Painkillers

Painkillers or analgesics are used to achieve analgesia or relief from pain.  These drugs act in various ways on the peripheral and central nervous systems.  The type of pain determines the analgesic choice.  There are several classes of analgesic drugs.  Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are both nonprescription and prescription. COX-2 inhibitors are prescription drugs derived from NSAIDs.  Another important class of analgesics is opioids, which are narcotics and require a written prescription and include morphine, codeine, oxycodone, hydrocodone.  There can also be pain relief benefit from classes of drugs that are not normally classed as analgesics, such as tricyclic antidepressants and anticonvulsants.

Most people take something when they have pain of any kind. There are analgesics or pain killers that are over-the-counter (OTC).  There is some confusion about dosage on these agents.  Patients tend to think that because these drugs are OTC that they are totally safe in all amounts, but they are not.  The most common OTC NSAIDs are aspirin, ibuprofen (Advil, Motrin, and others), and naproxen sodium (Aleve).  Many times physicians are not contacted for a painkiller and pain control until and unless the patient receives no relief from OTC medications. "Letting the pain get ahead," or allowing it to be untreated can make it more difficult to bring under control.  Being absolutely pain free may not be a realistic goal, but pain can usually be regulated so it does not interfere with daily life.

Pain

Pain is the most common reason physicians are consulted in the United States, the main reason for visiting the emergency department, and is present in 30% of family practice visits.  Pain is physical suffering or distress caused by injury or illness.  Ability to experience pain is essential for protection from injury and recognition of the presence of injury.  It can also protect the affected part of the body while it heals and help avoid harmful situations in the future.

For many medical conditions pain is a major symptom, and it can significantly interfere with quality of life and ability to function.  Acute pain resolves quickly, but chronic pain lasts a long time. There are many differences in the times assigned to the definitions of these types of pain and when pain is considered to be chronic.

Acute pain is managed with medications.  Chronic pain is more difficult and the efforts of a pain management team may be required.  Living with chronic pain can be devastating and can destroy people's lives.  It is not just an inconvenience and must be treated safely.

Treating pain is a crucial step in recovery from many conditions.

Sunscreen

Most people think of sunscreen use only during the summer months.  However, successful sunscreen use is to apply a lot of sunscreen liberally, repeatedly, and often to the body when exposed to the sun’s rays regardless of the time off the year.  Sunscreens are best applied 15 to 30 minutes before sun exposure to allow the active ingredients to dissolve into skin layers.  Epidemiologic data indicates that a history of five episodes of sunburn per decade increases risk for melanoma (a type of skin cancer) by threefold.

There is much confusion regarding the SPF (sun protective factor) values.  SPF is primarily an indication of UVB protection as this type of radiation causes more skin redness than UVA radiation.  Damaging effects from UVB occur mostly in the summer as sunburn, but damage resulting in skin aging and skin cancer can occur throughout the year from UVA as well as UVB.

SPF of 15 blocks 93% of UVB radiation.  SPF of 30 blocks 97% and an SPF of 50 blocks 98% of UVB radiation.  Sunscreens can no longer be labeled witn an SPF greater than 50 and are now labeled as SPF50+.  A “broad spectrum” sunscreen with protection from UVB and UVA is the most helpful and is recommended.

Use a “broad spectrum” product with SPF of 15 or 30. Apply to all exposed body parts.  The amounts used should be 4 tablespoons/12 teaspoons, a shot glass full, or an amount to fill a child’s cupped hand.  Sunscreen should be reapplied every 2 hours while outside and more when swimming.  A large bottle of sunscreen will not last a whole family during the summer months.  If it does, not enough is being applied.  Sunscreen is available as liquid creams, sprays, gels, and sticks.  Sprays are easy and convenient, but may cause too little sunscreen to be applied.  Spray an adequate amount into hands and then apply.  Gels may be good for the male chest or the scalp.

Sunscreens

Sunburn is a concern during the summer months.  The radiation from the sun causing sunburn is UVB (ultra violet B).  UVA1 and UVA2  age the skin.  The burning question, both literally and figuratively, is which type of sunscreen is best.  The most commonly used sunscreens are “chemical absorbers,” which the FDA prefers to refer to as organic because they contain carbon compounds.  Broad spectrum sunscreens are meant to protect against a range of radiation wavelengths.  The chemical absorbers absorb the active UV rays and release their energy in harmless ways.  The FDA recommends using sunscreen with an SPF (sun protection factor) of at least 15. 

Zinc oxide and titanium oxide are physical blockers.  They do not decompose through sun exposure and theoretically will remain on the skin longer.  When UV rays hit skin coated in physical blockers, they are reflected and cannot penetrate the skin.  A concern is whether blocking the sun’s rays can result in vitamin D deficiency.

A sunscreen of some type should be put on the skin before going out in the sun.  It should be reapplied every two hours as long as you are out in the sun.  No sunscreen of any type should be used on babies younger than 6 months, and they should be kept out of the sun.  People with broken skin or rashes should talk to a physician before applying sunscreen to the affected parts of the body.

When/How Do I Take My Medication?

There is an optimal time and way to take medications to receive the most benefits from them.

• Between meals is an hour before or two hours after eating.

• Blood pressure medication is more effective when taken at night.  Should you miss a dose, do not take it at a different time in attempt to make up for your missed dose.  Take it again at your regular time.
• Thyroid medication should be taken on an empty stomach with water.  Wait 30 minutes before eating or drinking anything.
• Never exceed the prescribed dose for a pain killer.  If the dose you are taking does not control the pain, talk to your doctor.  Do not try to adjust the dose.
• If you are taking a tetracycline and you also take a calcium supplement, be sure not to take them at the same time.  Calcium inactivates tetracyclines.
• If you take Fosamax, you must not lie down for 30 minutes after taking it.
• If you take a prescription amount of potassium, do not lie down for 30 minutes after taking it.
• Antibiotics and probiotics should not be taken at the same time.  Take them at different times such as taking one of them an hour before taking the other, or two hours afterward.
• Grapefruit juice and fresh grapefruit can interfere with the action of some prescription drugs including some statin drugs, some blood pressure lowering drugs, some antianxiety and antiarrhythmia drugs, and some antihistamines.  Ask a pharmacist or physician to find out if a drug you are taking is affected.

Where Did That Come From?

In May we acknowledge the role of women as mothers when we celebrate Mother’s Day.  Through the centuries women from all countries and of many races have made significant contributions in all fields.  Some of them have been celebrated and acknowledged such as women in science and medicine.  Elizabeth Blackwell was the first woman doctor in the US.  She graduated from medical school in 1849.  Clara Barton founded the American Red Cross and cared for soldiers during the Civil War.  Rosalyn Sussman Yalow developed the technique making it possible to scan blood donations for infectious diseases.

However, there are women who are “Mothers of Invention” and whose ideas have made a major impact on our day-to-day life.  These women all belong to the group of great American tinkerers who have made our lives easier and more efficient.  Most people are unaware of their contributions.  

• Margaret Knight – the square bottom paper bag
• Mary Anderson – the windshield wiper
• Florence Lawrence – turn and brake signals
• Katherine Blodgett – nonreflecting glass
• Marion O’Brien Donoyan – disposable diapers
• Stephanie Kwolek – kevlar (synthetic fabric stronger than steel of the same weight)
• Josephine Cochrane – dishwasher

We should all consider these outstanding women and the many more worldwide who have affected our lives so significantly.

When/How Do I Take My Supplements?

Supplements must be taken judiciously to receive maximum benefit.  Swallowing them all at one time will cause the benefits of some of them to be negated.

• Minerals are better absorbed when taken at night. 
• Vitamins should be taken in the mornings. 
• Do not take B vitamins after 4 in the afternoon to avoid their preventing your going to sleep. 
• Amino acids should be taken 30 minutes before meals.
• If taken with meals, proteolytic enzymes act as a digestive aid.  If taken between meals they act as an anti-inflammatory.
• Between meals is an hour before a meal or two hours afterward.
• Very few people need a multivitamin containing iron.  Women are more likely to need iron than men because of blood loss during periods.  Check with your physician to see if you need a multivitamin containing iron.
• Quercetin (400mg to 500mg) taken between meals acts as a powerful antihistamine

Many people cannot take B-Complex because they do not tolerate one or more of the B vitamins contained in the complex mixture.