Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua
Hospital
Pain. The most effective medical treatments for pain remain
narcotics. These drugs share common properties: they all may
cause stomach upset, they all may cause constipation, they
all have -- for the most part -- short half-lives, they all
can be reversed with the same antidote, they all can be
addictive. But there is still a wide variety in their effects
and usefulness.
The standard for all narcotics remains the oldest --
morphine. This drug is very effective and works best when
given in the vein. It is poorly absorbed by the stomach;
although MIR and MSR are oral forms that work pretty well
with somewhat lengthened half-lives (a half- life is how long
the medicine stays in the body -- basically a measure of how
long it works).
When you chemically attach oxygen or hydrogen to morphine you
get an even stronger drug. Hydromorphone is Dilaudid in the
USA and Palladone in Israel and is very strong. The oxygen-
morphine is unavailable in Israel. These drugs are rarely
used outside the treatment of cancer pain.
Another injectable pain reliever is Penthidine, known in the
states as Demerol or Meperidine. I do not like this
medication as it can cause confusion, ill feeling and it
offers no advantage over morphine. Furthermore, it is often
used with inadequate dosing. The correct dose is 1-1.5 mg/kg
-- a dose rarely seen.
A really nice drug called Fentanyl is also available. For use
in the vein it is a short-acting drug that is useful for
short painful procedures. In Israel it is fairly cheap. A
patch called Duragesic is available with this medication --
it is long-acting and effective.
Orally there are even more choices. Codeine used to be the
standard, but in order to get enough effect from this drug,
doses that can cause bad stomach effects must be given. Most
physicians do not use the medication any more. Even the
belief that it is good against a cough has been disproved.
Once again, adding oxygen and hydrogen to the medicine made a
more effective medication. Oxycodone is known as Percocet--it
is also made more effective by the addition paracetomol
(acetaminophen). All narcotics are more effective with a
combination with this drug, or aspirin or a NSAID -- one of
the drugs we discussed in the last article. Aspirin and
oxycodone is called Percodan. Hydrocodone is not available in
Israel. By mouth, these are the most effective pain relievers
available to the Israeli physician. Write me in care of the
Yated.
A message from GlaxoSmithKline, sponsor of this
column. It bothers me that so many of our community
smoke. If you can prevent someone from starting, that is the
best strategy. If not, Zyban can help. If you know a way that
we can communicate to our people the importance of getting
help to stop smoking, contact me at once. Glaxo will be
willing to help. They have two products that are known to be
the most effective in helping a person stop smoking. Zyban
for example shows results in one month.
