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Nathan Wei asked:




Non-steroidal anti-inflammatory drugs (NSAIDS) have been the mainstay of treatment for arthritis symptoms. Physicians often advise patients to use over-the-counter preparations… or also use prescription NSAIDS for more severe problems.

Unfortunately, NSAIDS do have many potential side-effects including the potential for creating stomach and small bowel ulceration, kidney dysfunction, liver damage, fluid retention and a small but real increased incidence of cardiovascular events.

So… a real dilemma for many clinicians is how to control arthritis pain in patients for whom NSAIDS have already caused problems or for patients who have the potential for developing problems.

One drug that has been used primarily for pain control is tramadol (Ultram). This is a drug that is a mild centrally acting narcotic drug with little addictive potential.

Tramadol is increasingly used for the treatment of osteoarthritis (OA) because it does not produce gastrointestinal bleeding or kidney problems and does not adversely affect cartilage, a controversial but possible side effect associated with NSAIDS.

A recent study sought to determine the analgesic effectiveness, the effect on physical function, the duration of benefit, and the safety of oral tramadol in patients with OA.

(Cepeda MS, et al. J Rheumatol. 2007; 34:543-545)

The scientists searched the Cochrane Central Register of Controlled Trials (Central), Medline, Embase, and Lilacs databases up to August 2005.

They included randomized controlled trials (RCT) that evaluated the effect of tramadol or tramadol plus paracetamol (equivalent to acetaminophen) on pain levels and/or physical function.

The researchers included 11 RCT with a total of 1019 participants who received tramadol or tramadol/paracetamol and 920 participants who received placebo or active control. Participants who received tramadol reported (1) less pain, a 12% relative decrease in pain intensity; (2) higher degree of global improvement: one of every 6 individuals taking tramadol or tramadol/paracetamol exhibited at least moderate global improvement; and (3) improvement in stiffness and function, than patients who received placebo. In terms of adverse events, one of every 5 participants who received tramadol or tramadol/paracetamol experienced minor adverse events and one of every eight stopped taking the medication because of adverse events compared to participants who received placebo.

Their conclusion was that tramadol or tramadol/paracetamol decreased pain intensity, produced symptom relief, and improved function in patients with OA, but these benefits were small.

In actual practice, tramadol is a drug that is often added to an NSAID for better pain control or used instead of an NSAID in high risk patients. As with most therapies, a patient’s response is often dependent on the expectations of the physician.

Caution must be exercised when using tramadol.

First, particularly in older patients dosing must start at a low level, probably 25 mgs per day with a gradual increase as tolerated.

Second, there have been sporadic reports of increased risk of seizures in patients taking anti-depressant medicines such as selective serotonin reuptake inhibitors (SSRIs).

Tramadol should also be tapered when discontinued.

There are some potential drug interactions and these need to be evaluated.

A sustained release form of tramadol (Ultram ER) is now available in the U.S and appears to have a good tolerability profile.



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Mark Ames asked:




Chronic pain is the reason many people seek relief.  Relief can come in the form of medication of some type of surgery.  The problem with surgery is that not all people who have operations experience relief from their chronic pain.  In fact, some patients experience higher levels of pain after surgery.

Most pain suffers will do just about anything to relieve the pain.  Unfortunately, modern medicine still has not come up with a cure for most pain suffers.  Most doctors will prescribe pain medications for chronic pain suffers.  The problem is these medications must be taken month after month and the cost can quickly add up.

Chronic pain suffers have even turned to natural remedies in hopes of relieving their pain.  The problem with most natural remedies is they just don’t work for people suffering from moderate to severe chronic pain.  In addition, many of companies offering so called natural remedies are just snake oil salesman.  Think about it – if there was an effective natural remedy wouldn’t people spread the word person to person.  If these natural remedies have been around for so many years then how come we haven’t heard of them before?  Why do you have to pay to learn of a natural remedy that has supposedly been around for many years? 

Unfortunately, the only effective relief most people can achieve is by masking the pain with pain medications.  While this may not be the preferred method – it remains the only reliable option.  If you chose to take prescription medication to relieve your pain then you should consider using an online pharmacy to purchase your medication.  Online pharmacies offer the same medications at much lower prices than your corner drug store.  Since they don’t have to pay to build drugs stores on every corner they are able to keep their cost extremely low and pass the saving on to the customer.  

Below is a list of the five most popular pain medications.  All of these drugs can be ordered online without a prior written prescription:

Tramadol – Tramadol is used to relieve moderate to moderately severe pain. It also may be used to treat pain caused by surgery and chronic conditions such as cancer or joint pain. Tramadol works by decreasing the brain’s perception and response to pain. It also reduces the size or magnitude of the pain signal passed from one nerve to another. This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

Fioricet – Fioricet is a barbiturate sedative mixed with a non-aspirin pain medication and caffeine. This non-narcotic pain medication and relaxant is often prescribed for tension headaches caused by contractions of the muscles in the neck and shoulder area, and migraine.

Ultracet – Ultracet is a unique pain medication. It is used to relieve moderate, acute pain such as pain following surgical procedures, including dental surgery. Ultracet may be used for other types of pain as determined by your health care provider.

Ultram – Ultram is used to relieve moderate to moderately severe pain. It also may be used to treat pain caused by surgery and chronic conditions such as cancer or joint pain. Ultram works by decreasing the brain’s perception and response to pain. It also reduces the size or magnitude of the pain signal passed from one nerve to another. This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

Butalbital – Butalbital/APAP/Caffeine is a barbiturate sedative mixed with a non-aspirin pain medication (acetaminophen) and caffeine. This non-narcotic pain medication and relaxant is often prescribed for tension headaches caused by contractions of the muscles in the neck and shoulder area, and migraine.

Motrin – Motrin Tablets are used for relief of the signs and symptoms of rheumatoid arthritis and osteoarthritis. Take this medicine for the relief of mild to moderate pain. Your doctor may prescribe Motrin for the treatment of primary dysmenorrheal.

Check out this site if you’re looking for a reputable Online Pharmacy

 



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Paul D Osborne asked:




Lower back pain is one of the commonest problems afflicting people around the world at some point of time in their life. In the initial stages of pain, stretching exercises work effectively as lower back pain treatment. The lower back supports the upper body and allows the body to turn, twist, bend, lift and walk. It plays a very important role in mobility. The lower back takes a lot punishment, as we tend to overuse or misuse it. There are many options available for lower back pain treatment, depending upon the problem.

Medication and Therapies for Lower Back Pain Treatment

The commonest lower back pain treatment in case of severe back pains is acetaminophen. It is an over-the-counter medicine for oral consumption. If the pain is very intense and chronic in nature, the doctor may prescribe additional oral medicines including non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants or opium-derived narcotic drugs (OPIOIDs).

Alternative therapies may also be used for lower back pain treatment, as they are quite effective. These therapies are recommended by physicians when medication does not provide the desired relief. These therapies include manipulation, traction, acupuncture, massage or biofeedback. Manipulation involves adjusting the spinal vertebrae for alignment, while acupuncture involves inserting of very fine needles into certain specific points in the body, which are believed to be located on the channels that carry subtle life-energy. If these methods do not provide with relief from pain, epidural steroid injections or anti-inflammatory medicines are directly introduced to the spine to control pain.

Lower back pain treatment may also include surgical procedure. Problems related to alignment of the spine and other degenerative disc problems may require surgical treatment. Spinal fusion surgery is the standard surgical procedure for degenerative discs. The damaged disc is removed from the spine, and replaced by a device filled with bone pieces taken from the patient’s hipbone. Now, the hipbone option is replaced by a genetically engineered protein called infuse bone graft.

However, the best lower back pain treatment is regular exercise coupled with a healthy diet.

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