FAQ - Medication Management

Q: I don't want to be on any pain medication, what other options are there?

A: We typically avoid pain medication when possible and always when the patient wants to avoid it. We are trained in a multitude of minimally invasive procedures and injections that can improve your pain. Other non-medication options include physical therapy, bracing, biofeedback, and use of a TENS device, among many other options. Please see our homepage at [ cahaba ] where we discuss many of our treatment options.

Q: Will I become addicted if I take pain medications?

A: Although addiction is always a risk with any controlled medication therapy, it is thankfully relatively rare in a comprehensive pain management treatment program where non-opioid strategies, procedures, and multi-modal therapy are emphasized. It is common for patients to be confused about the difference between physical dependence and addiction. Addiction includes a psychological craving for medication that can lead to self-destructive and anti-social behavior, such as a patient who steals to obtain medication. Physical dependence means that your body needs the medication, and you have symptoms when you do not take it. Dependence is a normal part of taking some medications. In regards to pain medication, some patients will have withdrawal symptoms such as nausea, sweating, anxiety, and flu-like symptoms when they stop taking the medication, which signifies physical dependence but does not equal addiction. Addiction is a psychological issue where patients lose control of their actions and the drug becomes the most important thing in their life. They may take street drugs, obtain medication from multiple physicians without permission, perform risky behaviors to get more medications, and continue taking medications when they are endangering their family and social relationships. If you find yourself thinking constantly about your medication, what you would do if you did not have it, and worrying that you will run out, please discuss this with your Physician. Certain people are at increased risk for developing addiction: those with a history of substance abuse, usage of psychiatric medications, depression, and younger patients.

Q: My Referring Doctor says he / she can no longer prescribe my opioids/ narcotics. Can you help?

A: This is a situation which is quite common today. In many if not most instances we can help you. We will need to review your prior physician’s records, any pain treatment records you may have had, your medical history, the reason you are taking the medication, your pain history, the type of medication you are currently taking, your psychiatric history, the doses of medication you are currently taking, any other sedating medications that you currently take, and perform a physical exam before making a determination. We may choose to continue your medications, Or we may recommend a medication change. Even if we are unable to prescribe your medication, we may be able to prescribe a buprenorphine regimen or other medications that will help you withdraw from your current regimen with minimal side effects. or we may be able to recommend a slow opioid wean which will minimize withdrawal symptoms. We may also be able to help you with procedures, TENS unit, topical medications, physical therapy, or other non-opioid medications to ease your pain.

Q: Which pain medication works the best?

A: This really depends on the patient and the source of the pain or disease process that we are treating. What works for one patient and one disease process, may not help or be appropriate for another. That is why your physician will work to individualize your treatment plan, taking into account your medical history, your comorbid conditions, your other medications, the severity of your illness, and make a decision regarding your treatment plan with your input and your treatment goals in mind.

Q: What are the common side effects of pain medications?

A: Every pain medication has potential side effects depending on how it works, the dose used, and where in the body the medication works. Some medications may affect memory and balance where others may only cause mild heartburn.

Q: What is buprenorphine?

A: Buprenorphine is an opiate medication that is utilized for both chronic pain and opiate dependence. Buprenorphine has advantages over traditional opiates (e.g. Oxycodone, Morphine, Hydrocodone) including less abuse potential and longer half-life. Other advantages include less respiratory depression (IE, not decreasing your drive to breath) and improvement in many types of neuropathic pain. The medication may provide around-the-clock, long-acting pain relief depending on the dosing.

Q: Isn't buprenorphine only meant for people addicted to narcotics?

A: No, Buprenorphine is also indicated for the treatment of chronic pain. Many buprenorphine products are labeled by the FDA for pain, not for addiction or opioid use disorder. Some of the buprenorphine formulations which are used for chronic pain include: buprenorphine transdermal (Butrans ™), Buprenorphine oral (Buprenorphine tablets, Belbucca ™). A Common side effect of Buprenorphine, transdermal, is itching at the site from the adhesive. Our recommendation of flonase, topically, pre-placement may be helpful.

Q: How long will it take for my medication to be approved through my insurance?

A: That depends on your insurance and the medication. Our physicians and staff will work diligently with your insurance company and pharmacy to get your medication approved. This may require a prescription authorization from your insurance company. This usually takes no more than a few days.

Q: Should I only take my medication when I have pain?

A: Some medications must be taken regularly while others are "as needed." These instructions are included with the prescription. Please take your pain medication regularly, as prescribed. This may mean that you take a medication twice daily or more often to help control your pain before it becomes very severe. You should not wait until you have severe pain to take your medication in most cases. Pain is typically easier to control when it is mild and may be harder to control when it is severe.

Q: Can you treat my anxiety with something prescribed?

A: As pain physicians we do not typically prescribe controlled medication for anxiety. This is because many anxiety medications may increase the effects of some of our common pain medications. In particular, benzodiazepines may cause an increased sedation effect for some patients. Patients that require regular anxiety medications are probably best served by discussing this with their primary care provider or psychiatrist. We are happy to refer our patients to psychiatrists when we feel it is necessary. Your PCP or psychiatrist may be able to recommend an option to control your anxiety that is not as potentially habit forming as a benzodiazepine, such as a SNRI/ Selective Norepinephrine Reuptake Inhibitor, SSRI / Selective Serotonin Reuptake Inhibitor, Hydroxyzine, buspirone, or other alternative.

Q: My pain medicine is no longer working. Am I addicted?

A: When one has been on medication for a long enough time, the patient may experience tolerance where the dose of the medication fails to produce the desired effect, in this case pain relief.

Another word of interest is physical dependence. This refers to the body’s acclimation to the medication such that if the patient stops the medication abruptly, the patient will experience withdrawal symptoms.

Finally, many people ask about addiction. Addiction is a complex socio-biological disorder in which the patient has lost control of use of the substance and is using it compulsively. This can include alcohol, illegal drugs, and prescription medication. In the case of addiction, the addict uses despite physical, social, and even legal harm. This disease requires a multifaceted plan which may include individual counseling, group therapy, and perhaps medication to reduce cravings. We recommend and refer patients who are struggling with addiction to addiction experts.

Q: How is an antidepressant going to help me?

A: Some of the antidepressants are very effective at reducing chronic pain including neuropathy, spine, or joint pain. They do this by blocking pain signals as they travel along the spinal cord. In many cases, antidepressants are in underutilized group of medications for patients in chronic pain. They are useful adjunct medication, as many patients have already tried muscle relaxants, anti-inflammatories, gabapentinoids, or other agents. Antidepressants may take 2-3 weeks or more to reach their full effect. Many patients who have chronic pain will develop depression at some point as part of their disease process, and some people who have depression may experience severe chronic pain as part of their disease process. In many cases, an antidepressant may help the patient who suffers from both depression and chronic pain. Whether the depression or the chronic pain came first, is not as important as treating both.

Q: Why cant I have my traditional opiate. Why is Buprenorphine preferred?

A: There are advantages to Buprenorphine that are addressed above. However, for many patients, there is a perceived safety benefit, with less risk of decreased breathing seen with a buprenorphine compared to a traditional opioid, and buprenorphine may provide a longer acting around-the-clock pain relief when compared to other traditional opioids.

Q: My mother/ brother/ spouse/ friend has the same problem I have, and they are prescribed a different medication that helps. Why won’t my doctor prescribe me this medication?

A: Our choice of pain medication is dependent on the individual patient, his/her history, and the condition that is causing the pain. Even if your condition sounds exactly like your friend’s condition, the likelihood is that both of you have different problems causing the severe pain. Furthermore, both of you have different medical history, different organ systems, and process medications differently.