Pain Relief Pharmacy

Medications can relieve neck pain and reduce inflammation of the soft tissues. Pain relief will allow you to move your neck gently, so you can begin easy exercises and start the healing process.

Although pain relievers, muscle relaxants, and antidepressants are commonly used for neck pain, none are well-proven treatments.

Nonprescription pain relievers include:

• Creams or gels, such as Bengay, that are rubbed into the neck.
• Nonsteroidal anti-inflammatory drugs, including aspirin (such as Bayer), ibuprofen (such as Advil), or naproxen sodium (such as Aleve), that can help relieve pain and reduce inflammation. Do not give aspirin to anyone younger than 20 because of the risk of Reye’s syndrome.
• Acetaminophen, such as Tylenol, which reduces pain.

Prescription pain relievers include:

• Muscle relaxants, which are used to treat severe neck pain and spasms when neck pain begins (acute neck pain). They include diazepam (Valium), cyclobenzaprine (Flexeril), and carisoprodol (Soma).
• Narcotic pain relievers, which are used to treat severe short-term (acute) neck pain. They include codeine, acetaminophen and hydrocodone (Vicodin, Lortab), aspirin and oxycodone (Percodan), and acetaminophen and oxycodone (Percocet).
• Antidepressants, which are used to treat long-lasting (chronic) pain. They include doxepin (Sinequan) and amitriptyline (Elavil, Endep).

FDA Advisory. The U.S. Food and Drug Administration (FDA) has issued an advisory to patients, families, and health professionals to closely monitor adults and children taking antidepressants for warning signs of suicide. This is especially important at the beginning of treatment or when doses are changed.

The FDA also advises that patients be observed for increases in anxiety, panic attacks, agitation, irritability, insomnia, impulsivity, hostility, and mania. It is most important to watch for these behaviors in children who may be less able to control their impulsivity as much as adults and therefore may be at greater risk for suicidal impulses. The FDA has not recommended that people stop using antidepressants, but simply to monitor those taking the medications and, if concerns arise, to contact a health professional.

Methadone is a narcotic pain reliever, similar to morphine. Methadone also reduces withdrawal symptoms in people addicted to heroin or other narcotic drugs without causing the “high” associated with the drug addiction.

Methadone is used as a pain reliever and as part of drug addiction detoxification and maintenance programs.

Methadone may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about methadone?

Taking methadone improperly will increase your risk of serious side effects or death. Even if you have used other narcotic medications, you may still have serious side effects from methadone. Follow all dosing instructions carefully.

Like other narcotic medicines, methadone can slow your breathing, even long after the pain-relieving effects of the medication wear off. Death may occur if breathing becomes too weak. Never use more methadone than your doctor has prescribed. Call your doctor if you think the medicine is not working.

Do not stop using methadone suddenly, or you could have unpleasant withdrawal symptoms. Talk to your doctor about how to avoid withdrawal symptoms when stopping the medication.

Do not drink alcohol while you are taking methadone. Dangerous side effects or death can occur when alcohol is combined with methadone. Check your food and medicine labels to be sure these products do not contain alcohol.

Methadone can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

What should I discuss with my healthcare provider before using methadone?

Before taking methadone, talk to your doctor if you have:

• a personal or family history of “Long QT syndrome”;
• asthma, COPD, sleep apnea, or other breathing disorders;
• liver or kidney disease;
• underactive thyroid;
• curvature of the spine;
• a history of head injury or brain tumor;
• epilepsy or other seizure disorder;
• low blood pressure;
• gallbladder disease;
• Addison’s disease or other adrenal gland disorders;
• enlarged prostate, urination problems;
• mental illness; or
• a history of drug or alcohol addiction.

Older adults and people with debilitating conditions may be more sensitive to the effects of this medication.

How should I use methadone?

Use methadone exactly as it was prescribed for you. Do not use the medication in larger amounts or for longer than recommended by your doctor. Follow the directions on your prescription label.

Like other narcotic medicines, methadone can slow your breathing, even long after the pain-relieving effects of the medication wear off. Death may occur if breathing becomes too weak. Never use more methadone than your doctor has prescribed. Call your doctor if you think the medicine is not working.

When methadone is used as part of a treatment program for drug addiction or detoxification, you will receive the medication through a clinic or special pharmacy.

Your doctor may recommend that methadone be given to you by a family member or other caregiver. This is to make sure you are using the medicine as it was prescribed as part of your treatment.

Additional forms of counseling and/or monitoring may be recommended during treatment with methadone.

Methadone is available in tablets, dispersible tablets, oral solution (liquid) and as an injection. The pill and oral liquid forms of methadone must never be used to make a methadone injection.

Measure the liquid form of methadone with a special dose-measuring spoon or cup, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.

The methadone dispersible tablet (Diskets) is made to be dissolved in water. Do not chew, crush, or swallow the tablet whole. Place the tablet into a 4-ounce glass of water, orange juice, or other citrus-flavored non-alcoholic beverage and allow the tablet to disperse in the liquid. The tablet will not dissolve completely. Drink this mixture right away. To make sure you get the entire dose, add a little more liquid to the same glass, swirl gently and drink right away.

Store methadone at room temperature away from moisture and heat.

Keep track of how much of this medicine has been used. Methadone is a drug of abuse and you should be aware if any person in the household is using this medicine improperly or without a prescription.

What happens if I miss a dose?

Use the medication as soon as you remember. If it is almost time for the next dose, skip the missed dose and wait until your next regularly scheduled dose. Do not use extra medicine to make up the missed dose.

What should I avoid while using methadone?

Do not drink alcohol while you are taking methadone. Dangerous side effects or death can occur when alcohol is combined with methadone. Check your food and medicine labels to be sure these products do not contain alcohol.

Methadone can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

What are the possible side effects of methadone?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any of these serious side effects:

• shallow breathing;
• hallucinations or confusion; or
• fast or pounding heartbeats, chest pain, trouble breathing, feeling light-headed, fainting.Other, less serious side effects may be more likely to occur, such as:
• feeling anxious, nervous, or restless;
• sleep problems (insomnia);
• dizziness, drowsiness, or weakness;
• dry mouth, nausea, vomiting, diarrhea, constipation, loss of appetite; or
• decreased sex drive, impotence, or difficulty having an orgasm.

This list is not complete and other side effects may occur. Tell your doctor about any unusual or bothersome side effect.

What other drugs will affect methadone?

Do not use methadone with other narcotic pain medications, sedatives, tranquilizers, muscle relaxers, or other medicines that can make you sleepy or slow your breathing. Dangerous side effects may result.

Do not use methadone with any of the following drugs without first talking to your doctor:

• a diuretic (water pill);
• antibiotics such as azithromycin (Zithromax), ciprofloxacin (Cipro), clarithromycin (Biaxin), erythromycin (E-Mycin, Ery-Tab), itraconazole (Sporanox), ketoconazole (Nizoral), metronidazole (Flagyl) or voriconazole (Vfend);
• heart or blood pressure medication such as diltiazem (Cardizem, Dilacor, Tiazac) or verapamil (Calan, Covera, Isoptin, Verelan);
• HIV medicines such as abacavir (Ziagen), amprenavir (Agenerase), didanosine (Videx), efavirenz (Sustiva), lopinavir/ritonavir (Kaletra), nelfinavir (Viracept), nevirapine (Viramune), ritonavir (Norvir), stavudine (Zerit), or zidovudine (Retrovir);
• an MAO inhibitor such as isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine (Nardil), or selegiline (Eldepryl, Emsam);
• other narcotic medications such as pentazocine (Talwin), nalbuphine (Nubain), buprenorphine (Subutex), or butorphanol (Stadol);
• rifampin (Rifadin, Rimactane, Rifater); or
• seizure medication such as phenobarbital (Luminal, Solfoton) or phenytoin (Dilantin).

This list is not complete and there are many other medicines that may cause serious medical problems if you take them together with methadone. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Keep a list with you of all the medicines you use and show this list to any doctor or other healthcare provider who treats you.

Nerve pain or neuropathic pain is caused by nerve damage or nerve disease. The pain is often aching, burning or shooting in nature.

• Drugs can be used to treat neuropathic pain. There are 3 types of drugs:
  Anti-depressants eg. amitriptyline, which were developed to treat depression, have long been used “off licence” to treat nerve pain.
• Anti-convulsants or anti-epileptic drugs (AEDs) such as carbamazepine, developed to control fits in epilepsy have long been used to treat nerve pain. Newer anticonvulsants such as gabapentin and pregabalin are licensed in the UK for the treatment of neuropathic pain.
• Opioids such as tramadol are sometimes useful in some people for nerve pain.

These drugs are available on prescription and may have side-effects. Nerve pain is difficult to treat and the best result is often only 50% pain reduction. Patience is needed in trying out various drug combinations to get the best pain reduction and least side effects. These drugs often need to be taken for several years.