A Medication Orchestra

  • Listening to an orchestra play music from the masters like Mozart or Bach can be very soothing. Each section of an orchestra: the woodwinds, the brass, the percussion, and the strings add a distinctive sound which, when combined, creates a beautiful harmony of sound. The conductor of an orchestra blends and directs this concoction of sound so that it will be pleasing to the ear. If an instrument is out of tune or missing the beat, the conductor is quick to correct the problem.


    In that way, the conductor's job is not that unlike a physician's job. Medication management of chronic pain is like trying to direct an orchestra; but instead of instruments, physicians deal with chemicals. Instead of sections, the physician deals with medication families like the anti-inflammatories, the analgesics, the anti-depressants, and the anti-convulsants. Such a menagerie of drugs can be quite intimidating for those who consume the drugs with questions like: Can I take this with that? Will this interact with that? When do I take this or that? The business of medication management can become quite confusing. Following some general rules that can keep your medication orchestra in tune and on the beat.

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    1.       Tylenol is not an anti-inflammatory; thus, Tylenol can be used with ibuprofen, naproxen sodium, and other drugs in the anti-inflammatory family. These over-the-counter medications are freely available for use by the public without a prescription. Unfortunately, "without a prescription" means that these members of the medication orchestra are disconnected from a conducting physician; thus, over-the-counter medications can easily get out of harmony.


    2.       Methadone is a damn tricky drug and does not blend well with other drugs like tramadol and most of the anti-depressant medications. One type of adverse drug interaction found when methadone is blended with an anti-depressant like Cymbalta is called "serotonin syndrome". Serotonin Syndrome causes rigidity, fever, blood pressure instability, muscle jerks, confusion, delirium and coma. If you have any of these symptoms, talk to your doctor. And please exercise caution with methadone.


    3.       An anti-inflammatory drug (NSAID's) should not be used all the time (24/7/365) for an indefinite period of time. Yes, this family of medications is available without a prescription, but that does not mean that these drugs are perfectly safe and can do no harm. Many people have developed life-threatening conditions due to the overuse of NSAID's like bleeding stomach ulcers or renal failure. These "side effects" can put you in the ICU quicker than you can swallow that next pill.


    4.       If you find a pill and do not know what it is, flush it down the toilet because it is better to be safe than dead.


    5.       Attacking pain from multiple directions with multiple families of medications can work well. Just like an orchestra is not an orchestra with just the woodwind section; pain management is not pain management with just one type of medicine. For example, anti-convulsants medications combined with anti-depressants medications can make for a beautiful harmony to drown the pain, especially nerve pain.


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    6.       When in doubt, talk to your doctor or pharmacist. This seems simple enough. However, face to face discussions are getting harder and harder to come by, yet can be very effective at clearing up confusion. If you do not have a doctor or pharmacist willing to take the time to answer your questions, find a new one.


    7.       Use our drug information tool to help you identify potential problems. I use mine all the time like a "second brain" because the mass of medications available is too much to keep completely straight with brain power alone.


    8.       Ask us a question. We answer many questions about medications when we can. Ultimately, we may ask you to consult your prescriber.


    You are not alone if you have questions or concerns about you medication orchestra. If your orchestra sounds like fingernails being dragged across the chalk board, then you might be due for a tune up. Keeping your medications in tune and on the beat will help you drown out the roar of chronic pain.


Published On: January 11, 2010