Welcome to Ask a Doctor!
Every week we’ll be asking our CarePoint Health doctors some questions that we’d all like to know the answers to. This week, Doctor John Rimmer DO visits us again. He’s one of our doctors in Hoboken at Hoboken University Medical Center with a focus on Emergency and Internal Medicine. He currently works in the E.R.
Q: What are the most common reasons to take pain medication?
A: One of my favorite sayings in medicine is “Pain is inevitable in life, but suffering is optional”, and this is ever more accurate as our understanding of pain expands. Pain is a complex cascade of signals in the body that everyone experiences, usually in some way, large or small, every single day. At a basic level, pain reminds us to remove ourselves from a noxious or harmful situation (putting your hand on a hot stove), therefore aiding in our survival. After such an event, pain may linger as damage to the area heals, and we are served with a frustrating reminder to avoid similar dangerous circumstances in the future. Pain medicines have been designed to help people cope with these conditions. From a toothache to a heart attack, relieving pain should be the first job of a physician and the first objective of the patient.
Q: How can I differentiate common pain from chronic pain?
A: Acute pain is a reaction to an immediate or recent injury or condition, such as a broken bone or sunburn. Nerve sensors in our body perceive pain signals, which are then transmitted to the brain, causing feedback among many other bodily systems. Not only do we feel the perception of pain, but our bodies also respond with a surge of reactions. These include changes in heart rate, blood pressure, and even the initiation of complex hormonal and inflammatory signals. These changes are used in healing, but some also aid in protecting our anatomy from the troubling stimulus. Usually, when the condition heals, pain most often resolves. Sometimes, however, chronic pain may develop, which can last months and even years. Researchers do not fully understand the reasons for chronic pain. Some doctors theorize it is caused by damage to the nerves themselves, some think it is related to neuro-hormonal or brain chemistry changes, but overall it is still a mystery. Chronic pain, which is an area of active research, is the cause for billions of dollars of lost productivity in society, and can have lasting unforeseen emotional and quality-of-life implications. Overall, if your acute condition has resolved, but your pain persists unexpectedly, you may be suffering from chronic pain.
Q: What are the most effective pain medications?
A: Pain medications are the most commonly taken medicines in the United States. Different types of pain medicines are effective for different conditions. All have side effects, however, and finding the right medicine based on your condition and other medical history is very important, for both safety and efficacy. Your doctor should always help you with this decision. Although there are many others types, the largest classes of pain medicines include:
- NSAIDs (or Non-Steroidal Anti-Inflammatory Drugs) can treat both inflammation and pain simultaneously, as inflammation is often the root cause of common pains. Motrin®, Advil®, and Alleve® are popular over-the-counter brands. They have side effects however, including gastrointestinal and cardiac complications. In addition to their pain properties, they can treat fever.
- Acetaminophen, or Tylenol®, helps to treat pain and fever, and is often added to other pain medicines to act as a synergistic compound. This often-overlooked additive property in other medication compounds is important to remember, as like any medicine, taking too much Acetaminophen can be harmful. In the right dose, it is very helpful to adults and pediatric patients with pain or fever.
- Narcotics, or opioid-based medicines, such as Percocet®, Vicodin®, and Oxycontin®, are some of the most powerful oral pain medicines, but also most risk-prone. They are usually safe when used as directed, but when used inappropriately can be dangerous and habit forming. Their side effects largely include respiratory, gastrointestinal, and cognitive effects. Never use a narcotic without physician supervision.
- Neuropathic medicines, such as Gabapentin, or newer preparations, such as Horizant® or Lyrica® act on the nerves to inhibit pain signals. They aren’t as helpful for acute pain syndromes, but in studies have been shown to help with lingering pain from conditions such as diabetic nerve pain, pain associated with the shingles virus, among other conditions. Like any pain medicine, they have side effects and require physician monitoring.
Q: Is it possible to become addicted to pain medication?
A: Some pain medicines, namely narcotics, are addicting. Prescription pain medicine addiction and abuse are now a preeminent public health concern. The CDC reports that in 2010, almost 2 million people, or almost 5,500 per day, used prescription pain medicines for the first time- for non-medical purposes. And the number of deaths from a prescription pain medicine overdose is now greater than that from cocaine and heroin, combined. This trend is alarming, and is requiring greater monitoring infrastructure via prescription registries, and penalties for abuse. If you find you are using these medicines for non-medical reasons, are requiring higher doses of a pain medicine to maintain the same pain control, or are seeking additional pain medicines from different doctors, you may need help and are encouraged to call 1-800-662-HELP for treatment options.
Q: Are there doctors that specialize in pain management?
A: Pain management specialists can be a valuable resource for both acute and chronic pain ailments. Some pain medicine regimens will even require a government approved pain specialist to prescribe and monitor. That said, your primary physician can adequately handle most pain management, but when medical problems compound the issue, or chronic pain is present, a consultation by a pain specialist is often indicated. There are also options for interventional pain therapies, such as injections and new medical devices used to treat pain. Other avenues of relief, including physical therapy, psychotherapy, proper sleep habits, and even adjunct treatments such as acupuncture and biofeedback can all relieve pain for some patients. And of course, vigilant caretaking of medical problems like diabetes, obesity, depression and sleep apnea can drastically help pain improve.
Q: Where can I find more information?
A: Pain is your body’s way of telling you something is wrong, so if you are in pain, seek professional medical advice and do not self-treat. Speak to your doctor about the specific quality and quantity of your pain, its history, and progression. Your primary care physician, emergency room physician, and specialists trained in the area of your particular injury or condition are the first place to find help.
Dr. John Rimmer is a board certified Emergency Physician and Internist. He completed his undergraduate education at The Pennsylvania State University and obtained his medical degree at the New York College of Osteopathic Medicine, where he was awarded a prestigious clerkship at the NASA/Kennedy Space Center Biomedical and Flight Surgery Office. He completed his internship at St. Vincent's Midtown Hospital in Manhattan, and then transitioned to St. Barnabas Hospital in the Bronx for a simultaneous residency program in Emergency Medicine and Internal Medicine. During his training he was commissioned as an Officer in the United States Naval Reserves and collaborated on award-winning research involving acute ophthalmologic emergencies. He is a currently a full time Emergency Physician at Hoboken University Medical Center, part of the CarePoint Network.