Stopping or reducing your medicines

For people with chronic pain, some doctors and specialist pain nurses suggest that stopping or reducing the number or types of medicines can be a helpful choice. This is especially true when there are many problems, or the side-effects are very distressing or severe. For instance, some people find that their pain-relief medicine make them very drowsy, moody and unable to concentrate.

If you decide that you want to stop or reduce your medicine, you first need to think about whether or not they help you to manage your chronic pain at present.

Start by making a list of the advantages and disadvantages of continuing to take medicine for your pain problem. You can use the following questions to help you:

1   How much do your medicines relieve your pain? Tick your answer.

0_––10_––20_––30_––40_––50_––60_––70_––80_––90_––100%

No pain relief                                     Pain-free

2   Do you have side-effects with your current medicines? Tick those that apply.

   Concentration difficulties

   Constipation

   Sickness

   Dizziness

   Hallucinations

   Rashes

   Blurred vision

   Dry mouth

   Mood changes

   Sexual difficulties

   Other (write them down)

3   Does the pain-relief effect reduce, despite increasing the dose regularly?

4   Do you get any dependence symptoms? Tick those that apply.

   Shaking

   Tremors

   Nausea/vomiting

   Diarrhoea

   Itching

5   Do drugs help in a setback with high pain levels?

6   Do they help you feel good about yourself?

7   Do they help you get a good night’s sleep?

8   Do they help you to keep doing the things that are important to you?

Think about your answers. Think about how much relief you get with your medicines, and how many side-effects or dependence symptoms. Do they help you? Or do they get in the way of doing all the things that are important to you?

Now write down in your notebook, in two columns, the advantages and disadvantages of continuing medicines for your pain problem.

Looking through this list, do the benefits of medicines on balance outweigh the disadvantages? If so, this would suggest that it is worth continuing to use them.

If there are more disadvantages than advantages, then you need to think over two options:

•   reducing the type and number of medicines

•   gradually stopping the medicines

You may want to discuss these options with your doctor or pain specialist team.

OPTION ONE

Option One involves reducing your medicines slowly over time, rather than stopping them all at once. There are a couple of important rules when following this option:

•   Reduce your dose by one tablet every two or three days, choosing a time when your pain level is low.

•   Reduce one type of medicine at a time.

This option is likely to lead to success. Up to 70 per cent of patients are able to cut down on the types of medicines or numbers of tablets, and some eventually stop their medicines completely.

If you are uncertain about the best way to reduce or stop your medicines, discuss the options with your doctor or pain specialist.

You can also use skills such as pacing (see Chapter 8), stretches and relaxation (see Chapter 12), and anger management (see Chapter 14) to help cope with the pain as you reduce your drugs.

OPTION TWO

It is possible to stop all pain-relief drugs at once. However, it can make you feel unwell and the pain can really increase. Gradual reduction is sensible, until you have stopped all your pain-relief medicine, ie. option one.

Note: If you take medicines for any other problem, such as diabetes or high blood pressure, do not reduce or stop them. Check with your doctor, pain specialist or pharmacist if you are uncertain at any stage as to what to do about your medication.

When you see your doctor or pharmacist, take a list of all the medicines you take and write down the questions you want to ask.

For instance, it may help to ask:

•   What does this medicine do?

•   How long will I need to take it?

•   How and when should I take it?

•   Are there any drugs, foods, drinks or activities I should avoid or change when taking this medicine?

•   What are the common side-effects and what should I do if I get them?

•   Other questions or notes?

CHAPTER SUMMARY

•   Chronic pain can sometimes be helped by analgesics and other medicines, such as amitriptyline. It is a process of trial and error to see if drugs can help.

•   Matching pain levels to the strength of the analgesic can be helpful to reduce pain. However, stronger analgesics may give more side-effects. The WHO ladder for analgesics can help guide medicine use, matching the right medicine to a particular pain level.

•   Predicting pain increases, and using drugs before high pain levels set in, can help you control pain. Filling in a Medicine Use Diary can enable you to understand your pain patterns and use medicines better. The diary can also give your doctor/pain specialist useful information on the helpful and unhelpful effects of medicines.

•   Reducing the number of different medications reduces side-effects. Stopping medicines can be very helpful when there are many problems with them, their side-effects or dependence symptoms.

•   It helps to use pacing, relaxation and other skills to manage pain levels as you make changes with your medicines.

•   Talk to your doctor or pain specialist team if you need help to make changes.