During his decade behind the prescription counter, Dr. Kinsey has dispensed a lot of advice and he’s agreed to share some of that advice with our readers.
Pulse: What are some of the best OTC oral medications for pain relief?
Willow bark has been known for centuries to provide analgesic and antipyretic effects. It contains a low amount of the prodrug salicin which is metabolized in the body (when ingested) into various salicylate derivatives. It also contains flavonoids and polyphenols which have been proven as of late to possess most of the analgesic effects. In the late 1800’s, Bayer began investigating and synthesizing a new compound called acetylsalicylic acid. They soon began producing and marketing this compound as Aspirin®. Today, aspirin is widely used as an analgesic to relieve minor aches and pain.
Negative gastrointestinal effects tend to be the most common side effect seen from aspirin therapy. The risk of developing abdominal discomfort, heartburn or an ulcer from routine use increases in those individuals with a history of GI issues.
Aspirin should not be used in those individuals with salicylate allergies or sensitivities or in children under the age of 18. Be aware that other oral OTC medications may also contain salicylates like Pepto Bismol® and should not be combined with aspirin or used in children under the age of 18. Routine aspirin therapy should be avoided in patients with renal or hepatic insufficiency. It should not be used in women who are pregnant or breastfeeding unless specifically recommended by a physician. It should not be consumed with alcohol.
NSAIDS Ibuprofen and Naproxen Sodium
Ibuprofen, a Non-Steroidal Anti-Inflammatory Drug, is probably the most widely used OTC for mild to moderate pain. As compared to its predecessors, ibuprofen tends to provide better relief for pain associated with dental pain and menstrual pain. It is most commonly used to relieve arthritis related pain, reduce fever and provide a reduction in swelling and inflammation. In the mid-1990’s, another NSAID joined the OTC market under the trade name of Aleve® (Naproxen Sodium). Like its “sister drug,” naproxen sodium is most often used for mild to moderate pain associated with arthritis, headaches and sports related injuries. It is often preferred to ibuprofen because of its longer acting effects and thus less frequent dosing intervals.
Side effects and cautions include gastrointestinal (GI) upset. This is probably the most common side effect but can be mostly avoided at lower doses. Other negative effects on the kidneys or the liver can also be avoided at lower, less frequent doses.
NSAIDs can also potentially cause fluid retention and should be used in caution in patients with cardiovascular disease because of the possibility of increasing the blood pressure secondary to fluid retention. Neither should be consumed with alcohol. Because of similar effects on the body, neither ibuprofen nor naproxen sodium should be used in conjunction with aspirin. Neither should be used in women who are pregnant or breastfeeding unless specifically recommended by a physician.
Acetaminophen is one of the most often used pain relievers. Because of its little to no direct effect on the heart, it remains one of the only options for pain relief for patients who also suffer from hypertension, GI ulcers/issues, kidney disease or for patients also on a daily regimen of aspirin therapy. It is effective for pain relief associated with toothaches, headaches, sports related injuries, arthritis related pain, menstrual cramps, and aches/chills/fever. It also has a strong record of being proven safe and effective for children when used at appropriate and recommended doses. However, at large or excessive doses, acetaminophen can be toxic to the liver and has been known to cause acute liver failure and even death.
Very few (if any) side effects are ever reported with the use of acetaminophen and a severe, allergic reaction is extremely rare. Overall, this medication is very well tolerated.
Because acetaminophen is considered toxic to the liver at high doses and because it can be found in so many OTC and prescription medications, patients need to be extremely careful not to exceed the daily recommended amounts. If a patient is unsure whether or not a product contains acetaminophen, they should contact their pharmacist or physician for assistance and guidance. It should also not be consumed with alcohol. Although it has been proven safe and effective in children, it should not be used in women who are pregnant or breastfeeding unless specifically recommended by a physician.
Contrary to popular belief, ibuprofen and acetaminophen should NOT be alternated to reduce a fever or assist with pain relief unless specifically recommended by a physician. Also, patients instructed to alternate the two medications by a physician should seek the professional advice of a pharmacist for dosing and frequency/interval instructions.
Pulse: What are some other pain relief options?
The most often used soak is epsom salt. It is a natural exfoliator and possesses minimal anti-inflammatory properties. The most common uses are as a soak or paste for sore muscles or small (not deep or open) wounds or as a spray/rub for sunburn relief.
Hot and Cold Therapy
Hot Therapy: Heat increases the blood flow to cause relaxation and to reduce spasms. One should apply heat if they have chronic muscle pain or stiff joints. Never apply heat directly to the skin. Always cover the heat source with a towel. A general rule for heat application is no more than 15-20 minutes at a time. Never apply heat to an open wound or immediately after an injury (apply cold first in the latter situation). Never apply heat after applying a topical agent (cream or ointment) as it could increase the rate of absorption and thus cause burning of the skin.
Cold Therapy: Cold decreases the blood flow…especially to an injury site. It should be applied first at the onset of an injury to reduce the amount of swelling and/or inflammation. One should use cold if they have an injury or a bruised/swollen area. Always wrap the cold source in a thin towel before applying directly to the skin and never leave on for more than 15-20 minutes at a time. Use cold therapy for 24-48 after an injury before changing to heat therapy (if necessary).
Products in this category cause irritation and reddening of the skin due to dilation of the capillaries and increased blood flow. They are also known as counter-irritants. Although they are widely used and are believed to relieve musculoskeletal type pain, there is little evidence to support their use as pain relievers. The products in this class of medications will most often include a salicylate.
Burning or itching is a common side effect though it generally subsides.
Patients with skin sensitivities or allergies to ingredients, including salicylates, should not use. These topical agents should not be used on broken skin or open wounds. Contact with eyes and nostrils should also be avoided.
Some examples of rubefacients are menthol, capsaicin, methyl salicylate, trolamine salicylate and camphor and menthol.