Stricter guidelines on pain meds designed to reduce opioid abuse
Q: I’m not a drug addict. I was in a bad car accident that destroyed five of the disks in my back.
When I asked for pain medicine, I was told to take ibuprofen. It didn’t matter that I am allergic to it.
As a result of the accident, I am in constant pain. My doctors don’t seem concerned. Thank goodness I’m in a state where medical marijuana is legal. That’s the only way I get by.
A: The Food and Drug Administration, Drug Enforcement Administration and Centers for Disease Control and Prevention all have joined together to make narcotics much less accessible. This is because of excessive deaths from misuse and overdose of opioids.
Restricting access might reduce abuse, but chronic-pain patients like you have written to us about the dilemma they face. Because of military injuries, accidents or unsuccessful surgeries, they suffer unbearable agony that sometimes persists, even after trying many pain-management approaches.
Marijuana (cannabis) is not a recognized pain medication, but some cancer specialists have noted that it may be helpful in treating pain, depression and insomnia (Current Oncology, March 2016). A recent survey of chronic-pain patients found that those using medical cannabis had significantly cut their use of opioid drugs and reported improved quality of life ( Journal of Pain online, March 19, 2016).
Q: I’ve been on Nexium for several years, and it has “cured” Barrett’s esophagus and stomach ulcers. The directions say to take Nexium daily one hour before a meal. So I have to wake up earlier than I want to take it one hour before breakfast.
The PA at my doctor’s practice says she takes Nexium with breakfast. My question: If I eat breakfast (or lunch) two or more hours after taking Nexium, have I lost its benefit? What if I take it only 15 or 30 minutes before breakfast? How important is that one hour?
A: We are not surprised that you are confused. The official labeling information on prescription Nexium (esomeprazole) specifies that health professionals advise patients to take Nexium “at least one hour before a meal.”
Over-the-counter Nexium 24HR directs people to “swallow 1 tablet with a glass of water before eating in the morning.” The instructions are ambiguous about how long people should wait before eating.
Taking Nexium with a meal could reduce the amount of medication that gets into your bloodstream by as much as 50 percent. Waiting at least an hour avoids that problem. You could avoid getting up early if you took your acid-suppressing drug an hour or two before lunch or supper.
Q: In a recent article, you mentioned that fenofibrate could help with chronic diarrhea. I have had bouts of diarrhea for months, and in recent months it had become very frequent.
I have been using fenofibrate for four weeks, with amazing results.
I still have some gas and bloating due, I think, to recent gallbladder removal, but the diarrhea is mostly under control. Thank you for this great tip, which none of the doctors had suggested.
A: Fenofibrate is prescribed primarily to treat elevated blood lipids such as LDL cholesterol and triglycerides. There is no research on its use for diarrhea following gallbladder surgery, but we are happy it was helpful. Some people may experience diarrhea as a side effect of this lipid-lowering drug.
Q: I read a newspaper column that mentioned cilantro herb in the diet could be helpful for psoriasis. I tried this, adding fresh cilantro to my diet. It is a very versatile herb, and I was delighted to experience dramatic improvement in my psoriasis symptoms.
A: A few months ago, we heard from the reader who initially suggested this approach: “I have been using this as needed for more than 10 years. When I first notice small red patches, usually on my legs, I get two bunches of cilantro leaves and eat them over the next three days or so. The red spots go away.”
We have not found any scientific studies of eating cilantro leaves (Coriandrum sativum) to control the redness and itching due to psoriasis. Cilantro is a popular component of many cuisines, from Southeast Asia and China to Latin America and the Mediterranean.
Not everyone likes the taste of cilantro, however. For some people, the leaves taste like soap. They may wish to look for dietary supplements with cilantro in health-food stores.
Write to Joe and Teresa Graedon via their website: PeoplesPharmacy.com.