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Information and education resources are described below for the benefit of healthcare providers to make available for their pain patients, as appropriate. Professional discretion in their distribution and application is advised. Pain Treatment Topics does not provide medical advice, diagnosis, or treatment (also see, Disclaimer below and Site Policies).
Researcher/Reviewer - Winnie Dawson, MA, RN, BSN; Reviewer/Editor - Stewart B. Leavitt, MA, PhD.
Some of the resources listed below require purchase, as indicated, and reviews are provided only for the interest and convenience of website visitors. Pain Treatment Topics has no financial interest in these offerings and does not receive any compensation from their publishers or providers.
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Recommended for ALL Patients...
U.S. FDA - Patient Network Website
From: U.S. Food and Drug Administration.
Go to website at: http://www.patientnetwork.fda.gov/
This interactive website helps educate patients, patient advocates, and consumers on how prescription and over-the-counter medications and medical devices move from the drawing board to the marketplace. This site also helps patients/consumers to better determine whether medical products are safe and effective, and encourages them to become involved, contributing their ideas and concerns about the development and regulation of these products. They also can report drug side-effects on MedWatch. Access checked May 16, 2013.
How to Evaluate Health Information on the Internet
From: U.S. Food and Drug Administration; 2005; 3 pages.
HTML document available online at:
http://www.fda.gov/Drugs/...BuyingMedicinesOvertheInternet/ucm202863.htm (Access updated 4/13/10)
Thousands of websites offer health information, some good and some bad. This document from the FDA offers essential guidance for identifying sources of information via the Internet that are most likely to be reliable and up-to-date. Access checked November 6, 2008.
NOTE: Pain-Topics.org has been designed to comply with all requirements for a trustworthy website specified in this official government document.
Check Here Before Buying Medicines Online
The Internet can be a hazardous place to buy medicines unless the source is legitimate and follows high standards for product quality and delivery. The websites below specialize in evaluating Internet Pharmacy sites and providing other helpful information to consumers. (Access to sites checked December 31, 2012.)
Online Pharmacies You Can Trust
From: LegitScript; updated often.
Go to: http://www.legitscript.com/
(Enter pharmacy name in search box, or click on “Pharmacies” tab for listings.)
LegitScript is a private organization whose mission is to assist consumers and businesses in determining which online pharmacies operate safely and in compliance with Federal and state laws and regulations, as well as with accepted medical standards and ethics. LegitScript Internet-pharmacy verification standards have been recognized by the National Association of Boards of Pharmacy (NABP). This website allows consumers to find the right online pharmacy for them, based on factors such as the state where the online pharmacy is authorized to deliver prescription drugs, pharmacy specialty, method of payment, and other factors.
Safely Buying Medicine Online
From: NABP (National Association of Boards of Pharmacy); updated often.
Go to: http://www.nabp.net/programs/consumer-protection/buying-medicine-online/
NABP (National Association of Boards of Pharmacy) is an independent international association assisting its member boards in developing, implementing, and enforcing uniform pharmacy standards for the purpose of protecting the public health. The organization has reviewed numerous websites selling prescription medicines and has identified those that are accredited through its Verified Internet Pharmacy Practice Sites™ (VIPPS®) or are not recommended because they are out of compliance with state and federal laws or NABP patient safety and pharmacy practice standards.
Buying Medicine & Medicinal Products Over the Internet - FDA
From: U.S. Food & Drug Administration, updated 2012.
HTML page at: http://www.fda.gov/Drugs/ResourcesForYou/.../BuyingMedicinesOvertheInternet/default.htm
Updated resources from the FDA include tips to help you buy medicines safely and securely over the Internet. There also is a one-page list of medicines that absolutely should not be purchased over the internet, and a link to a site where consumers can report Web sites that they suspect are illegally selling drugs, medical devices, and other products.
Patient Medication Wallet Card
From: Iowa Healthcare Collaborative, 2010.
Download MedCard PDF: http://pain-topics.org/pdf/MedCard.pdf
(Access checked 3/29/10)
This convenient document allows you to briefly list your vital personal medical history and to keep track of all of your medications. There are instructions at the website for folding the document down to a wallet-size card. It is a good idea to always bring this with you during visits to the doctor, hospital, dentist, clinic, and pharmacy.
There also is a 2-page Reminder Card that has tips about asking important questions when talking with healthcare providers and pharmacists about your medications. And, it has information about how you can be more safe when it comes to medications.
Download Reminder Card PDF: http://www.ihconline.org/UserDocs/Pages/Medication_Safety_Tips.pdf
(Access checked 3/29/10)
ePain: Electronic Pain Diary
From: Scarth-McKillop Psychologists, Canada; 2011.
Download the software at: http://www.scarthmckillop.ca/epain.html
ePain is an easy-to-use computer program that automates the collection of daily pain ratings for persons with chronic pain. It replaces traditional paper-based pain diaries. The program works on the MS Windows operating system and also requires that you have the Adobe PDF viewer (available free here).
There are separate versions for men and women to (1) rate your current pain, (2) indicate areas that are painful today, and (3) describe how your day was, including your activity level and mood. You can enter as many diary entries as you wish on any given day. Then, you can easily print out reports of the diary to take with you to your next medical appointment.
(Access checked May 27, 2011)
For paper & pencil pain diaries: Chronic Pain [click here] or Headache Pain [click here].
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General Pain Resources
ACPA Consumer Guide to Chronic Pain Medication & Treatment - 2013 Edition
From: American Chronic Pain Association (ACPA); updated 2013; 116 pages.
PDF available at: http://www.theacpa.org/uploads/ACPA_Resource_Guide_2013_Final_011313.pdf
Also see, video presentations of this document: http://www.theacpa.org/medsup/default.aspx
This annual edition is of value for both patients and practitioners. Patient knowledge is important and they benefit from being well informed about their medications and treatments. This excellent document is reviewed each year to provide current information and, beginning with the 2009 edition, the guide features expanded coverage of non-drug interventions and complementary therapy options. Basic information is provided on invasive interventions, such as spinal cord stimulation and implanted intrathecal drug delivery systems, as well as non-invasive passive interventions, like acupuncture and manipulation therapy.
Descriptions of non-opioid analgesics are in a convenient table, and a list of the trade names of commonly used opioid medications precedes an easy to understand explanation of issues related to tolerance, physiological impairment, dependence, addiction, and withdrawal. A checklist helps patients work with their physicians to determine if opioid use is appropriate for their overall health. Uses of antidepressants, anticonvulsants, sedatives, muscle relaxants, and topical analgesics in pain management are discussed to help patients understand why each can be useful. This booklet can be printed or when used online it has many links in the text to additional website resources. Access checked January 15, 2013.
A Patient Resource Guide: Reducing Your Pain
From: Nurse Practitioner Healthcare Foundation; 2011; 19 pages. (Supported by an educational grant from Endo Pharmaceuticals.)
See booklet online at: http://www.myvirtualpaper.com/doc/nphf_pain/p719_b_pain_gtg/2012022301/#0
This booklet begins with an overview of the challenges involved in managing chronic pain and offers useful definitions and tools for understanding chronic pain. A worksheet and a list of questions are provided to help guide meaningful discussions with practitioners about pain. Useful printable pages include forms to help track pain, record medications, and guide self-management of pain. A section on pain therapy includes a description of analgesic medicines, including safety notes, as well as a description of several non-drug treatments that can provide pain relief. The safe use of opioids is described in more detail. This treatment section includes a brief video program that can be easily accessed, and the booklet closes with a list of additional resources for further information on managing pain. [Note: most sections include an option to listen to the content in audio format.] Access checked April 10, 2012.
Pain Relievers: Understanding Your OTC Options
From: American Academy of Family Physicians; Updated January 2011; 2 pages.
See HTML article online at: http://familydoctor.org/x8389.xml.
There is much confusion regarding the use of pain relievers, and products that are readily available over-the-counter are no exception. This brief, easy-to-read article can provide basic guidelines when selecting non-prescription pain medications. It includes information on the types of pain that are relieved by each type of medication and, more importantly, lists certain health conditions that should preclude a patient from taking acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs). Additional PDF links to two related and important tables are provided immediately below. A 3-page table lists potential health effects of drug-drug interactions for selected pain relievers and other common over-the-counter products. And, as an aid to reducing the possibility of unknowingly taking more medication than intended, a 5-page table contains the names of active ingredients for many over-the-counter analgesic products. Access to all sites was checked January 26, 2011.
"Drug Interactions Chart" PDF is available at:
"Know What's in the Medicines You Take" PDF is available at:
In light of recent results of a study published in the October 2006 issue of JAMA, these websites could be exceptionally important to patients who are 65 years and older. The study results, based on a national surveillance of emergency room visits, showed that more than 3% of the visits were due to the adverse effects of nonsteroidal anti-inflammatory drugs alone. In addition, people aged 65 and older were reported as being more than twice as likely to experience an adverse event. (Study reference: Budnitz DS, Pollock DA, Weidenbach KN, et al. National surveillance of emergency department visits for outpatient adverse drug events. JAMA. 2006(Oct);296(15):1858-1866).
Which Analgesics Work Best? What Do They Cost?
From: Consumer Reports Best Buy Drugs, 2008-2011.
Selecting an appropriate analgesic (pain-reliever drug) can be difficult, especially when cost is a concern. The Consumers Union – an independent, nonprofit organization and publisher of Consumer Reports – offers guidance via their public education project, Consumer Reports Best Buy Drugs™. Funding comes primarily from educational grants; reviews are conducted by physicians and researchers. Access to all pages checked August 21, 2012.
The website page for each drug class below provides a brief summary of the pain-relieving benefits of the drugs and has a quick-reference tab for drug comparisons.
A small box on the right-hand side of the description has links to...
- Full Report – ranging 17 to 27 pages – includes a discussion of considerations for choosing an appropriate analgesic for each patient, provides administration recommendations, and compares the effectiveness, safety issues, and relative costs for each drug in the class.
- 2-Page Summaries – in English and in Spanish – include recommendations plus listings of generic and trade names along with dosing and cost information for drug comparison purposes.
> Opioid Drugs
For acute severe pain and sometimes longer-term moderate to severe pain. (2011)
See page: http://www.consumerreports.org/health/best-buy-drugs/opioids.htm
For fibromyalgia, nerve pain, and bipolar disorder. (2011)
See page: http://www.consumerreports.org/health/best-buy-drugs/anticonvulsants.htm
For the treatment of migraine headaches. (2010)
See page: http://www.consumerreports.org/health/best-buy-drugs/triptan.htm
> Nonsteroidal anti-inflammatory Drugs (NSAIDs)
Most frequently used for osteoarthritis and mild to moderate pain. (2011)
See page: http://www.consumerreports.org/health/best-buy-drugs/nsaids.htm
> Laxatives (for drug-induced constipation)
Special edition on constipation discusses effective, economical treatment options. (2008)
See page: http://www.consumerreports.org/health/best-buy-drugs/constipation.htm
NIH Pain Consortium — Pain Information Index
From: National Institutes of Health; provides multiple links to NIH pain management topics.
See HTML options online at: http://painconsortium.nih.gov/pain_index.html.
This NIH website provides an A-Z listing of pain-related conditions as well as treatments and topics related to the management of pain. The list is comprehensive and many topic headings contain multiple links to information sources from various institutes under the NIH umbrella. Subjects range from disease conditions (e.g. Arthritis, Back Pain, Carpal Tunnel Syndrome, Diabetic Neuropathy, Gout, Herpes Zoster, Juvenile Rheumatoid Arthritis, Psoriasis, Trigeminal Neuralgia) to treatment options, including a few that address complementary and alternative medicine issues. Many of the information pieces are in fact-sheet format, but some contain photos (e.g. Shingles) or videos (e.g. Acupuncture for Osteoarthritis of the Knee). The site is easy to navigate and pleasantly devoid of distracting advertising banners. Access checked November 6, 2008.
Two-page Summaries of Common Medical Conditions (with Questionnaires)
From: Taylor MicroTechnology, Inc (TMT); 2006; 41 pages.
Website PDF available at:
This guide contains summaries of 20 medical conditions, half of which relate to common pain conditions. The summaries are highly condensed versions of review articles provided by the National Institutes of Health. The 10 pain-related topics include: Headache, Low Back Pain and Sciatica, Knee Pain, Shoulder Pain, Hip Pain, Toothache, Chest Pain, Jaw Pain and Temporomandibular Joint Disorder (TMJ), Peripheral Neuropathy, and Wrist/Carpal Tunnel Problems. Each summary includes potential causes, symptom differentiation, and standard diagnostic and treatment methods. Most summaries provide a helpful anatomical drawing relevant to the site of pain.
Questionnaires for the 10 conditions listed above are available under the 'Questionnaires' tab on the Taylor MicroTechnology home website, see: http://www.masterdocs.com/pain.htm.
These questionnaires, plus two surveys that can aid in the identification of chronic pain types, ask specific questions that will help a patient define the pain in terms of intensity, duration, location, and precipitating factors. Descriptions of pain symptoms are designed to make it easy for a patient to create a document that will provide the most accurate portrayal of their pain. The final step of the questionnaire includes an optional easy-to-use drawing pad that allows a patient to mark specific regions of pain on a body outline. Most questionnaires will take 10 to 20 minutes to complete and the results can be printed so the patient can take a copy to their healthcare provider.
Taylor MicroTechnology, Inc. (TMT), is a nonprofit organization with 22 years experience in the design of medical diagnostic systems as well as the design and administration of clinical research studies. Access checked November 6, 2008.
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Pain Medications After Surgery
From: Mayo Clinic Staff; 2011.
Article available here: http://www.mayoclinic.com/health/pain-medications/PN00060
Patients should not have to endure severe pain after surgery. This article discusses how modern pain medications and anesthesia can control postsurgical pain and help the body to heal. The best treatment for pain after major or minor surgery requires a careful balance between benefits and risks, and the goal is finding the right balance at each point during and after the procedure. A number of different options for pain relief are described. Access checked April 15, 2013.
Sickle Cell Disease [Including Pain Control]
From: FamilyDoctor.org; Updated 2011; 7 pages.
PDF available here for download: http://familydoctor.org/online/famdocen/home/common/blood/550.html.
A painful sickle cell crisis can occur when sickled red blood cells accumulate and stop the passage of blood flow through narrow blood vessels. This resource reviews sickle cell disease, risk factors, symptoms, diagnostic testing, and complications. Because there are many causes of an acute pain attack and steps can be taken to reduce their frequency, this article provides self-care techniques and prevention tips for patients with sickle cell disease. Access checked April 15, 2013.
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Alternative & Complementary Therapy
Get the Facts: Acupuncture for Pain
From: National Center for Complementary and Alternative Medicine (NCCAM); revised May 2009; 8 pages.
Available online at: http://nccam.nih.gov/health/acupuncture/.
This NCCAM web page offers information on acupuncture therapy for several different pain disorders. The most comprehensive article 'Acupuncture for Pain' is available in HTML format or as an 8-page PDF which can be downloaded by following the links. It provides a brief summary of studies that have been published showing evidence in support of the therapeutic use of acupuncture for a variety of pain conditions. The web page above also offers a link to 'Acupuncture: An Introduction', a 5-page data sheet from NCCAM that provides an overview of acupuncture, a brief hisory of the practice, and a statement about the growth of acupuncture therapy in the United States. Evidence of the safety and effectiveness of acupuncture is explained; tips for finding a licensed practitioner and a short glossary of terms are also included. Access checked August 30, 2010.
Vitamin D: A Champion of Pain Relief
By: Stewart B. Leavitt, MA, PhD, Pain Treatment Topics, June 2008.
Download PDF: http://pain-topics.org/pdf/vitamind-brochure.pdf (200 KB, 6-pages)
Chronic pain – often involving muscles, bones, and joints – is a common problem leading patients to seek medical care. Overcoming these problems may be as simple, safe, and inexpensive as an extra dose of vitamin D each day.
This 6-page brochure explains in easy-to-understand language what vitamin D is and how it works. In also describes how inadequate vitamin D intake may play a role in aches and pains, as well as the benefits of vitamin D supplementation for relieving these symptoms.
Pain Control — How to Use Imagery
From: National Cancer Institute; January 2008; 2 pages.
Available in HTML online at: http://www.cancer.gov/cancertopics/paincontrol/page14.
Imagery can be a useful technique to achieve more effective pain management. Complementary therapies can be added to pharmacotherapy and oftentimes reduce the medication dosage needed to adequately manage pain. This report is part of an NCI booklet on cancer pain management and includes instructions in the use of imagery and breathing exercises to achieve relaxation. Access checked November 6, 2008.
Copies of the complete booklet, entitled 'Pain Control: Support for People With Cancer', is available at no charge from NCI and may be ordered by telephoning 800-422-6237. Access checked November 5, 2008.
Meditation for Health Purposes
From: National Center for Complementary and Alternative Medicine (NCCAM); reviewed 2011; 6 pages.
Available online at: http://nccam.nih.gov/health/meditation/.
Studies have shown that meditation can promote pain relief and reduce other symptoms that can aggravate pain, such as anxiety, depression, and insomnia. Several types of meditation, including the main elements of all meditative practices, are discussed. A brief look at the theories on how meditation affects the body and the specific topics of recent NCCAM scientific studies are included. Access checked March 26, 2012.
Selecting a CAM Practitioner
From: National Center for Complementary and Alternative Medicine (NCCAM); revised 2011; 6 pages.
Available online at: http://nccam.nih.gov/health/decisions/practitioner.htm.
The selection of a complementary or alternative medicine (CAM) practitioner can be confusing and intimidating. This fact sheet offers some key considerations for the patient who is interested in finding and selecting an appropriate CAM therapist. Guidance for the patient regarding the kinds of questions to ask during the initial visit are included. Access checked March 26, 2012.
From: StopPain.org, Beth Israel University Hospital; undated; 15-minute audio with slides
Play audio-visual exercise at: http://www.healingchronicpain.org/content/relax/default.asp.
Relaxation exercises have been shown to reduce pain, anxiety, and depression. This audio-visual program uses visualization and breathing as the basis for relaxation and offers basic instruction for patients who are new to this type of relaxation exercise. The visualization component offers options for three different slide formats: sky, water, and trees. The slides change continually as the speaker gently instructs the user on techniques for focusing on mental images that soothe and comfort and, therefore, relax and aid the release of physical discomforts. This is a useful tool that is instructive and one that can be used repeatedly. Access checked November 6, 2008.
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Arthritis Pain (Osteoarthritis & Rheumatoid)
Managing Osteoarthritis Pain With Medicines: A Review of the Research for Adults
From: U.S. Agency for Healthcare Research and Quality; February 2012.
12-page English language PDF available at: http://www.effectivehealthcare.ahrq.gov/...cons_fin_to_post.pdf
16-page Spanish language PDF available at: http://www.effectivehealthcare.ahrq.gov/...Summary_20120511.pdf
This booklet helps consumers — patients and their caregivers — work with their doctors or nurses in choosing pain-relief medications for osteoarthritis. It is based on an updated review of 270 research reports that evaluated the effectiveness and safety of nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, oral supplements, and analgesic skin creams. The guide describes each type of pain reliever and provides information about the trade-offs between pain relief, risk of problems, and the price of the medications. Access checked July 26, 2012.
American College of Rheumatology Patient Education Fact Sheets
From: American College of Rheumatology (ACR); All revised and/or updated in 2012; 2-4 pages each.
See the list of fact sheets (organized alphabetically by disease or condition) at:
The American College of Rheumatology and the Association of Rheumatology Health Professionals have developed about 40 information sheets on rheumatic diseases and conditions. These include carpal tunnel syndrome, fibromyalgia, back pain, neck pain, tendonitis/bursitis, the many types of arthritis, and many others.
Each fact sheet describes the condition, the diagnostic process, an overview of treatment, and also provides information on locating caregivers who treat patients for the disorder. Some topics are related to one specific aspect of a disorder; several fact sheets are written in both English and Spanish languages. Access checked December 31, 2012.
Arthritis Symptoms by Body Part
From: Arthritis Foundation; undated, multiple topics.
This website offers an easy-to-use pictorial approach allowing the user to select a specific joint on the body and learn more about the diagnosis and treatment of arthritis. The web page for each joint includes links to additional information containing a description of the anatomy for that joint, information on the types of tests needed for a thorough diagnosis, and specific articles for each method of therapy used to help manage symptoms. The treatment considerations for each joint vary but can include discussions on drug therapy, conservative measures such as braces, techniques to reduce pain, and surgical procedures. Access checked 8/27/10.
[Arthritis] Drug Guide
From: Arthritis Foundation; undated, multiple topics.
Medications are frequently taken to treat the symptoms of arthritis and consumers should learn more about drugs that have been prescribed or are available over-the-counter. This information source provides charts according to drug type in a format that includes possible side effects, dosing, and special instructions for each medication. Added sections discuss different types of drugs and their effectiveness in the treatment of arthritis symptoms, ways to minimize drug side effects, and information on the potential dangers of drug interactions when taking multiple medications. Access checked 8/27/10.
Osteoarthritis of the Knee: A Guide for Adults
From: U.S. Agency for Healthcare Research and Quality (AHRQ); April 2009; 4 pages.
PDF available for download at: http://effectivehealthcare.ahrq.gov/repFiles/04082009_OsteoKneeConsumer.pdf
This easy-to-read pamphlet explains knee osteoarthritis in basic terms. Patients are reminded that there is no cure for osteoarthritis. Staying active and losing weight are ways to help you feel better, and some people need to take pain medicine to stay active and control the pain.
Several treatments are mentioned as not being helpful…
> Glucosamine and chondroitin usually do not reduce pain or improve knee movement.
> Joint lubricant shots (not the same as cortisone shots) usually do not reduce pain or improve knee movement.
> Arthroscopic knee surgery usually does not reduce pain or improve knee movement.
A list of questions for patients to consider before visiting their healthcare provider are provided to help ensure good communication. Access checked April 20, 2009.
Additional technical report for healthcare providers…
Summary Guide for Clinicians (April 2009; 4 pages)
Three Treatments for Osteoarthritis of the Knee: Evidence Shows Lack of Benefit
PDF available for download at: http://effectivehealthcare.ahrq.gov/repFiles/20090408_OsteoKneeClinician.pdf
Rheumatoid Arthritis Medicines – A Guide for Adults
From: U.S. Agency for Healthcare Research and Quality; 2008; 12 pages.
PDF available at: http://effectivehealthcare.ahrq.gov/repFiles/RheumArthritisConsumerGuide_Singlepage.pdf
This easy-to-read booklet helps patients and their caregivers work with their healthcare providers in choosing medications for rheumatoid arthritis (RA) that will provide the best symptom relief for inflammation and pain. While the guide does not cover all medications that might be used to treat RA, it does provide a basic introductory guide to DMARDs and their costs administered by 3 different routes (oral, injectable, intravenous). DMARDS, or Disease-Modifying Antirheumatics Drugs, work by altering the immune system to halt the underlying processes that cause certain forms of inflammatory arthritis. The pamphlet explains that while DMARDs can provide symptom relief and slow the progression of disease, they come with some risks that can be reduced by taking a few extra precautions. Access checked March 6, 2009.
Take Control With Exercise
From: The Arthritis Foundation; 2006; 60-minute audio-visual exercise program.
See the Arthritis Foundation website for DVD ordering information:
This audio-visual program demonstrates a variety of exercises that can benefit people with varying levels of disability due to arthritis. The program includes strengthening and range-of motion exercises as well as a relaxation component. The DVD can be purchased for US$19.95 by calling the Arthritis Foundation at 800-283-7800 or by visiting the website listed above. A Pain-Topics.org review of this program is provided under the Education/CME Locator, Resource Review section.
Access to all checked January 20, 2012.
Managing Arthritis Pain — Hot and Cold Treatments
From: University of Washington Medicine; 2005; 2 pages.
See HTML article online at: http://www.orthop.washington.edu/uw/livingwith/tabID__3376/ItemID__96/....
Patients are frequently confused about the use of heat or cold packs for pain relief. This information sheet provides tips on how to use both effectively, including the rationale behind using one or the other. The article includes safety tips when using heat or cold therapy. Access checked November 6, 2008.
Handout on Health: Rheumatoid Arthritis
From: National Institute of Arthritis and Musculoskeletal and Skin Diseases; reviewed July 2009.
Available online at: http://www.niams.nih.gov/Health_Info/Rheumatic_Disease/default.asp .
The pain and inflammation associated with Rheumatoid Arthritis, an autoimmune disease, are manifested differently from one patient to another. This booklet describes these differences and is helpful for patients, as well as family members and friends. The symptoms and progression patterns of the disease are presented in an easy to understand manner. The exact causes of rheumatoid arthritis are unknown, but this booklet presents what is currently known about the factors that could play a part in this immune disorder. Treatment can be a multi-faceted combination of medical care and self-care. A list of commonly used prescription drugs for rheumatic diseases, including each drug's benefits and potential side effects, is presented in a convenient table. This booklet encourages the patient to monitor lifestyle behaviors to ensure adequate rest, appropriate levels of activity, a nutritious diet, and low stress levels. A section on alternative and complementary therapies suggests that patients first discuss any therapy they are considering with their doctor. Access checked August 4, 2009.
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From: National Cancer Institute; revised April 2010; 12 pages.
Available online in HTML at: http://www.cancer.gov/cancertopics/pdq/supportivecare/pain/patient/allpages.
Effective cancer pain management begins with assessment and this article includes a good tip list for the patient to use when describing pain to healthcare professionals, including their emotional and behavioral responses. The WHO 3-step approach to pain management and the various classes of analgesic drugs are discussed briefly. This guide encourages patients to consider noninvasive physical and psychological interventions as an adjunct to drug therapy, and also provides instructions for 4 common relaxation techniques. The issues involved in assessing and treating older patients are summarized nicely. This HTML text contains web links to other PDQ summaries for managing medication side effects, nausea and gastrointestinal complications, nutritional concerns, and sexuality and reproductive issues.
The link provided above includes a tab for the 54-page Health Professionals version (updated February 2011) as well as a Spanish-language tab for access to both the Patient and Health Professionals versions. Copies of this booklet are available at no charge from NCI and may be ordered by telephoning 800-422-6237. Access checked March 4, 2011.
Pain Control: A Guide for People with Cancer & Their Families
From: American Cancer Society (ACS), latest revision November 2008; 31 pages.
HTML document available online at: http://www.cancer.org/docroot/MIT/content/MIT_7_2x_
Pain can present many challenges for a cancer patient and family members. This easy-to-read document explains the types and origins of pain associated with cancer, and the obstacles that can interfere with its treatment. A list of sample questions about the pain experience are provided as an aid to a patient's preparation for an appointment with their healthcare provider. The need for pain assessment is explained. Alternative treatments, non-opioid drugs, and weak and strong opioids are defined using specific examples. The concept of adjuvant analgesics — specifically, antidepressants, anticonvulsants, steroids, and topical anesthetics — are explained. Techniques for scheduling medications and managing side effects are offered. Various other therapies, as well as the importance of psychosocial and emotional support, are discussed and a useful glossary of terms is provided. Access checked December 30, 2008.
Pain Control — Other Ways to Control Pain
From: National Cancer Institute (NCI); 2008; 4 pages.
Available online in HTML at: http://www.cancer.gov/cancertopics/paincontrol/page8.
Nondrug therapy can provide effective pain management as a stand-alone treatment or in concert with pharmacotherapy. Complementary therapies can oftentimes reduce the medication dosage needed to adequately manage pain. This report is part of an NCI booklet on cancer pain management and includes information on 13 different pain relieving techniques. Some techniques are explained in detail (relaxation, deep breathing, imagery) while other treatment modalities are simply described (Tai Chi, yoga, Reiki). Special precautions are suggested for any treatments that require advanced knowledge.
Copies of the complete booklet, entitled 'Pain Control: Support for People With Cancer', is available at no charge from NCI and may be ordered by telephoning 800-422-6237. Access checked November 5, 2008.
Pain Management (Blood Cancer)
From: The Leukemia & Lymphoma Society; October 2005; 14 pages.
Website PDF available at: http://www.leukemia-lymphoma.org/attachments/National/br_1130788384.pdf.
Also online in HTML at: http://www.leukemia-lymphoma.org/all_mat_toc.adp?item_id=104411&cat_id=1214.
In this patient booklet, the types of pain related to blood cancers (leukemia, lymphoma, and myeloma) are described and the patient is reassured that the pain can usually be managed by oral medications. The descriptions of the differences between acute, chronic, and breakthrough pain are easy to understand. This handout makes suggestions on how to prepare for good communication with healthcare staff and supplies a list of words to use to effectively describe pain. A list of questions is provided that can be useful for patients when asking their physician about medication use to treat their pain. The tools for patient use that are provided include the 1) numerical pain rating scale, 2) the FACES pain scale, and 3) a pain diary sheet that can be copied and used repeatedly. Access checked November 6, 2008.
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Chronic & Intractable Pain
The Management of Persistent Pain: Resources for Older Adults and Caregivers
From: AGS (American Geriatrics Society) Foundation for Health in Aging. Updated regularly.
Go to: http://www.healthinaging.org/
This site provides practical and easy-to-use tools intended to help older adults and their caregivers better manage persistent pain in consultation with their physicians and other health care providers. Available resources, include:
- Patient Education Forum — includes frequently asked questions with answers on the assessment and management of persistent pain.
- My Pain Diary — to help describe and keep track of how and when pain is experienced.
- My Medication and Supplement Diary — helps record and keep track of all prescription drugs, over-the-counter medications, and natural remedies being used.
- Assessing Pain in Loved Ones with Dementia — a brochure for family members and other caregivers provides advice on assessing pain in older adults with dementia.
- Eldercare at Home — is a comprehensive online guide for family caregivers, offering an orderly problem-solving approach to managing pain at home and working cooperatively with health care providers.
These resources were developed in collaboration with the American Geriatrics Society (AGS) and are based on the new AGS clinical practice guideline for health care providers entitled Pharmacologic Management of Persistent Pain in Older Persons. See details…>
My Pain Management
From: Leonard Schanfield Research Institute (LSRI) at CJE Senior Life; 2008.
Go to website at: http://www.mypainmanagement.net (Free registration is required.)
My Pain Management is a website that is most appropriate for people who are experiencing chronic pain. The site provides a variety of exercises for managing pain, which are not intended to be specific to a particular condition or cause of pain. Since the symptoms of pain can vary and pain is a very personal experience, everyone will have different ways of handling their pain. This website was developed and tested by the Leonard Schanfield Research Institute (LSRI) at CJE Senior Life in Chicago, IL, and it was demonstrated as being helpful for persons of all ages suffering from chronic pain conditions.
Intractable Pain Patient's Handbook for Survival
By: Forest Tennant, MD, DrPH; from Pain Treatment Topics, 2007, 36 pages.
PDF available here for download: IntractablePainSurvival.pdf (459 KB)
This first-of-its-kind handbook, exclusively available from Pain Treatment Topics, is specifically for persons with intractable pain, or IP. This is pain more serious than typical chronic pain conditions; such as arthritis, headaches, back pain, bunions, and others. IP involves severe and often disabling pain that never stops; and, it can also harm heart function, hormonal balance, and other body systems if undertreated.
According to the author -- Dr. Forest Tennant, who has more than 30 years experience as an IP-treatment specialist -- IP afflicts a small percentage of persons with chronic pain. Consequently, many healthcare providers do not know how to effectively treat IP, which requires a customized treatment plan often involving a combination of strong medications. This unique handbook takes a no-nonsense approach, explaining in everyday language how to communicate with healthcare providers, insurance companies, family, and others to receive proper care. Dr. Tennant also offers advice on medication options and safety, diet and weight control, how to adopt a positive attitude, and many other helpful suggestions for not only surviving IP but improving one's quality of daily living with this chronic and severe condition. Access checked November 6, 2008.
Surviving a Loved One's Chronic Pain
By: David Kannerstein, PhD and Sarah M. Whitman, MD; from Practical Pain Management; 2007; 4 pages.
PDF available here for download: LovedOnesChronicPain.pdf
This article is suggested as a handout for patients' families, friends, or caretakers to help them understand what patients in chronic pain are going through. It provides guidance for understanding chronic pain and its treatment, and how to best communicate with and provide support to the patient. It recognizes that dealing with severe, ongoing pain can be overwhelming for both patients and those who care for them and/or about them. Access checked November 6, 2008.
Mistakes Made by Chronic Pain Patients
A patient guide for avoiding pitfalls and becoming part of their pain management team to restore a better quality of life.
By: Ron Lechnyr, PhD, DSW and Terry Lechnyr, PhD, LCSW; from Practical Pain Management; 2007; 3 pages.
PDF available here: http://pain-topics.org/pdf/mistakes-by-chronic-pain-patients.pdf (56 KB)
Entering the world of chronic pain is a confusing and difficult process for patients, as well as their caregivers. Often they do not understand the basics of pain management approaches to long-term care. However, helping patients to become aware of various potential problems and mistakes ahead of time, will allow them to respond differently and learn how to become part of the pain management team.
This guide is intended for healthcare providers to give to patients, and their caregivers, at the start of treatment for any chronic pain problem. Knowledge is power and it can help reduce what may appear to healthcare providers as 'treatment resistance' on the part of patients or their loved ones.
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From: American College of Rheumatology (ACR); Updated 2012; 6 pages.
Website PDF available at:
This factsheet provides an overview of fibromyalgia syndrome, from definition to treatment. Because fibromyalgia symptoms can vary from patient to patient, the full range of potential symptoms are listed, and a graphic depiction of the common "tender points" associated with fibromyalgia pain is provided. Medications for symptom relief, complementary beneficial therapies, and techniques for improving the daily quality of life are all reviewed. The rationale for utilizing the diagnostic expertise of a rheumatologist is explained. Access checked November 29, 2012.
From: Mayo Clinic; Updated February 2008; 8 pages.
See HTML article online at: http://www.mayoclinic.com/health/fibromyalgia/DS00079
Authors at Mayo Clinic address some of the frustrations related to diagnosis, risk factors, and various chronic symptoms of fibromyalgia syndrome. This information resource explains the American College of Rheumatology classification criteria for diagnosis and includes a diagram of the common locations of physical pain and tenderness. A discussion of treatment includes information on effective drugs as well as techniques for self-care. The section on medications includes the benefits of using analgesics, antidepressants, muscle relaxants, and Lyrica®, an anti-convulsant recently FDA-approved for the treatment of fibromyalgia. Complementary therapies that have shown some evidence for effectiveness in the relief of fibromyalgia symptoms are discussed. Access checked November 6, 2008.
What is Fibromyalgia? Fast Facts: An Easy-to-Read Series of Publications for the Public
From: National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); Updated July 2009; 3 pages.
English-language PDF available at: http://www.niams.nih.gov/Health_Info/Fibromyalgia/fibromyalgia_ff.pdf
Spanish-language PDF available at: http://www.niams.nih.gov/Portal_en_espanol/Informacion_de_salud/Fibromialgia/fibromyalgia_ff_espanol.pdf
These factsheets on fibromyalgia syndrome provide a brief, easy-to-read overview of the common symptoms, contributing factors, and treatments known to provide some symptom relief. The handout emphasizes that a team approach to professional diagnosis and treatment is common. The factsheet is ideal for patients who are in the diagnostic process and others who are unfamiliar with fibromyalgia syndrome. Access checked December 10, 2009.
Questions and Answers About Fibromyalgia
From: National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); Updated April 2009; 6 pages.
See HTML article online at: http://www.niams.nih.gov/Health_Info/Fibromyalgia/default.asp
Fibromyalgia syndrome, a common disorder of unknown etiology, is characterized by widespread chronic pain which is frequently accompanied by multiple symptoms — like fatigue, sleep disturbances, headaches, irritable bowel syndrome, and memory problems — that can reduce the quality of life. This factsheet describes current scientific knowledge related to possible causes of the syndrome, best diagnostic practices, and the most effective forms of therapy. Additional topics include behavioral changes that a patient can initiate to minimize the impact of fibromyalgia, as well as tips for improving sleep. The final section provides an overview of the current research being conducted to learn more about the disorder. The booklet is ideal for newly-diagnosed patients, as well as family members, friends, and others who would like to learn more about fibromyalgia syndrome. Access checked December 10, 2009.
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From: Office on Women's Health; 2008; 9 pages.
Website PDF available at: http://www.womenshealth.gov/.../fact-sheet/migraine.pdf
Also available online in HTML at: http://www.womenshealth.gov/.../fact-sheet/migraine.cfm
This booklet uses a 'Frequently Asked Questions' format and provides answers to 17 questions. The topics covered include the causes of a migraine, the types of migraines, headache as it relates to a woman's menstrual cycle, migraines in pregnancy, and treatments. Topics on treatment include medications as well as an emphasis on modifying lifestyle factors. The writers encourage women to keep a headache diary as a useful tool to learn more about what triggers headache episodes.
The womenshealth.gov website is a service of the Office on Women's Health (OWH) in the US Department of Health and Human Services. The OWH provides valuable information on many Women's Health Topics at: http://www.womenshealth.gov. Access checked January 20, 2012.
Patient Headache Diary Information
Pain journals or diaries are valuable tools to help patients identify patterns in the timing and intensity of headaches. A diary can also help a patient to notice foods, lifestyle factors, or environmental changes that trigger headaches. These tools are a valuable asset in the assessment process and there are three different forms available for patients to print and use at home. Remind your patient to bring their completed diary pages to their next appointment.
Access to following sites was checked November 6, 2008.
From: American Academy of Neurology
A 1-page Trigger Tracker that provides a list of possible headache triggers plus tips on how to keep notes in a headache diary is available at:
From: National Headache Foundation
Two single-page handouts — a 1-page diary "how-to" sheet for keeping a useful diary plus a printable diary form to record all aspects of headache episodes — are available at:
From: University of California Berkeley Health Services
A 2-page handout on Migraine Triggers that covers lifestyle and environmental triggers in addition to a full page of common food triggers is available at:
A 1-page printable patient diary (2 forms per page) for notations of all aspects of headache episodes that includes a space for treatment notes is available at:
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Musculoskeletal Pain (Back, Neck, & Joint)
JAMA Patient Page: Sciatica
From: American Medical Association. JAMA. 2009;302(2):216.
See HTML article at: http://jama.ama-assn.org/cgi/content/full/302/2/216
This one-page patient handout from the Journal of the American Medical Association focuses on sciatica — the term for low back pain spreading into the buttock, hip, and down one leg to the foot. The pain often is associated with tingling, numbness, or weakness of the leg due to pinched nerves. The most common cause of sciatica is a herniated disk and colorful illustrations in this handout clearly show the anatomy involved in this disease process. Access checked August 4, 2009.
Information From Your Family Doctor. Low Back Pain
From: American Academy of Family Physicians (AAFP); 2007; 3 pages
See HTML article online at: http://www.aafp.org/afp/20070415/1190ph.html
This question-and-answer sheet from the American Family Physician provides a good summary of the basic issues related to low back pain. In addition to a general discussion on the causes of back pain, 2 drawings can serve as an aid to an improved understanding of the physiology involved. Several tips and techniques for pain relief and the prevention of back injury are offered. Access checked November 6, 2008.
Low Back Pain Fact Sheet
From: National Institute of Neurological Disorders and Stroke (NINDS); Updated in December 2011; 8 pages.
See HTML factsheet online at: http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm
This factsheet covers back pain basics, including a description of the anatomy of the back and a brief definition of acute versus chronic pain. The causes of low back pain, plus the names and descriptions of conditions that cause it are discussed. Explanations of the methods used for a thorough diagnosis, including a description of all tests that could be prescribed, are presented. Potential treatments, from self-care to surgery, are described and tips for prevention and back-strengthening are offered. Access checked April 10, 2012.
What Is Back Pain?
From: National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); 2009; 5 pages.
PDF of factsheet available here for download: http://www.niams.nih.gov/Health_Info/Back_Pain/back_pain_ff.pdf
This easy-to-read factsheet contains a good summary of the causes of back pain as well as options for prevention. A concise checklist of specific symptoms that should alert a patient to see a doctor precedes an explanation of the various types of treatment available for back pain. Access checked January 17, 2011.
Handout on Health: Back Pain
From: National Institute of Arthritis and Musculoskeletal and Skin Diseases; July 2010; 12 pages.
See HTML version of this booklet online at: http://www.niams.nih.gov/Health_Info/Back_Pain/default.asp
This booklet is for patients with back pain, as well as family members, friends, and others who want to learn more about it. In straightforward language, the booklet describes causes, diagnoses, and treatments, and research efforts seeking to learn more about back pain, many of which are supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and other components of the Department of Health and Human Services' National Institutes of Health (NIH). Patients having further questions after reading this booklet, can discuss them with their healthcare providers.
Topics covered include: How common is back pain and what are the causes? When should I see a doctor for pain? How is back pain treated?
Copies of this booklet are available at no charge from NIAMS and may be ordered using the contact information at the bottom of the website noted above. Access checked January 17, 2011.
Anatomy Guide: Low Back Disorders
From: WebMD; 2004; 6 pages
See animations online at: http://www.webmd.com/content/tools/1/anatomy_low_back.htm?z=3628_81000_0000_03_04&src=pemedscape
This web page presents an animated display of the pathophysiology of 6 low back disorders. Each animation offers a good depiction of how physiological changes in the body cause the pain experienced by the patient. Each disorder is described in one paragraph of text and an animation displays the changes in normal physiology for the following 6 disorders: herniated disc, spinal stenosis, osteoporosis, osteoarthritis, ankylosing spondylitis, and spondylisthesis. To see the animation, click the button marked 'Click for Animation', then, when the animation begins, click on the 'View Labels' button to display anatomical landmarks. Access checked November 6, 2008.
Lower Back Pain: Self-Care Flow Chart
From: American Academy of Family Physicians (AAFP); 1996; 1 page.
See HTML chart online at: http://familydoctor.org/online/famdocen/home/tools/symptom/531.printerview.html
Back pain is common, but its causes range from minor strains to serious disorders and injuries. This self-care flow chart from AAFP helps to guide patients through a series of yes-&-no questions about their symptoms to assist them in decision-making related to seeking medical help. It is meant to help educate the patient with low back pain and not to serve as the sole tool in the decision-making process. Access checked November 6, 2008.
Back Pain Exercises
A healthcare provider should be consulted before beginning an exercise program for back pain. The following resources provide instructions and/or demonstrations of back exercises that may be beneficial in healing or preventing back pain.
From: MedlinePlus Patient Education Institute; Updated in 2005; 69 slides.
Access the audio-visual program online at: http://www.nlm.nih.gov/medlineplus/tutorials/backexercises/htm/_no_50_no_0.htm
This easy-to-follow audio-visual slide program begins with an explanation of the benefits of back exercise and emphasizes that regular stretching and strengthening exercises can prevent back pain. A few general tips on the safe and effective implementation of an exercise routine are presented and would be exceptionally beneficial for the beginner who has not previously received such guidance. Stretching and strengthening exercises are demonstrated with the use of drawings; specific muscles being exercised are indicated in each graphic. Access checked November 6, 2008.
Low Back Pain Exercise Guide
From: American Academy of Orthopaedic Surgeons; 2007; 5 pages.
See HTML article online at: http://orthoinfo.aaos.org/topic.cfm?topic=A00302
To meet the needs of patients at various levels of recovery and ability, this handout provides basic descriptions and drawings to instruct patients in performing 15 back strengthening exercises at 3 different levels: initial, intermediate, and advanced. The exercise ball is used in several intermediate and advanced exercises. Access checked December 10, 2009.
From: American College of Rheumatology (ACR); updated August 2009; 4 pages
See HTML article online at:
This patient fact sheet provides a good summary of basic important facts about neck pain. Diagnostic techniques and causes of neck pain are discussed; specific description of spinal stenosis, osteoarthritis, and intervertebral disc herniation are included. Prevention is covered in a cursory manner but patients could benefit from the techniques for treating neck pain which are provided. Access checked February 9, 2010.
Practical Management of Whiplash
From: British Columbia Medical Association; 2002; 5 pages.
PDF available here for download: http://www.bcmj.org/article/practical-management-whiplash-guide-patients (275 KB)
This handout begins with a question-and-answer section that addresses many patient uncertainties regarding different types of whiplash, diagnosis, treatment, and the recovery process. The second half of the handout discusses the need for neck-specific exercises, suggests precautions, and describes 5 exercises in detail (including graphic instructions for implementation). Access checked December 13, 2010.
JAMA Patient Page: Knee Pain
From: Journal of the American Medical Association (JAMA); April 2007(Apr);297(15):1740. 1 page.
PDF available online at: http://jama.ama-assn.org/cgi/reprint/297/15/1740
HTML version also available online at: http://jama.ama-assn.org/cgi/content/full/297/15/1740
This patient information page provides a good overview of the causes of knee pain, including recommendations for initial care and guidelines regarding when to get medical advice. The drawings of the knee are nicely detailed and include the ligaments that are frequently injured. Access checked November 6, 2008.
TMJ (Temporomandibular Joint) Disorders
From: National Institute of Dental and Craniofacial Research; 2006; 20 pages.
PDF available here for download: http://www.nidcr.nih.gov/NR/rdonlyres/39C75C9B-1795-4A87... (687 KB)
This booklet from the National Institutes of Health describes TMJ disorder, its causes, and other conditions that may challenge a patient simultaneously. Diagnosis and the symptoms of TMJ are discussed briefly. An overview of treatment—from conservative measures and self-care treatments to surgery—provides brief information on the current thinking regarding effectiveness for pain relief in TMJ. The booklet suggests that readers need to be cautious in finding a qualified practitioner and warn against choosing treatments that will cause permanent changes in the jaw. Access checked November 6, 2008.
From: American College of Rheumatology (ACR); 2009; 4 pages.
See HTML article online at:
The pain of tendonitis or bursitis can be severe and can occur suddenly. This factsheet defines tendonitis and bursitis—each caused by an inflammatory reaction involving the elbow, knee, hip, wrist, ankle, or shoulder—and includes a discussion of diagnostic methods. Treatment approaches are described and prevention methods that may reduce the risk of injury are explained. Access checked February 9, 2010.
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Nerve (Neuropathic) Pain
About Neuropathic Facial Pain and TN (Trigeminal Neuralgia)
From: TNA-The Facial Pain Association; Undated; 2 pages. A Pain Treatment Topics affiliate organization.
See HTML article online at: http://www.fpa-support.org/knowledge-base/about-facial-pain-tn/general-information/
Trigeminal neuralgia is a nerve disorder that can be very painful and somewhat challenging to diagnose. This webpage provides a description of trigeminal neuralgia and other less common nerve disorders that cause facial pain. The site also provides a good drawing of the placement of the trigeminal nerve in relation to other facial structures. Several links are available to the reader for additional descriptions of facial nerve pain and a 22-item diagnostic questionnaire that could benefit patients and practitioners during the diagnostic visit. Access checked November 1, 2010.
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Opioid & Other Medication Safety
How to Travel with Opioids
From: PainAction/Inflexxion. 1-page handout.
PDF available at: http://www.painaction.com/uploadedFiles/General/Documents/actionStep10.pdf
This 1-page patient handout provides important tips for patients who must travel with opioid analgesics. The handout emphasizes the importance of pre-trip planning — including packing an ample supply of prescribed medications and having access to all paperwork that could become needed. Health insurance cards, written prescriptions, and letters from healthcare providers can provided added security if a prescription refill is required. Access checked May 9, 2013.
See additional travel safety tips in the section “How can I prevent problems with opioids?” at the Opioids911 website, here: http://www.opioids911.org/prevent.php
Help for Safely Using Opioid Pain Relievers
From: Pain Treatment Topics, 2010-2013.
See website at: http://Opioids911.org
Opioids911-Safety is an independent, noncommercial, Internet-based educational activity from Pain Treatment Topics for patients and their family caregivers focusing on the proper and safe use of opioid pain relievers. The mission is to provide an understanding of opioid analgesics and their various risks, and to suggest specific actions for preventing opioid-related problems, including: misuse, abuse, addiction, diversion, adverse reactions, overmedication, and life-threatening overdose. Instruction is provided on recognizing opioid problems if they do occur and on being prepared for what to do during an emergency. Access checked 10/15/10.
Hydrocodone with Acetaminophen – Consumer Safety Tips
From: Institute for Safe Medication Practices (ISMP); 2012; 2 pages.
PDF available for download: http://www.ismp.org/tools/highalertmedications/hydrocodone.pdf
This consumer leaflet on the safe use of hydrocodone with acetaminophen was developed by ISMP as a resource for people who need this high-alert medication to manage their pain. A high-alert medication is defined as a drug that is considered safe and effective when used as prescribed, but carries a much higher risk of causing harm when the drug is used improperly or taken by the wrong person. This 2-page fact sheet covers the most important safety information — tips for proper use, managing constipation, storage safety, and product disposal — in an easy-to-read format. The table on page 2 covers the most important aspects of using the drug, including dosing limits, special precautions, adverse effects that require urgent attention, and other drugs and OTC products that should be avoided when taking hydrocodone with acetaminophen. Access checked December 6, 2012.
Oxycodone with Acetaminophen – Consumer Safety Tips
From: Institute for Safe Medication Practices (ISMP); 2012; 2 pages.
PDF available for download: http://www.ismp.org/tools/highalertmedications/oxycodone.pdf
This consumer leaflet on the safe use of oxycodone with acetaminophen was developed by ISMP as a resource for people who need this high-alert medication to manage their pain. A high-alert medication is defined as a drug that is considered safe and effective when used as prescribed, but carries a much higher risk of causing harm when the drug is used improperly or taken by the wrong person. This 2-page fact sheet covers the most important safety information — tips for proper use, managing constipation, storage safety, and product disposal — in an easy-to-read format. A table on page 2 covers the most important aspects of using the drug, including dosing limits, special precautions, adverse effects that require urgent attention, and other drugs and OTC products that should be avoided when taking oxycodone with acetaminophen. Access checked December 6, 2012.
Fentanyl Patches – Consumer Safety Tips
From: Institute for Safe Medication Practices (ISMP); 2012; 2 pages.
PDF available for download: http://www.ismp.org/tools/highalertmedications/fentanyl.pdf
This consumer leaflet on fentanyl patches was developed by ISMP as a safety resource for people who need this high-alert medicated patch to manage their pain. A high-alert medication is defined as a drug that is considered safe and effective when used as prescribed, but carries a much higher risk of causing harm when the medication is used improperly or by the wrong person. This 2-page fact sheet covers the most important safety information — tips for proper use, storage safety, and patch disposal — in an easy-to-read format. The table on page 2 covers the most important aspects of using the patch, including how to handle a missed dose, special precautions, adverse effects that require urgent attention, and other drugs and OTC products that should be avoided during fentanyl patch use. Access checked December 6, 2012.
FDA Fact Sheets on Unused Medicine Disposal [including Opioids]
Improper disposal of unused prescription drugs raises concerns from both environmental and societal perspectives. A particular problem is that the improper disposal of opioid pain relievers has led to their diversion and misuse. The list of specific controlled analgesic drugs that should be disposed by flushing is provided in the first fact sheet below. These 2 brief handouts present summaries of the guidance contained in the Federal guidelines for prescription drug disposal that went into effect in February 2007 and include subsequent revisions. Access updated 5/4/10.
From: U.S. Food and Drug Administration; “Disposal by flushing of certain unused medicines [opioids]: what you should know”; 2010 (March); 3 pages.
See: http://www.fda.gov/Drugs/ResourcesForYou/... /ucm186187.htm
From: U.S. Office of National Drug Control Policy and the FDA; "How to Dispose of Unused Medicine"; 2009 (October); 2 pages.
See: http://www.fda.gov/downloads/Drugs/ResourcesForYou/... /ucm107163.pdf
Follow Directions: How to Use Methadone Safely
From: SAMHSA/FDA; 2009.
See brochure: http://www.dpt.samhsa.gov/methadonesafety/print_materials.aspx
Methadone often provides relief for patients who do not respond to other pain medicines. When taken as prescribed, methadone is safe and effective; but all medicines have risks. Patients need to understand the power and physical effects of methadone in order to get maximum benefits. This 8-page brochure available in English and Spanish provides background information on safely using methadone and steps for navigating the risks and recognizing dangerous side effects. Accessed checked April 29, 2009.
A Guide to Safe Use of Pain Medicine
From: U.S. Food & Drug Administration; February, 2009.
See HTML document online:
This helpful document from the U.S. FDA discusses safety concerns with the various types of pain-relief medicines. These come in many forms and potencies, are available by prescription or over-the-counter (OTC), and treat all sorts of physical pain — including pain brought on by sudden trauma, chronic conditions, and cancer. The document discusses the different types of pain relievers and their active ingredients, how they must be used as directed, concerns about misuse and abuse, and 3 steps for safely using opioid pain relievers. The document also is available for download as a 3-page brochure. Access updated 6/1/09.
Methadone Safety Handout for Patients [in English and Spanish]
From: Pain Treatment Topics, updated March 2008; 7 pages.
PDF available here for download: MethadoneHandout.pdf (266 KB)
These special 2-page Handouts for patients and their families or caretakers (in English and Spanish) offer vital instructions for treatment compliance and safety.
When appropriately prescribed and used, methadone is a safe medication offering effective and economical relief for chronic pain. However, patients must clearly understand that misuse or abuse of this strong opioid can be fatal. Taking extra doses or mixing methadone with alcohol or other drugs can have dire consequences. They also must appreciate the importance of safeguarding the medication from unauthorized access by other persons, children or adults. It should not be casually stored as other medications might be. NOTE: These instructions do not take the place of practitioner-provided guidance or the methadone package insert. Access checked November 6, 2008.
Pain - Opioid Facts
From: PainKnowledge.org, Thomson Professional Postgraduate Services; 2007; 2 pages.
PDF available here for download: http://www.painknowledge.org/patiented/pdf/... (350 KB)
This factsheet provides patients with a good overview of the commonly prescribed opioids, routes of administration, and tips for taking them. Several concerns regarding addiction, dependency, and adverse effects are addressed in a question-and-answer format. Definitions for addiction, misuse, dependence, and tolerance are provided. Access checked November 6, 2008.
Patient Instructions Handout: Safely Taking Oxycodone [in English and Spanish]
From: Pain Treatment Topics; June 2007; 7 pages.
PDF available here for download: OxycodoneHandout.pdf (350 KB)
These special 2-page, peer-reviewed “Patient Instructions” handouts on the safe use of oxycodone are available in English and Spanish and can be downloaded and reproduced free of charge for distribution at the time oxycodone analgesia is prescribed. Ideally, these also would be used as discussion guides for face-to-face education of patients — and their families or caregivers. The emphasis of the handouts is on medication compliance and safety, to help prevent misuse and avoidable adverse events potentially associated with oxycodone analgesia therapy. Access checked November 6, 2008.
Facts About Prescription Drug Abuse
From: U.S. National Institute on Drug Abuse; April 2005; 2 pages.
PDF available here for download: RxDrugAbuseFacts.pdf
This brief fact sheet describes the most commonly misused or abused prescription drugs, and how the reader can help prevent such problems. A convenient reference table lists the drugs by category and name, and provides examples of commercial or street names, how they are administered, intoxication effects, and potential health consequences. Access checked November 6, 2008.
Fact Sheets For Families: Acetaminophen Safety
From: California Childcare Health Program; 2002; 1 page.
PDF available here for download: http://www.ucsfchildcarehealth.org/pdfs/factsheets/acetaminen011804.pdf
This fact sheet alerts consumers to the dangers of using acetaminophen inappropriately. Information is provided on potential side effects, the symptoms of intoxication, and the types of individuals who may be at risk for toxicity. Tips for using acetaminophen safely are discussed. Access checked November 6, 2008.
Buying Prescription Medicine Online: A Consumer Safety Guide
From: U.S. Food and Drug Administration; undated; 2 pages.
PDF available here for download: BuyRxOnline.pdf
This pamphlet points out the many dangers of buying prescription drugs over the Internet. Helpful tips are provided for identifying legitimate websites and safe practices to follow when ordering online. Links to additional government websites are provided for further information. Access checked November 6, 2008.
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Palliative Care: What You Should Know
From: Center to Advance Palliative Care; 2012; 1 page.
PDF available online at: http://www.getpalliativecare.org/wp-content/uploads/2012/10/GetPCHandoutRevised.pdf
This one-page handout briefly describes palliative care and how it can help those with pain and other symptoms of serious illness. Many patients and their families don't know that palliative care can be used alongside curative treatments and is not only for end-of-life situations. Readers are referred to the website http://www.getpalliativecare.org for further information. Access checked November 12, 2012.
Hospice – Myths About Pain
From: Hospice Foundation of America; 2007; 2 pages.
HTML article available online at: http://www.hospicefoundation.org/pages/page.asp?page_id=86538
End-of-life care frequently requires aggressive pain management and patients can be fearful of potential side effects as well as withdrawal and tolerance issues. This web page addresses 14 common concerns voiced by patients and their families. The 2-page document can be printed to provide patients with further information and reassurance that stronger pain medications can be used safely and comfortably. Access checked March 26, 2011.
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Shingles / PHN (Postherpetic Neuralgia)
Important Note: Several resources presented in this section refer to the availability of Zostavax®, a shingles vaccine for adults 60 years and older. However, in March 2011, the FDA lowered the age for the vaccine to include persons 50 years and older.
Shingles [JAMA Patient Page]
By: Torpy JM, Burke AE, Golub RM; from Journal of the American Medical Association; 2011; 1 page.
PDF available online at: http://jama.ama-assn.org/content/305/2/212.full.pdf+html
This concise information page explains the cause of shingles, describes symptoms, and presents options for treatment. A descriptive photo of the shingles rash, a short explanation of the potential complication of postherpetic neuralgia, and additional resources help to provide a full overview of the condition. Access checked June 14, 2011.
Shingles: Hope Through Research
From: National Institutes of Health, National Institute of Neurological Disorders and Stroke; updated February 2011.
This National Institutes of Health web page provides a basic overview of shingles and postherpetic neuralgia (PHN), a complication of shingles. In question and answer format, information is provided on the risk of contagion and the potential risk to an unborn child when a mother-to-be contracts the infection during pregnancy. The section on prevention includes a brief report of the positive results of the Zostavax® vaccine. The website also offers a link to a Spanish language version on this topic. Access checked June 14, 2011.
Shingles Vaccination: What You Need to Know
From: Centers for Disease Control and Prevention (CDC); updated January 2011.
The Centers for Disease Control and Prevention recommends Zostavax® — the one-time shingles vaccine — for adults aged 60 and older. This website provides a basic overview of the vaccine, including information on possible reactions to the vaccine and a list of people who should not receive the shingles vaccine. Note: The vaccine was previously approved for persons 60 years of age and older but is now recommended for persons aged 50 and older. Access checked June 14, 2011.
Patient Information: Shingles
From: UpToDate for Patients; updated August 2010.
This easy-to-read patient information page provides a basic overview of shingles, also known as the herpes zoster virus. It includes a thorough list of complications, several of which offer a link to additional information on the complicating event. The names of commonly used antiviral and pain-relieving drugs used in the treatment of shingles are provided, along with the rationale for their use. Access checked June 14, 2011.
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Healing Inspirations for Living with Pain
These resources are not intended to replace appropriate medical care, and should not be viewed as trivializing the struggles of dealing with pain by simply providing inspiration or the unspoken message to “learn to live with it.” While modern medicine can do much to allay the physical experience of pain, certain dimensions of pain can be difficult to treat and may benefit from other approaches. Pain Treatment Topics has no financial interest in these offerings and does NOT receive any compensation from their publishers or providers.
Stories of Hope
Living in Serenity with Chronic Pain and Chronic Illness
By: Chronic Pain Anonymous members, 2012, 155 pages.
Order at https://www.createspace.com/4030523 or Amazon.com (enter title in search box)
Soft Cover $12.99 USD (ISBN: 9780985652401)
Stories of Hope was written by members of the Chronic Pain Anonymous, or CPA, 12-Step fellowship to help illustrate how the tools and principles of the program can serve as catalysts for emotional, mental, and spiritual transformation. CPA was founded in 2004, adapting the proven Steps and Traditions of programs like Alcoholics Anonymous to persons with chronic pain and illness, and is more completely discussed in a Pain-Topics UPDATE here.
Stories of Hope is the organization’s first book, telling the stories of members who have experienced “living in serenity with chronic pain and chronic illness,” as the subtitle says. The book is divided into 17 chapters focused on topics like Pain, Acceptance, Courage, Strength, Hope, and so on. Each of the anonymous men and women who contributed to this collection shares a brief personal story of their journey through pain and illness, traveling from despair to hope.
Stories of Hope, like the CPA program itself, is not for everyone. It is for persons with an obsession that controls their lives and interferes with their peace of mind. It is for persons who are ready to take a different path toward dealing with pain and illness, and are willing to work a program of steps leading to renewed hope and serenity. CPA is about a different way to live life and it is a program that works only for those who work it. This book provides helpful inspiration and guidance for that spiritual adventure. Also visit the CPA website here: http://www.chronicpainanonymous.org/.
A Guide for the Newly Disabled and for Those Who Love Them
By: Dinah Chaudoir Federer, 2005, 123 pages.
Info and ordering at Amazon.com: http://www.amazon.com/Chasing-Normal.../0615262627/
Immediate download of PDF costs US$ 9.95; printed version is US$14.95 (access checked 11/6/08).
The author of this self-published book relates, in simple conversational language, her very personal journey in learning to live with disability and pain. Dinah Chaudoir Federer was born with an inherited condition that affects nerves and weakens muscles, forcing her to walk with crutches. At age 35, she also was diagnosed with Trigeminal Neuralgia, which causes intense electrical shock-type pain in the nose, lips, and eyes.
Dinah has worked in the field of rehabilitation for 20 years, and is currently a vocational rehabilitation counselor for the disabled. Chasing Normal is meant to help newly disabled persons and their loved ones calm down, get centered, and take their individual journeys one step at a time. As she suggests, becoming disabled with a painful condition is like being dropped in the middle of a foreign country and told to find your way home. This book is meant to act as a compass on this often overwhelming path. Her ongoing inspirational message is blunt and hopeful: “There is life after disability and it doesn’t have to suck!”
Chronic Pain: A Way Out
Comprehensive Treatment & 12-Step Recovery Guide
By: Stephen Colameco, MD, MEd, 2012, 208 pages.
Available from http://Amazon.com (enter title in search box)
Soft Cover $12.95 USD (ISBN-10: 1477513949); eBook Kindle edition $5.99 USD (ISBN: 1477513949).
As the old saying goes, “Pain is often inevitable, but suffering is optional.” While medical science can do much to help allay the physical experience of pain, there are other dimensions of pain, particularly chronic pain, that are more difficult for patients to cope with.
Chronic Pain: A Way Out by Stephen Colameco, MD, MEd, is an expanded update of his earlier book, 12 Steps For Those Afflicted With Chronic Pain, published in 2005. This provided a guide to recovery from the emotional and spiritual suffering often associated with pain.
To accomplish this sort of recovery, Colameco built upon the successes of the 12-Step approach — a spiritual (not religious) movement founded in 1935 to help persons addicted to alcohol. It has helped millions of individuals worldwide, and the model has been extended to disorders involving many types of drugs, overeating, gambling, out-of-control spending, and, now, chronic pain.
Colameco devotes the first 7 chapters to an evidence-based discussion of the nature of pain and its medical management. Readers will welcome the clear and concise descriptions of medications and the many nondrug approaches that are available today for treating chronic pain from a physical perspective. For many patients, however, these are simply not enough.
Where traditional medications, surgeries, injections, physical therapy, and the like have failed, Colameco proposes that chronic pain may be helped with psychological and theological approaches. He asserts that a person’s beliefs profoundly affect how they experience pain, and they need to identify the beliefs that contribute to suffering — deciding how such beliefs can be changed.
Readers come to learn that they are not alone in their situation, and there is great comfort in knowing that others have felt the same way and are finding respite. And, while one may not be able to permanently vanquish physical pain, the 12 Steps hold a promise of divine relief coming from a Higher Power.
In some parts of the country, there are even organized meetings of the group Chronic Pain Anonymous that focus on the 12-Step approach. See their website at: http://chronicpainanonymous.org/. Dr. Colameco's website is at: http://addictionpain.com/.
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