After the Interview
After your doctor has fully evaluated the kind of pain that is affecting you, he will now make a plan as to how to maximize pain control. There are different modalities available such as pain medicines, non-drug management such as acupuncture, medicines that strengthen bone for patients with bone metastasis, radiation therapy and other special procedures.
Mild, Moderate and Severe
Most of the patients I encounter are those in the moderate intensity of pain. The type of treatment that your doctor will give you depends on the severity of pain. We generally follow the guidelines given by the World Health Organization (WHO) in giving medicines.
We divide patients into those with mild, moderate or severe pain.
Patients with mild pain are given any of the following:
• Paracetamol or Acetaminophen
• Non-steroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen, Mefenamic Acid, Naproxen
• COX-2 inhibitors such as Celecoxib, Eterocoxib
Medicines given for moderate pain are the opioids. Opioids are drugs that control pain by exerting their action in the central nervous system. These drugs are regulated and patients cannot buy them over the counter such as those given for mild pain.
Examples of Opioids used for Moderate Pain:
Your doctor may decide to continue prescribing the medicines previously used for mild pain and combine them with any of the opioids above.
Patients need a doctor’s prescription with an S2 license number for Tramadol. Be sure to check that your doctor’s S2 license is written to prevent the inconvenience of having to go back to your doctor. The pharmacy or drugstore will only honor these prescriptions up to one month from the date on the prescription. After than time period, the pharmacy will not serve the medicines even if the number of drugs on the prescription has not yet been entirely dispensed.
Severe pain definitely require stronger opioids. The strong opioids include:
These medicines are also classified as regulated drugs. Unlike Tramadol where an ordinary doctor’s prescription pad will be honored as long as his S2 license number is affixed, all the other opioids will require a special prescription that we call a “Yellow Pad”.
Not all doctors have a yellow pad even if they have an S2 license. Doctors who do not often prescribe the strong opioids don’t bother to get the yellow pad because they are we don’t like dealing with government agencies.
The yellow pad comes in triplicate. The first 2 copies are given to the patient and the 3rd copy is left with the doctor. Upon dispensing the drugs, the pharmacy is required to get the original copy which will serve as their file copy. Pharmacies that dispense these drugs undergo a lot of scrutiny by the Philippine Drug Enforcement Agency (PDEA). If the pharmacy did not dispense the entire number of tablets or ampoules prescribed, they will mark your prescription with a stamp and indicate the number prescribed as well as the number remaining. Remember that the yellow pad will also expire 1 month from the date written on it. The pharmacy will not serve you the remaining drugs when your yellow pad has already lapsed.