Pain Management Resources -- Drug Schedules, Pregnancy Drug Categories, Neuropathic Pain Medications, etc.

[Justin]

Drugs have different schedules ranging from 1 to 5. Schedule I drugs have a high abuse potential and are not accepted for medical use in the US due to lack of safety. On the other hand, Schedule V drugs have a low potential for abuse and have been accepted for medical use in the US.

Here are the Schedules and a few examples in each Schedule:

• Schedule I: think street drugs (Cannabis, Heroin, MDMA [Ecstacy], Psilocybin ["Good" Mushrooms], Mescaline, etc.)
• Schedule II: Cocaine, Methadone, Morphine, Fentanyl, Codeine and Hydrocodone (without NSAIDs)
• Schedule III: Hydrocodone / codeine, when compounded with an NSAID or acetominophen (Vicodin)
• Schedule IV: Benzos, Phenobarbital
• Schedule V: Lyrica

Here's a comprehensive list.

Here's the breakdown on refills:



Schedules describe potential for abuse, accepted medical use and safety:

(1) Schedule I.
(A) The drug or other substance has a high potential for abuse.
(B) The drug or other substance has no currently accepted medical use in treatment in the United States.
(C) There is a lack of accepted safety for use of the drug or other substance under medical supervision.

(2) Schedule II.
(A) The drug or other substance has a high potential for abuse.
(B) The drug or other substance has a currently accepted medical use in treatment in the United States or a currently accepted medical use with severe restrictions.
(C) Abuse of the drug or other substances may lead to severe psychological or physical dependence.

(3) Schedule III.
(A) The drug or other substance has a potential for abuse less than the drugs or other substances in schedules I and II.
(B) The drug or other substance has a currently accepted medical use in treatment in the United States.
(C) Abuse of the drug or other substance may lead to moderate or low physical dependence or high psychological dependence.

(4) Schedule IV.
(A) The drug or other substance has a low potential for abuse relative to the drugs or other substances in schedule III.
(B) The drug or other substance has a currently accepted medical use in treatment in the United States.
(C) Abuse of the drug or other substance may lead to limited physical dependence or psychological dependence relative to the drugs or other substances in schedule III.

(5) Schedule V.
(A) The drug or other substance has a low potential for abuse relative to the drugs or other substances in schedule IV.
(B) The drug or other substance has a currently accepted medical use in treatment in the United States.
(C) Abuse of the drug or other substance may lead to limited physical dependence or psychological dependence relative to the drugs or other substances in schedule IV.

Link --> Schedules of controlled substances

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• Percocet is a Schedule II drug (It contains oxycodone and acetaminophen). Oxycodone is a Schedule II drug; thus, Percocet cannot be called in to a pharmacy (a physical prescription must be presented to the pharmacy and refills are not possible).
• Vicodin is a Schedule III drug (it contains hydrocodone and acetaminophen). "Pure" codeine and hydrocodone are Schedule II drugs, but when they are mixed with acetaminophen or NSAIDs they become Schedule III drugs (they can be written for 6 months [refilled 5 times]).

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Here are the FDA's Pregnancy Drug Categories:

CATEGORY A

Controlled studies in humans have demonstrated no fetal risks. There are few category A drugs. Examples include prenatal vitamins, but not massive dosages of vitamins.

CATEGORY B

Animal studies indicate no fetal risks, but there are no human studies; or adverse effects have been demonstrated in animals, but not in well-controlled human studies.

CATEGORY C

There are either no adequate studies, either animal or human, or there are adverse fetal effects in animal studies but no available human data. Many medications pregnant women use fall into this category.

CATEGORY D

There is evidence of fetal risk, but benefits are thought to outweigh the risks.

CATEGORY X

Proven fetal risks clearly outweigh any benefit. Accutane would be an example.

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I just thought I'd ask about this to see if anybody could shed any light on it. I've read on a site somewhere (not sure how reputable it was) & I've heard somebody mention it on another forum site that anti-inflammatories can help with nerve pain?

Post op I've been taking them twice a day anyway but I'm not sure if they're giving me any relief on the nerve pain side of things . I was thinking of maybe dropping one off as I have IBS & they tend to aggravate it & make me bloated which isn't great for maintaining good posture.

Any ideas?

Ruth,

Anti-inflammatories help relieve pain and reduce swelling by blocking an enzyme called cyclooxygenase (and subsequent products made "down stream" like prostaglandins). NSAIDs don't discriminate and inhibit the normal activity of two forms of the cyclooxygenase enzyme (COX-1 and COX-2). However, "newer" drugs like Celebrex, Vioxx, etc., target COX-2 only in an effort to minimize inhibition of COX-1, which has the ability to produce prostaglandins that protect the gastric mucosa.

Medications such as Lyrica (Pregabalin) and Neurontin (Gabapentin) are frequently prescribed for nerve pain. These medications are considered anticonvulsants (also called neuroleptic medications).

Tricyclic antidepressants (TCA's) like Amitriptyline and Nortriptiline are also used to treat nerve pain.

Anticonvulsants and TCA's are usually first-line drugs for neuropathic pain. NSAIDs are not preferred for treating neuropathic pain. However, NSAIDs can greatly help some patients that are utilizing a combination of drugs for complex neuropathic pain.

Good luck and keep us posted.

[KBear]

Thank you Justin, this is very informative and helpful!

[Justin]

Sure thing, Kathy! Your sticky suggestion was a great idea--I can add to it in the future.

[Carolf]

Hi to all,

I wanted to ask you about Lyrica. I have been taking it for over 8 months now, 75mg twice a day. I had the meds in my suitcase and it got misplaced so I ended up missing two doses of the Lyrica. I felt the pain get very bad, and got shakey and blurred vision. Is this related to missing the Lyrica? I have nerve damage in my right leg I believe, a lot of nerve pain and occasional shooting pains that seem to be getting worse. Almost making me jump out of my chair, a lot more intense than i can remember from before my ADR surgery. How long does a person typically stay on Lyrica? Is it a life-long medication? I am also taking a spinal muscle relaxant called muscodal twice a day. I don't seem to be totally back to normal after having missed the Lyrica which was almost a week ago, but I am drained almost and am having a lot of pain and shooting pain.
Any advice or help would be great. I was also wondering if anyone had problems with their hips as a result of the surgery. Where does it end up, does it gradually take disc by disc, or hips? I know there is no real answer for that one
Has degenerative disc disease ever killed anyone?
Kind regards,
Caroline
A lot of questions, not depressed, just so many unanswered ones that doctors in Bahrain don't have any answers for as they are so unfamiliar with ADR patients

[KBear]

Caroline- I never really could tell any difference if I missed Lyrica or not, other than my hands would go numb (I have something similar to carpal tunnel). I don't think my pain was nerve pain, so it never really made a difference. I did have hip and leg pain after ADR, even though I never had it before. It went away by the 6 month point.

[Jack-of-all-trades]

after going to the link posted it called to mind an article written on the editorial page of our local paper. The writer concluded that since we have had such success with hard liquor being sold through state controlled ABC stores we should do the same with street drugs. His idea, and he must have been own some of these street drugs when he thought up this little jewel, was that not only would it eliminate a certain criminal element of our society but the state could make money off of it by a big tax. Personally, the difference in ETOH and street drugs is that responsible people know when to say when to stop. This would be harder to do with maryjane or heroin or most all of the street drugs. Besides, where is the money going to come from to buy them, who takes care of the kids, who drives their cars?

Just a side note to Justins post, In NC as of two years ago anyway, you could by cough supressors like Robitussin with codiene OTC as long as you signed for it without a Rx. You had to ask the pharmacy for it though as it wasn't advertised. Seems I recall it was just 8 mg but definitely not over 15 mg. Last time I obtained some for a cough I had to go to a independent pharmacy, not a chain like Walgreens or CVX. It still said Schedule V on the bottle.