September is a busy month. The holidays have come to an end and everyone is getting back to work. That means a lot of catching up to do as you get back into the rhythm of life. But, for an increasingly large percentage of the U.S. population, work is just one more battleground where they have to fight pain. And when they do find the time to go see their local health provider, they are faced by an authority figure under time pressure to get them into and out of the room as fast as possible. Summoning the courage to sit there and describe the extent of their pain takes courage. (more…)

There are two main classes of medications used to treat pain: the so-called narcotics and the non-steroidal anti-inflammatory drugs (NSAIDs). The use of the word “narcotic” has been hijacked. In its medical sense, it originally referred to drugs derived from plants that would stupefy or knock you out. However, it is now linked to the opiates - those drugs derived from the opium plant which is recognized as having a good painkilling effect, i.e. it numbs the senses. In the legal sense, it refers to more or less any prohibited drug that has an addictive effect. NSAIDs painkillers are not addictive and are particularly effective to treat pain caused by inflammation. (more…)

Sometimes, the pain can come and you feel helpless. It wears you down. It leaves you lost and alone, wondering when it will stop. This is the time you reach for ultram - the non-addictive atypical opioid that helps to keep moderate to severe pain under control. I started the article this way because it is often impossible to separate pain from the emotions that accompany it. In fact, in many cases, there is a very definite connection between them. Let us leave purely psychosomatic conditions to one side and take a simple ulcer as an example. Although scientists blame poor Helicobacter pylori for ulcers, there is considerable evidence that stress is intimately involved whether as the original cause or by worsening the condition. (more…)

Ask anyone with back pain and they are likely to tell you a story about what they were doing when they were “injured”. It is often something trivial. I twisted awkwardly as I was getting out of the car or as I was lifting the bag of groceries out of the trunk. When the individuals are more sporty, they may tell you about the tennis match they were on the point of winning or the strikes they were racking up at the bowling alley. But the fairly consistent theme is that pain always follows an injury. (more…)

There has been a wealth of research into what causes pain. It is a symptom or warning of an underlying medical problem. Researchers can describe in detail how the sensation is transmitted from its source to the brain so we become aware of the problem and can take action to treat it. Unfortunately, despite our better understanding of what it is, actually relieving the pain remains a challenge. If we are dealing with a non-fatal physical injury, we can set the broken bones, stitch up the wounds and wait for the body to repair itself. During this time, the pain management choices for doctors focus on the various side effects of the medications, the interactions between medications, etc. If the pain becomes more acute due to a terminal condition, the issues of addiction and, to some extent, adverse side effects are less relevant. The humanitarian need is to make a person as comfortable as possible during the final period of life. But long-term neuropathic pain represents a completely different set of challenges. (more…)

  Ultram is marketed in some seventy countries around the world for the treatment of moderate to severe pain in multiple dose format. The simple rule is that the dose should be individualised so that each person takes the smallest dose required to produce the required relief from pain. Normally, this means that patients start with a very low daily dose and slowly increase the dosage every three days until a stable and effective concentration in the blood stream is achieved. After that, the level is maintained by taking one tablet every four to six hours. No-one should take more than 400mg per day. If there is a more urgent need for pain relief and that need outweighs the risk of dependence, people may take an initial high dosage. This well-established system may be about to change in the US. (more…)