This blog includes things that were taught about medications at the Mayo Clinic Pain Rehabilitation Center as I, the patient and blogger, understood them. The purpose of this blog is to help people understand, in layman's terms, what drugs and medications are and how they affect the body. Some of the explanations are short and only give enough limited information for the general point to get across, so as not to give the reader the feeling that they are reading from a medical journal or encyclopedia.
Analgesics:
Pain medications of any type are called analgesics.These medications affect the central nervous system to block pain signals to the brain. There basically are three types of analgesics; Acetaminophen (APAP), Ibuprofen, Aspirin and Naproxin (NSAIDS) and opiates such as Morphine, Codeine, Oxycodone, Oxycontin, Hydrocodone and Percocet.
APAP is also known by the names Paracetamol and Acetaminophen. We know it by the brand name of Tylenol. If the name contains "cet" then it probably contains APAP. APAP is an anti-pyretic, which means it reduces fever. It is also used as a mild analgesic and as a weak anti-inflammatory. Anti-inflammatory basically means that it reduces swelling. It is very easy to overdose on APAP because it is found in most cold medications. If you take Tylenol and also a cold medication like Nyquil, you will exceed the recommended dosage. It is very bad to exceed the recommended dosage of APAP because it is metabolized (digested and processed) mostly in the liver. If a person takes more than the liver can process at one time, it causes liver damage. You may not even notice that you have caused the liver damage at the time, but after causing the same small damage over and over, liver function will decrease. Large overdoses usually result in liver failure and death either immediately or within days. It is perfectly safe to take for extended periods of time without liver damage if one sticks to the recommended dosages. Unfortunately, it is only a mild analgesic and its effects may not even be noticed in cases of moderate pain.
NSAIDs are non-steroidal anti-inflammatory drugs. That's where the acronym comes from. They are known by the names, Acetlylsalicylic acid or Acetoxybenzoic acid (Aspirin), Ibuprofen (Advil, Motrin) and Naproxen, Naprosyn, Naprelan and Anaprox--or the brand name Aleve. NSAIDS are also blood thinners. That's why taking Aspirin at the first sign of a heart attack can save a life. It reduces inflammation and pain and thins the blood so that if there's a clot blocking blood flow, the thinner blood can still squeak by until a procedure can be done. Many herbs used for their anti-inflammatory properties are also blood thinners. If you are taking herbs and also NSAIDS, you are thinning your blood considerably, and bleeding can occur inside the body as well as having cuts that won't stop bleeding and bloody noses. Easy bruising is a way to tell if you are thinning your blood too much. NSAIDS are metabolized largely through the kidneys. Prolonged use of NSAIDS is discouraged, as it can lead to kidney damage. If you have diabetes, you are already taxing your kidneys. If you frequently use NSAIDS while you have diabetes, you will damage your kidneys.
Opiates or Opioids are created from unripe poppy seed pods, specifically poppies with the scientific name Papaver Somniferum. Heroin is also derived from the poppy seed pod. It is has very effective pain reducing effects. It also induces sleep, as well as gives a feeling of happiness and well-being. It is highly addictive and is therefore a controlled substance and can only be obtained through a doctor's prescription. It is a depressant. That means that it slows, or depresses, body functions like breathing, digestion, etc. Because it slows digestion, many users of opiate medications complain of constipation. In addition, when the effects of the drug wear off, the patient feels depressed. Sometimes patients will experience hangover symptoms like headache and nausea. The reason it is so addictive is because those symptoms can be alleviated by taking another dose, thereby making the patient feel better. Opiates suppress breathing. The reason patients die in an overdose is because it interferes with the chemicals that the brain uses to tell the body to breathe. Patients with severe asthma are discouraged from using opiates. Alternative medications are used in surgery. Opiates are also addictive because the body builds up a tolerance to the effects. If a patient takes two Percocet every 6 hours for pain, after a week or so the same dosage is not as effective, so the patients want to increase the dosage. They may complain to their doctor that the pain medication is not working. Generally, a patient who is taking opiates for pain has undergone a procedure and the body's own natural healing processes reduce the pain. Doctors usually don't prescribe more than ten days worth of opiate medication. As the medication runs out, the body has healed enough that the pain medication is no longer needed. However, for patients with chronic pain, doctors will usually not prescribe opiates because although they decrease pain short-term, long term use causes more problems than it solves. Opiates are largely metabolized in the liver. It is important to note that most doctor-prescribed opiate medications also contain APAP. Since opiates are highly addictive, patients tend to take more than the recommended dosage thereby causing liver damage.
Recreational Drugs:
Alcohol is a depressant. Depressants slow heart rate, breathing, digestion, and reflexes as well as induce sleep. It is metabolized in the liver, although it affects the kidneys, as well. If you take APAP and drink, you are damaging you liver because the recommended dosage for APAP is the greatest amount that can safely be taken without liver damage. Using other substances that are processed in the liver while taking APAP will cause liver damage. If a patient drinks while taking opiate medication, they compound the hangover effect. Depression is common for those who drink. Usually drinking starts because of depression. The hangover effect makes the depression worse. That's why it is easy for depressed persons to become alcoholics. This is doubly true if a person consumes alcohol while taking opiate medication.
Nicotine is a stimulant. It increases heart rate and constricts blood vessels which increases the likelihood of stroke. Prolonged use causes circulatory damage. If you are diabetic, you are already at risk for circulatory damage. If you are diabetic and are using tobacco products, you are probably causing circulatory system damage. Since circulation provides oxygen to every tissue in the body, every body system is affected from breathing and circulation to kidney function and digestion. If you are taking blood thinning medications as well as stimulants, you increase your risk of stroke. Stimulants keep people awake and interfere with sleep patterns.
Caffeine is a stimulant. It is largely metabolized by the kidneys. It is found predominantly in coffee, tea and soft drinks. It is a diuretic, which means that it removes excess liquid from the body and makes the kidneys work harder. Caffeine is often used in menstrual pain medications for this reason. Headaches are often caused, in part, by mild inflammation, or excess fluid, so caffeine is often added to headache medication. It is used for patients with water on the brain, or with brain injury to remove excess fluid. It is used in hospitals for premature infants to keep their heart beating and lungs breathing, and it prevents the patient from going into deep sleep. Caffeine is also a stimulant, thereby causing all of the stimulant effects that nicotine does, including the constriction of blood vessels. If you have heart problems, breathing problems like asthma or COPD, or are diabetic, it causes further tissue damage and it is best to avoid consuming products with caffeine.
Marijuana is currently an illegal drug in most states, although it is becoming more widely accepted as a legal recreational drug. It is metabolized largely in the liver. It is a depressant. Many abusers of opiates also smoke marijuana. This practice causes liver damage. It also slows breathing and digestion. People who smoke marijuana and also take opiates most surely will suffer from constipation.
Cocaine is a stimulant. It is metabolized largely in the liver. It is made from alkaloids found in the cocoa leaf, which are obtained by grinding up the leaves, boiling them, and retrieving the residue. It is an illegal drug in the United States and in most other countries. It is highly addictive. Crack is a derivative of cocaine. These drugs stimulate heart rate, increase breathing, suppress appetite and cause anxiety. Overdoses cause the heart to stop beating and often result in death.
Hallucinogens are usually derived from plants like peyote and mushrooms. Hallucinogens are illegal in the United States, except in some religious rituals. Most are metabolized in the liver. The Mayo Clinic Pain Rehabilitation Clinic (PRC) does not condone the use of hallucinogens.
The list of man-made (synthetic) recreational illegal drugs is very long and grows longer every day as new ways are found to combine chemicals to affect the brain and not cause immediate death. Each is metabolized a different way. Know that most drugs are metabolized either by the liver or by the kidneys. Most of these drugs are highly addictive and are usually abused. Most lead to death by overdose. These include but are not limited to Methamphetamine, Ecstacy, Bath Salts, Spice, Ketamine, etc. The PRC highly discourages the use of these drugs. If you or someone you care about has an addiction problem, there are resources in your area that can help you. Some churches, like the Church of Jesus Christ of Latter-Day Saints, offers free group therapy sessions through their Family Services offices. You can attend in person, or online. You can also contact American Addiction Centers. More information on drugs and their affects, and how to help someone who might be addicted can be found at www.drugfree.org.
Muscle Relaxers:
Soma, Flexeril, Valium, Skelaxin and Robaxin are brand names of muscle relaxants. Some are depressants, others are not. Some are metabolized in the kidneys and some in the liver, some in both. Most are habit-forming, although some are not. It is very important to follow your doctor's orders closely and read the patient information that the pharmacy prints off so that you know how this medication will affect your body. Most times the pharmacy info will give a list of contraindications, or a list of conditions that a person can have that are dangerous with the medication. Muscle relaxers are not opiates, but are synthesized chemicals created to affect the central nervous system and relax the entire body, thereby relaxing muscle spasms. They make the patient very sleepy. Patients should not drive while taking muscle relaxers. Overdosing causes the heart to stop beating, as it relaxes the heart muscle until it stops beating.
Steroids:
Some popular steroid medications are Prednisone, Cortisone and Hydrocortisone. Often times a doctor will prescribe a steroid medication for short periods of time to reduce pain. Steroids are not stimulants or depressants. They are derived from cholesterol. They affect the body's metabolism in different ways depending on the type of steroid used. They are metabolized in the endocrine glands such as ovaries and testes. The reason why a steroid reduces pain is because it reduces inflammation. Many long-term asthma medications contain steroids because they reduce the inflammation in the airway tubes, thereby making more room for the air to flow. Doctors will often give a patient suffering localized pain a steroid injection of cortisone to reduce inflammation in the afflicted area. Topical steroids, such as hydrocortisone, often used for insect bites and skin rashes, can absorb into the blood stream through the skin and cause side effects. This is especially true for old people and young children. Because steroids affect metabolism, they cause weight gain. Prolonged used can cause damage to the hormone-producing reproductive organs as well as obesity. Other side affects of prolonged steroid use include thinning of the skin and breakdown of other connective tissues in the body, excessive hair growth and depression. For this reason, they can only be obtained through a doctor's prescription. If you are taking steroids of any kind for an extended period of time, and also blood thinning medications, you increase your risk of stroke. If you add Nicotine and/or Caffeine to that mix, you greatly increase that risk.
Herbs:
There are many herbs that are sold as pain-reducing products. The reason for this is because many herbs have anti-inflammatory properties. Inflammation causes pain. If you reduce inflammation, you reduce pain. It is important to know that most plant-based products are metabolized in the liver. If you take handfuls of herbs on a daily basis, you could be overtaxing your liver. There have been many deaths associated with the over-use of herbs. I personally knew three people who died as a result of liver failure due to the over-use of herbal capsules. It is dangerous to take herbs and also APAP, as it can cause liver failure. Many herbs are also blood-thinners. Taking herbs with NSAIDS can cause internal bleeding, cuts or bloody noses that won't stop bleeding, or stroke. There is also the risk of allergic reaction for those who take herbs with other medications. Taking herbs without drinking adequate amounts of water is also hard on the kidneys. As a general rule, if you take any medication, drink at least 8 ounces of water with it.
By now you should have a basic idea of what medications do what to the body. The thing that most impressed me while I was at the PRC, and what prompted me to include this in my series of blogs, was the fact that I have type II Diabetes. I had been taking Ibuprofen (yes, sometimes more than the recommended dosage) for my chronic pain in order to avoid taking opiates. When I learned that I was potentially harming my kidneys in the process, it made a big impression on me. I don't want to spend the rest of my life getting dialysis every three days. The more we know, the better we can take care of ourselves. By now you may be getting depressed, feeling like there is nothing you can do about your chronic pain. Not to worry. Future blogs will include natural, stress-reducing alternatives to medication such as deep breathing, relaxation, imagery, mindfulness and ways to naturally release endorphins.
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