Managing your medications

Medications can form an important part of managing your chronic pain condition. Nurse Specialist Jacquelyn Watson explains how to make informed decisions along with your healthcare practitioner about what is most appropriate for you

Five golden rules

Keep in mind these five simple principles to manage your medications effectively:

1. Follow the instructions

Sounds obvious, but how many of us would admit to not quite taking our medicines as prescribed? Perhaps you’ve found yourself taking them earlier or later than you ought to. Perhaps you have been taking more or less than was recommended. Although this is very common when people are taking medicines for a long time, it can make your medicines less effective and can even be dangerous.

2. Stick to a routine

Some people forget to take their medicines or take them at different times of the day or night. To get the most out of your medicines, it is helpful to get into a routine; this helps to remind you when to take them and gives a good guide to what may be helping more, what gives you side effects, etc. Also remember that some medications must be taken at the same time each day to be effective.

3. Talk to the experts

It is always a good idea to have the support and expertise of your GP, nurse and/or pharmacist. They have experience and the advantage of talking with lots of people who have pain and so have learnt many tips from them.

4. Handle with care

It is really important to continue taking your pain medicines when you are feeling okay – if you stop suddenly this could cause a flare-up in your pain later on. It is also harder for your body to get used to the side effects of your medications if you aren’t taking them regularly. There is some more advice on stopping or reducing your medications below.

5. Don’t be a hero!

Many people don’t like taking medicines and some people even think that they are giving in or being weak by having to take painkillers. However, there is no point struggling with pain if you have something that may help to reduce it; there are no prizes for seeing how long you can tolerate it. Also waiting until the pain is unbearable may make it harder for the medication to control it.

Side effects

The side effects that can occur with a lot of the pain medicines you may have tried can often play a large part in deciding whether you persevere with them. It may be that the medication has reduced your pain – sometimes even significantly – but the side effects from the drugs are so difficult to cope with that you have to stop taking them.

It’s worth bearing in mind that many of these side effects reduce with time so, if you can, it’s worth giving the medicines a fair trial before you stop taking them.

Useful questions to ask your doctor about your medication

• What common side effects might I expect or watch out for?
• Are they OK to take with my other medicines?
• What exactly are they for?
• Should I take them with food?
• How many times a day should I take them?
• Do I need to take them even if my pain isn’t so bad?
• Can I drink alcohol whilst taking this medication?
• What should I do if they aren’t effective?
• How long should I trial them for?

Reducing your medications

There may be times when you might want to consider reorganisation of your medicines. It is not something that has to be done and there is no timescale to set; it is just something that you may begin to think about and have perhaps thought about in the past. Or perhaps it is something your GP or pain specialist has suggested you could try.

If you speak to your healthcare practitioners and they agree that you could benefit from trying your medication at a reduced dose or stopping taking it entirely, they can then help you to do this while minimising the risk of withdrawal symptoms or a pain flare-up. This has to be done with thought and preparation.

Reasons for reducing medication

• Reducing your medication can help you feel more in control which positively affects many other aspects of your life.
• You will have fewer side effects to put up with and will perhaps feel less drowsy, depending on what you are taking.
• Reducing your use of painkillers can also sometimes allow you to use them more effectively when you are having a flare-up. (This applies particularly to the anti-inflammatories and morphine-based drugs.)

All of these things are self-explanatory but reducing medication is still very daunting for most people, as the worry is that the pain will get worse and you will end up back at square one. That is why it is really important to do this systematically and by following the golden rules.

Ten tips for reducing your medicines

1. Choose the right moment. If there are other things going on, for example, going on holiday, or any problems or added worries, this can affect how you manage. During or directly after a flare-up is not a good time to consider reducing medication.
2. Start at a quiet time of the week, for example, when you have no school runs or everyone out of the house: this gives you a couple of days peace when there may be an increase in pain or side effects.
3. Use techniques such as mindfulness, relaxation and other coping strategies that may have helped you in the past. For helpful tips visit moodjuice.scot.nhs.uk/chronicpain.asp
4. It is very important for you to get the support of your GP or nurse to help you work out your plan – they must be aware of what you are trying to achieve.
5. It can be difficult to get a clear picture of your pain if you are on lots of medicines for a long time and your pain can rise and fall naturally. Keep a pain diary, over a long period if required, as this can help you to spot the variations in your pain levels. If you keep a diary you can sometimes be surprised by how your pain changes when you change medicines, doses, or dose times. It is really important to have this clear in your head before you start changing any medicines.
6. Starting this process with a drug that could be difficult to reduce or must be reduced very slowly can be a bit disheartening for anyone. It is a good idea to get the advice of your doctor or nurse to choose the medicine that is going to be easiest to stop taking first.
7. It is important that you have been taking your medications regularly, by the clock, before you start reducing them as this helps to get you into a routine and set a pattern.
8. Only ever reduce one drug at a time. Yes, this takes longer and can be frustrating, but remember what the long term goal is and that this will be reached more easily by doing things very slowly. Doing this when you are taking lots of different medicines can also help you work out which medicines are working best for you.
9. Never try to increase the time between doses: this will just increase your pain and is not a good way to reduce medicines. The best way is to continue to take them regularly but very gradually reduce the dose. Again, medical staff can offer advice and support with this.
10. And finally, give yourself credit for making positive changes even if they seem small; reward yourself. Have a long bath, read a magazine or watch your favourite film; remember that you’re making progress in a difficult area and you deserve a treat.

 
Managing your medications © Pain Concern. All rights reserved. August 2014. To be reviewed August 2017.

If you would like to know more about the sources of evidence consulted for this publication please click here.