How to be informed and evaluate treatment risks

At your visit with your healthcare provider, a new medicine is prescribed for you. You talk with your friend, who says that you should worry about the long-term effects of the medicines you take. She recommends an herbal supplement. Then you hear of two people who took the medication; it helped one person, but the other person had to stop it because the medicine made them feel terrible. What should you do? Your healthcare provider prescribed the medicine because it is helpful for people with pain. But will the treatment help you? This article points out factors to consider when you are weighing the risks and benefits of treatments for chronic pain.

Every treatment has risks

Every treatment has risks. Even aspirin, considered by most people to be a “harmless” drug can be dangerous for someone with an allergy to it, or someone who has a bleeding problem, or who takes too much it. The Food and Drug Administration (FDA) is responsible for approving new medications. Different types of studies have to show the FDA that the medicine is safe and effective for a certain condition. Not all of the possible long-term side effects may be known when the FDA approves a medication. Some of these effects may be bad enough that they result in the medication being taken off the market several years after they are approved. Medications are approved for a specific condition, but may be used for other conditions as well. The pamphlet that comes with your medication from your pharmacy should list the most common side-effects, and symptoms of serious complications that might occur if you take the medicine.

Some non-medication treatments, such as herbal preparations, are not required to go through the rigorous process that’s required by the FDA for medications. Manufacturers may claim they are safe and effective without research studies proving they are as safe and effective as using other treatments, or doing nothing.

You can’t always know how a treatment will affect you before you try it. Sometimes side-effects appear early, but then go away after a short period of time. Even when you are told that a medication has a two-fold higher risk, (meaning you would be twice as likely to experience it) that doesn’t mean it will happen. It may mean that you are among the ten out of every 10,000 people with the side effect, instead of five out of every 10,000 people. You may or may not think this is a risk worth taking.

Ask your healthcare provider or pharmacist:

  • Were the treatment studies for the FDA done on people with my medical condition?
  • Were large studies conducted, with many people?
  • Were any groups of people found to have higher risk due to their gender, age, or other medical condition?
  • What are the most common side effects with the medication?
  • What are the known long-term risks of the medication?

Most treatments have benefits

Your healthcare provider would not prescribe a treatment for you if he/she did not feel there was some benefit. Some treatments may not have large studies that support them, but can still make you feel better. This is the case with many alternative treatments, such as music therapy or aromatherapy, providing a sense of relaxation or well-being. Most treatments prescribed for pain are meant to reduce your type of pain, and to increase your functioning and quality of life.

Weighing risks and benefits

Weighing the risks and benefits can sometimes be easy, like when a treatment is necessary to sustain or lengthen life. Sometimes when managing pain, the choices are less clear. Factors that may affect the choice are:

  • Expected benefits and risks – A medicine may reduce your pain and help you walk farther, but make you too sleepy to do much. Your healthcare provider can tell you whether this side effect usually diminishes over time. Ask your healthcare provider about the risks specific for you. Do you have a condition that raises your risk for certain treatments? Is your age or sex a risk factor? Are long-term risks known? What are they?
  • Other options – Choosing a chemotherapy treatment that has the potential to save your life may not feel like much of a choice. Starting a treatment that has never been tried for chronic pain, when there are well-studied treatments available, means you may be accepting more risk. Ask your healthcare provider about all the choices available to you. Also ask what happens if you do nothing.
  • Your personal values and preferences – You may have no problems taking oral medications, or you may hate taking pills. Perhaps you prefer alternative treatments, such as acupuncture, and want to try those first.
  • The time and expense compared to the benefit – You may want to try a treatment, but the time and expense are big factors for you. For example, you may decide to try self-management strategies for sleep disturbance before you take a medication or seek an evaluation in a sleep lab.

Weighing the risks and benefits of treatments can be tricky. Get as much information as possible. Think through your options thoroughly. Don’t be afraid to ask questions. When you and your healthcare provider talk about the risks and benefits of your treatments, you will both feel more comfortable with your decision.

References

National Institute of Neurological Disorders and Stroke. (2008). Pain: hope through research. Retrieved June 19, 2008 from http://www.ninds.nih.gov