Earlier this year I posted this on our News and Research Page; but due to running into several cases the last few weeks regarding people significantly overusing acetaminophen I decided to re-post it on my blog today.  Many people undergoing chronic pain management and on several different medications, including those purchase over the counter, may not realize how much acetaminophen they are really taking.  Please share this information.

As a starting point I want to reiterate that my premise is that there is no such thing as a “bad” medication; how it’s used and who uses it determines positive or negative outcomes. To most people, acetaminophen is something of a ubiquitous mystery appearing in many combination cough and cold products as well as many prescription pain medications (such as Vicodin and Percocet).  Since many different medications contain this ingredient many consumers may not realize they are taking multiple products that contain acetaminophen, an error that can cause significant liver damage in a very short time.

The maximum daily dosage of acetaminophen historically has been 4,000 mg, and it can cause dangerous side effects if people take it in excessive dosages or they have liver disease or drink large amounts of alcohol. This maximum dose recommendation was recommended to be revised in June of 2009 by the FDA advisory panel who voted 21-16 to lower the maximum daily dose of nonprescription acetaminophen, which is currently 4 grams(4,000 mg) - equal to eight pills of a drug such as Extra Strength Tylenol.

In addition the panel voted 24-13 to limit the maximum single dose of acetaminophen to 650 milligrams. The current single dose of Extra Strength Tylenol, for instance, is 1,000 milligrams. The panel also voted 26-11 to make the 1,000-milligram dose of acetaminophen available only by prescription.  It should be noted that the FDA is not required to accept the panel’s recommendations, but it typically does so.

Due to these and other concerns John Hopkins Medical center recommends that even though acetaminophen is the drug with the lowest overall risk of side effects, if someone uses acetaminophen regularly, they should see their doctor periodically to be monitored for adverse effects.

However, there are many legitimate benefits for using acetaminophen.  For example, a 2004 study that was presented at the 9th World Congress of the Osteoarthritis Research Society International (OARSI) in Chicago showed that the over-the- counter pain reliever acetaminophen, when used as directed, is a safe and effective treatment option for patients suffering from the pain of osteoarthritis of the hip or knee.

According to the results of this study, acetaminophen was found comparable in safety to placebo. There were no statistically significant differences in the number of serious or non-serious adverse events between patients treated with either dose of acetaminophen and placebo. The results of this study confirm that when used as directed, acetaminophen is an effective and safe choice for patients with osteoarthritis and reinforce the American College of Rheumatology guidelines that recommend acetaminophen as a first line therapy to relieve osteoarthritis pain.

Along with its other benefits, acetaminophen is less likely to interact with other medications or irritate the stomach. It is also considered safe for patients with conditions such as heart disease and diabetes.

Below is information from the manufacturer of Tylenol® (active ingredient acetaminophen) that they posted on their website for people who want—or need—to take it, so they can do so responsibly and safely.

Importantly, you can confidently continue to take TYLENOL® according to the directions currently on the package and can prevent inappropriate use by:

Reading the label before each use and always following the directions

Never taking more than the recommended dose

Never using two products containing acetaminophen at the same time

Keeping medicine out of the reach of children

Consulting a healthcare professional with questions

The safety and efficacy of acetaminophen has been established through more than 50 years of clinical use and scientific investigation and it is safe when used as directed.

Any decisions about taking medications should be made with the advice and consultation of an appropriate healthcare provider.  I believe that learning as much as possible and educating our patients is one of the most important components of an effective chronic pain management plan.

To learn more about effective medication and chronic pain management please check out my article 12 Personal Action Steps for Chronic Pain and Medication Management that you can download for free on our Article page.

If you’d like to receive training for helping people with relapse prevention, I’m very excited to announce that the Gorski-CENAPS Corporation is presenting The Relapse Prevention Therapy44 Hour Certification Training in Ft. Lauderdale October 18-22, 2010. To learn more about this 5 day 44 hour training you can check out our Calendar page.

You can learn about the Addiction-Free Pain Management® System at our website www.addiction-free.com. If you are working with people undergoing chronic pain management and want to learn how to develop a plan for managing their chronic pain and coexisting psychological disorders; including depression, addiction and other coexisting psychological disorders effectively; please consider my book Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System. To purchase this book please Click Here.

To read the latest issue of Chronic Pain Solutions Newsletter please click here. If you want to sign up for the newsletter, please click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

People living with chronic pain often receive negative messages from their healthcare providers.  How would you react if you were told “it’s all in your head,” “you need to try harder,” or maybe “you’re making yourself hurt so you can get drugs?”  Unfortunately, many pain patients or told that or worse.

Another phrase I have heard from doctors and nurses, as well as mental health and substance abuse counselors, is “they’re just drug/med seeking.”  Before I worked extensively with this group of people, I used to think my clients were “drug seeking” as well.  However, I have learned that what they really are looking for is relief from their pain—both physical and emotional.

These negative messages, combined with feelings of hopelessness and helplessness, can cause someone suffering with chronic pain to become confused, guarded, and defensive.  Teaching them how to effectively connect with supportive people is an important part of every recovery program that strengthens the probability of relapse prevention.  This positive support often leads to overcoming confusion and defensiveness. 

Unfortunately, mistaken beliefs about chronic pain and chemical dependency in the healthcare system and recovery community can discourage recovering people from connecting with appropriate support.  In fact, misguided advice has often led to life threatening situations for the person in pain.

I have seen patients with chronic pain and coexisting addiction problems receive completely inappropriate treatment from their healthcare providers.  These situations are very frustrating because they are so unnecessary.  I get very concerned because inappropriate treatment can easily lead to relapse, and in some cases death.

The blame the victim mentality is not limited to treatment providers.  I have also seen Twelve-Step members who shame, blame, and shun others who relapse.  This is particularly true if the person had long-term sobriety before the relapse.  I have heard newcomers being told to avoid such people because they are “losers.”  When a chemically dependent person returns to alcohol or other drug use, they need compassion, understanding, and support—not shame and blame, in order to once again experience quality recovery.

To learn out of the problem and into the solution for successful chronic pain management please check out my article Overcoming Obstacles for Effective Chronic Pain Management that you can download for free on our Article page.

If you’d like to receive training for helping people with relapse prevention, I’m very excited to announce that the Gorski-CENAPS Corporation is presenting The Relapse Prevention Therapy44 Hour Certification Training in Ft. Lauderdale October 18-22, 2010. To learn more about this 5 day 44 hour training you can check out our Calendar page.

You can learn more about the Addiction-Free Pain Management® System at our website www.addiction-free.com. If you or a loved one is undergoing chronic pain management, especially if you’re in recovery or believe you may have a medication or other mental health problem and you want to learn more effective chronic pain management tools, please go to our Publications page and check out my books; especially the Addiction-Free Pain Management® Recovery Guide: Managing Pain and Medication in Recovery. To purchase this book please Click Here.

To read the latest issue of Chronic Pain Solutions Newsletter please click here. If you want to sign up for the newsletter, please click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

It is important to know about the connection between stress levels and pain symptoms, as well as understanding that stress management can also decrease suffering.  Physically, chronic pain raises stress levels and drains physical energy, while psychologically it affects the ability to think clearly, logically and rationally, as well as to effectively manage feelings or emotions.  Remember that in most cases if people can learn to lower their stress levels, they will also experience a decrease in their perception of pain.

It is crucial to learn how to self-assess levels of stress and then learn how to develop some simple but effective stress management tools.  I like to use a stress thermometer concept.  This concept proposes that there are ten levels of stress and when people get to the seven to ten moderate to higher levels of stress their thinking and behavior are impacted.  The goal is to keep stress at levels four to six and for relaxation to get down to the one to three levels.

Managing Stress Helps Manage Pain

Another step in stress management is to learn how to identify and challenge irrational thinking that leads to uncomfortable emotions. For example if people are under high stress the thought might be “I can’t stand this… I need to escape.” This in turn could lead to, fear, anger, anxiety, or even cravings to use self-defeating behaviors or even inappropriate pain medication for stress relief.

The next step is to be aware of and learn how to manage those uncomfortable feelings before they lead to self-defeating urges. Developing healthy feeling management skills is very important. Learning to share with trustworthy people is one way to deal with uncomfortable emotions. If the feelings are too intense or overwhelming, counseling or therapy may be necessary.

If those negative self-defeating urges do surface, it is important for people to learn how to make healthier decisions before indulging in self-destructive behaviors. There is a decision point between the urge and the behavior that is almost non-existent when people are under high stress. If people keep reacting to their impulses instead of thinking and responding they very well could indulge is self-defeating behaviors. That is why learning impulse control and delayed gratification is so important.

When people are more aware of their stress levels, they can then take action to reduce their stress, which in turn leads to a decrease in their pain symptoms.  A very effective stress management strategy is exercise.  In addition to lowering the stress levels regular exercise can also be an important part component of an effective pain management program.  It is also important to reduce, or even eliminate, nicotine, caffeine, and sugar, and have a healthy eating plan. 

Other stress management tools could include breathing and relaxation exercises, meditation, Yoga, Tai Chi, listening to soothing music, being in nature, soaking in a hot bath (or Jacuzzi), etc.  Sometimes a good stress management plan includes appropriate activity pacing and taking time for leisure and recreational activities. An additional intervention is massage therapy, which also helps you with pain management goals. People living with chronic pain and coexisting addiction need all the help they can get.  Stress management is one of the most important pain management tools someone with chronic pain can learn. 

To learn more about coping with stress for more effective chronic pain management that includes an example and explanation of a stress thermometer please check out my article Effective Stress Techniques for Chronic Pain Management that you can download for free on our Article page.

If you’d like to receive training for helping people with relapse prevention, I’m very excited to announce that the Gorski-CENAPS Corporation is presenting The Relapse Prevention Therapy44 Hour Certification Training in Ft. Lauderdale October 18-22, 2010. To learn more about this 5 day 44 hour training you can check out our Calendar page.

You can learn about the Addiction-Free Pain Management® System at our website www.addiction-free.com. If you are working with people undergoing chronic pain management and want to learn how to develop a plan for managing their chronic pain and coexisting psychological disorders; including depression, addiction and other coexisting psychological disorders effectively; please consider my book Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System. To purchase this book please Click Here.

To read the latest issue of Chronic Pain Solutions Newsletter please click here. If you want to sign up for the newsletter, please click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.