I am prescribing a strong medication for your pain, based on what you have told me about it, its location and severity, and the overall effect your pain has on your life. This medication is restricted or controlled by the US Government. When prescribed by a Medical Doctor who has knowledge and experience in the use of controlled mediations, as I do, they can be very effective. I believe this medicine will improve the overall quality of your life or I would not be recommending it for you. We usually prescribe this medication on a schedule by the clock. This is so your pain does not get too severe for you to handle. If you are given this medication for maintenance, you should take it on time, even if your pain is not severe, in order to prevent the severe pain rather than treat it.
Problems are very uncommon in patients with pain who are prescribed controlled drugs (narcotics or sedatives) and take them exactly according to instructions: the right medication, at the right dose and at the right time.
Even so, you should think of this medication as a dangerous drug. This medication can be fatal if given or found accidentally by small child, thin adult or anyone who is not used to (tolerant of) narcotic medications.
When you start or increase your pain medication, for a few days have someone watch for repeated sighing, yawning or slow breathing. If you are very hard to wake up or cannot stay awake for at least some of the time, you should skip a dose and call for a dosage change. Respiratory depression—dangerously slow breathing---may occur when narcotics are taken in doses higher than prescribed, when they are taken with sedatives, tranquillizers or sleeping pills, or with alcohol. The effects of each medication change the way the other medications are processed by your body, usually resulting in a summation of all of them. This can be used to your advantage, but because the results are unpredictable, should always be with a Dr’s knowledge and supervision, and prescription. Breathing difficulty may occur very quickly and without warning when oral medications are chewed, inhaled or injected--in other words when they are abused. The potential for people to abuse this and other similar medicine is one of the reasons for restrictions.
Never share your medication with others or take someone else’s medication.
Withdrawal or abstinence symptoms may occur if you stop this medicine abruptly. Taper this medication should you or your Doctor decide to discontinue it. Symptoms of abstinence include agitation, irritability, nervousness, rapid heart rate, nausea and abdominal pain and shakes or tremors. All controlled substances should be tapered gradually Constipation is one side effect of this medication that you may have. It is the one side effect that will not improve over time. Increase fiber, fluids and fruit to decrease this. You may need to take Senna with a stool softer on a regular schedule.
Narcotics or sedatives will not take your pain or anxiety completely away, but reduce it to a level that will allow you to function even while you have pain or anxiety. While restricted (controlled) medications can cause drowsiness, this is usually a temporary side effect. I encourage you to continue to use other methods of pain relief. Even if they did not work before, they may now be helpful. These include heat or cold, gentle massage, soothing music and activities to distract you from your pain such as puzzles, games, or conversation. If you only think about your pain, the pain will be worse. How will narcotics affect my function?
Sometimes you will be prescribed or given instructions to use medication for breakthrough pain—pain that suddenly increases, for no apparent reason. The intent is that you should only take a break-through medication when your pain is greater than 50% above baseline. You should not be taking the maximum dose of a breakthrough medication on a regular basis or it may no longer be prescribed. Instead, you should make an appointment to have your maintenance medication increased.
Regrettably some people use narcotics for purposes other than relieving their pain and may become addicts. An addict is someone who wants more medication in spite of increasingly adverse consequences. An addict craves the medication and therefore may want to steal yours. This includes friends and family! You should treat your medication as you treat your money. At home your narcotics or sedatives should be kept in a safe secure, preferably locked place. When away from home if you take your narcotics with you they should be in a pocket. Do not put them in a coat pocket or purse if you intend to hang them up or check them. Keep your narcotics in the container they are dispensed in by the pharmacy or a clearly labeled container.
Together we can help you feel better, while taking care to preserve your right-and other’s-- to use controlled substances for pain in the future.
Alda L Knight MD FACP
The Other Medical Clinic, PLC.
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