take more than is prescribed without consulting the office
- Do not drink alcohol while taking opiates
- Do not drive while impaired
- Use of other sedative or anti-anxiety medication can be dangerous, please provide us with a full list of medications you take and keep it updated
- Always store your medications in a safe and secure location, preferably locked up. Do not tell anyone you are taking opiate medications. Do not carry your prescription bottle or all of your medication with you
- Do not share your prescriptions with friends or family, for any reason
- Always count your pills at the pharmacy, before you leave. After you walk away from the counter, they are no longer responsible for missing pills
- Always follow the pain treatment agreement
- Please let us know if you ever have any questions or concerns
Medications to Stop Before Injections
- Aspirin 81mg
- Aspirin 325mg
- Excedrin (Extra Strength, Migraine, Menstrual Complete, Back & Body
- NSAIDS (Advil, Aleve, Diclofenac, Etodolac, Ibuprofen, Motrin, Naprosyn, Naproxen, Vicoprofen, Voltaren)
- Plavix 75mg/300mg
In order to ensure the safety of our patients, we have created this checklist of important items to be reviewed before your injection. Please read carefully and let us know if you have any questions or concerns.
- Please let us know of any medical allergies you may have.
- You must have a driver for any procedures performed at the hospital. You will be rescheduled if you do not have a driver. This is a state law and unfortunately, no exceptions can be made.
- You will need to bring your photo ID, insurance card and medication list for your appointment. You do not need to bring your MRI/Xray films/discs.
- We ask that you do not eat for four hours prior to your procedure and you may take all regular medication unless instructed otherwise. Please contact the office if you have questions about the medications you are taking.
- You have the option of receiving IV sedation during the procedure. The nurses will start an IV and you will receive a combination of Versed and Fentanyl (unless an allergy or something else prevents the use of these medications).
- Expect to be at the hospital for 2½ to 3 hours. You are required to arrive one hour prior to your procedure time and you are required to stay one hour after the procedure to ensure your safety and well being. If you arrive late you may be rescheduled and if you leave before being dismissed by the medical staff, you will be ineligible for additional procedures.
- You will be given information regarding the procedure that is planned for you. If you experience symptoms in another area and would like to have a different procedure performed, please contact the office first. The procedure you are scheduled for is entered into your chart and pre-op paperwork/permit, if a change needs to be made, it must be done before your appointment time.
- If you have any questions regarding the procedure that is planned for you, please contact the office before your scheduled appointment. Appropriate time is scheduled for each patient at the hospital, however, consultation time is not available at the hospitals. We will be happy to answer any questions and make time in the office for further review. Your procedure may be rescheduled until all questions and concerns are addressed.
- If you get sick or have any type of active infection (including but not limited to: UTI, sinus infection, skin/wound infection, ear infections, etc.) we will have to reschedule your injection until you are well and the infection is cleared.
- You will be given a local anesthetic during the procedure, which may cause sensations and motor functions to be disrupted. We ask that you take precautions and have someone available to help you until this has worn off (usually within a few hours).
In the News
What You Knead to Know
Many people associate massage with vacations or spas and consider them something of a luxury. But research is beginning to suggest this ancient form of hands-on healing may be more than an indulgence—may help improve your health.
Massage therapists use their fingers, hands, forearms and elbows to manipulate the muscles and other soft tissues of the body. Variations in focus and technique lead to different types of massage, including Swedish, deep tissue and sports massage.
In Swedish massage, the focus is general and the therapist may use long strokes, kneading, deep circular movements, vibration and tapping. With a deep tissue massage, the focus is more targeted, as therapists work on specific areas of concern or pain. These areas may have muscle “knots” or places of tissue restriction.
Some common reasons for getting a massage are to relieve pain, heal sports injuries, reduce stress, relax, ease anxiety or depression, and aid general wellness. Unfortunately, scientific evidence on massage therapy is limited. Researchers are actively trying to understand exactly how massage works, how much is best, and how it might help with specific health conditions. Some positive benefits have been reported.
“Massage therapy has been noted to relax the nervous system by slowing heart rate and blood pressure. Stress and pain hormones are also decreased by massage, reducing pain and enhancing immune function,” says Dr. Tiffany Field, who heads a touch research institute at the University of Miami Medical School. Much of her NIH-funded research focuses on the importance of massage for pregnant women and infants. Some of her studies suggest that massage may improve weight gain and immune system function in preterm infants.
A study published earlier this year looked at how massage affects muscles at the molecular level. The findings suggest that kneading eases sore muscles after exercise by turning off genes associated with inflammation and turning on genes that help muscles heal.
A recent NIH-supported study found that an hour-long “dose” of Swedish massage therapy once a week was optimal for knee pain from osteoarthritis, especially when practical matters like time, labor and convenience were considered. Other research suggests that massage therapy is effective in reducing and managing chronic low-back pain, which affects millions of Americans.
If you’re considering massage therapy for a specific medical condition, talk with your health care provider. Never use massage to replace your regular medical care or as a reason to postpone seeing a health care professional.
Every therapist and every massage is unique. If you decide to try massage therapy, work with different therapists until you find one that meets your needs. One of the best ways to get a great massage is to communicate with your therapist. Most will check in with you during your session for feedback, but—if not—speak up!
Dealing with Chronic Pain
Halt the Hurt!
Dealing with Chronic Pain
Pain—it’s something we’ve all experienced. From our first skinned knee to the headaches, back pain and creaky joints as we age, pain is something we encounter many times. Most pain is acute and goes away quickly. But in some cases, when pain develops slowly or persists for months or even years, then it’s called chronic pain, and it can be tricky to treat.
Chronic pain is a huge problem. Over 115 million people nationwide—about 1 in 3 Americans—suffer from some kind of long-term pain. It’s the leading reason that people miss work.
NIH-funded scientists are working to better understand and treat chronic pain. They’re uncovering the intricate pathways that lead to long-term pain. And they’re looking for approaches beyond medication that might help you control your pain.
Chronic pain differs in many ways from acute pain. Acute pain is part of the body’s response to an injury or short-term illness. Acute pain can help prevent more serious injury. For instance, it can make you quickly pull your finger away from a hot stove or keep your weight off a broken ankle. The causes of acute pain can usually be diagnosed and treated, and the pain eventually ends.
But the causes of chronic pain aren’t always clear. “It’s a complex problem that involves more than just the physical aspects of where the hurt seems to be,” says Dr. John Killen, deputy director of NIH’s National Center for Complementary and Alternative Medicine. “There’s a lot of accumulating scientific evidence that chronic pain is partly a problem of how the brain processes pain.”
Chronic pain can come in many forms, and it accompanies several conditions including low-back pain, arthritis, cancer, migraine, fibromyalgia, endometriosis and inflammatory bowel disease. These persistent pains can severely limit your ability to move around and perform day-to-day tasks. Chronic pain can lead to depression and anxiety. It’s hard to look on the bright side when pain just won’t go away. Some experts say that chronic pain is a disease itself.
The complexities of chronic pain can make it difficult to treat. Many of today’s medications for chronic pain target inflammation. These drugs include aspirin, ibuprofen and COX-2 inhibitors. But if taken at high doses for a long time, these drugs can irritate your stomach and digestive system and possibly harm your kidneys. And they don’t work for everyone.
“With hard-to-treat pain, the opioids are also used, sometimes in combination with the other drugs,” says Dr. Raymond Dionne, who oversees some of NIH’s clinical pain research. Opioids include prescription painkillers such as codeine and morphine and brand-name drugs such as Vicodin, Oxycontin and Percocet. Opioids affect the processes by which the brain perceives pain. If used improperly, though, opioids can be addictive, and increasingly high doses may be needed to keep pain in check.
“As with all drugs, you have to find a balance between effectiveness and side effects,” says Dionne. He and other researchers have studied potential new pain medications to learn more about how they work in the body. But for the most part, pain medications are similar to those used 5 or more decades ago. That’s why some researchers are looking for approaches beyond medications.
“One thing we know is that currently available drug therapies don’t provide all the answers. Many people find that medications don’t fully relieve their chronic pain, and they can experience unpleasant side effects,” Killen says. “Evidence on a number of fronts, for several conditions, suggests that mind and body approaches can be helpful additions to conventional medicine for managing chronic pain.”
Research has shown that patients with chronic low-back pain might benefit from acupuncture, massage therapy, yoga or cognitive-behavioral therapy (a type of talk therapy).
NIH-funded scientists have also found that people with fibromyalgia pain might find relief through tai chi. This mind-body technique combines meditation, slow movements, deep breathing and relaxation.
But how much these approaches truly help is still an open question. Studies of pain relief can be difficult to interpret. Researchers must rely on patients to complete questionnaires and rate their own levels of pain.
One puzzler is that the exposure to the exact same pain-causing thing, or stimulus, can lead to completely different responses in different people. For example, when an identical heat stimulus is applied to different people’s arms, one may report feeling uncomfortable, while another might say that the pain is extreme.
“How do we account for these differences? We’ve now learned that genes play a role,” says Dr. Sean Mackey, who heads Stanford University’s neuroscience and pain lab. “Some differences involve our personality and mood states, including anxiety.”
Mackey and his team are using brain scans to gain insights into how we process and feel pain. One study found that a painful stimulus can activate different brain regions in people who are anxious than in those who are fearful of pain.
In another study, volunteers were taught strategies that could turn on specific brain regions. One technique involved mentally changing the meaning of the pain and thinking about it in a non-threatening way.
“We found that with repeated training, people can learn how to build up this brain area, almost like a muscle, and make its activity much stronger,” says Mackey. “That led to a significant improvement overall in their pain perception.” The researchers also found that different types of mental strategies, such as distraction, engaged different brain regions.
Another study found that intense feelings of passionate love can provide surprisingly effective pain relief. “It turns out that the areas of the brain activated by intense love are the same areas that drugs use to reduce pain,” says Mackay.
“We can’t write a prescription for patients to go home and have a passionate love affair,” says Mackey. “But we can suggest that you go out and do things that are rewarding, that are emotionally meaningful. Go for a walk on a moonlit beach. Go listen to some music you never listened to before. Do something that’s novel and exciting.”
That’s a prescription that should be painless to try.
Surgery and Procedure Locations
Arizona Spine and Joint Hospital
- 4620 E Baseline Rd
Mesa, AZ 85206
- phone: 480-413-0065
- 1950 S Country Club Dr, Ste 102
Mesa, AZ 85210
- phone: 480-413-0065