Over-the-counter pain relievers are alternatives to opioids

Jan 30, 2019 | Richard H. Rho, M.D. | @richardrho | Comments (59)

OTC medication aisleOpioid medications are among the most powerful pain relievers available and can be effective in managing severe short-term pain and cancer pain.  However, side effects including nausea, vomiting, sleepiness, constipation, and dizziness leading to falls are common.  Opioid addiction and death from overdoses are very serious issues that can occur with the use of opioids.  If pain episodes can be managed using pain medications other than opioids, side effects and addiction risk can be minimized.

What evidence would support this?

A recent medical study revealed that in the emergency department, ibuprofen and acetaminophen (over-the-counter pain relievers) were shown to be as effective in managing moderate to severe short-term pain as opioids.  Of the 104 study participants, only about 18% required an opioid due to failure of the ibuprofen/acetaminophen to manage the pain.

How does this apply to me?

There are many scenarios of moderate to severe short-term pain that can be successfully managed with ibuprofen/acetaminophen, without any need for opioids.  In many cases, addiction to opioids often begins with short-term use of opioids.  If opioids can be avoided altogether, serious side effects, as well as addiction and death from overdoses can be avoided.  In most cases, acute pain episodes are time limited, and many patients can successfully get through the episode by taking over-the-counter pain relievers instead of opioids.

The people in the study aren’t like me and my pain is different.

The study patients had pain due to acute injuries involving their extremities (i.e. arms and legs), but it would be medically reasonable to apply the same concepts to many other conditions such as acute low back pain and other bodily aches and pains.  It is important to note that severe pain, such as pain due to surgery or cancer, may require treatment with opioids.   Furthermore, different types of pain (i.e. nerve pain) may respond better to other non-opioid, prescription pain medications.

What do I do if over-the-counter pain relievers aren’t working for me?

The first place to start is by visiting your primary care provider to make sure that there is not an underlying medical issue that is causing your pain, that might require a different treatment other than taking pain relievers.  If there are no worrisome underlying conditions, then your primary care provider can refer you to the Pain Medicine Clinic, which can offer the full spectrum of treatments available.  The treatments might include medications, physical therapy, cognitive behavioral therapy, injections, or possibly implanted devices to help manage the pain.

 

Helpful Links:

 

Interested in more newsfeed posts like this? Go to the Adult Pain Medicine blog.

The cream I use is called Hempvana Roller ball with 4% lidocaine. You can just roll it in. My pain is in my lower back.

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@yvie

The cream I use is called Hempvana Roller ball with 4% lidocaine. You can just roll it in. My pain is in my lower back.

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You can get this cream at Amazon.

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@mandy75

What is the cream called please?

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Just ask the pharmacist. They make all kinds of OTC lidocaine creams, including ones for hemorrhoids and one for burns.

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@yvie

It breaks my heart to hear of so many of you in horrible pain. I, too, have occasional severe pain but I rub cream with 4% Lidocaine on the area and the pain is then very minimal and I can go on with my life. I am so, so very sorry for those who cannot do the same. Today is Easter Sunday and I pray for all of you who are suffering so terribly.

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Thank you, QueenMother. I bet you really are one! Take care and God bless.

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@yvie

It breaks my heart to hear of so many of you in horrible pain. I, too, have occasional severe pain but I rub cream with 4% Lidocaine on the area and the pain is then very minimal and I can go on with my life. I am so, so very sorry for those who cannot do the same. Today is Easter Sunday and I pray for all of you who are suffering so terribly.

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Thank you, Cookie Girl. I appreciate your responding that you liked what I had to say. I hope all is bearable for you. Take care and God bless.

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@sherry26

Thc is nessary to reduce my pain. Have to really work with someone knowledgeable so you can test different ways. During the day I can’t be high so microdose a bit at a time until desired effect. At night I take a higher dose and am high so I can sleep

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I was so happy to read this. I have had chronic pain since 1999. 3 surgeries& 30 epidurals. I need to find a doctor who has knowledge of THC. I use Percocet now,but am glad to hear your experience.

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@linamend

WHERE is your pain?

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You asked “where is my pain?.
My biggest pain is in my lower back. If I stand in the kitchen to fix myself something to eat, I have to finish in 15 minutes or the pain will be so bad that I have to get to my recliner fast and then it subsides.
Recently, I have developed neuropathy in three of my smallest toes. One would think that tors could not hurt that much but I cannot even describe how bad it hurts. However, I have discovered that if I smear a lot of lidocaine on them, after about 15 minutes the pain is tolerable. I also have bone rubbing on bone arthritis in my left shoulder so I try not to do things that will aggrevate it such as putting my bra on that has the hooks on the back. WOW! That really hurts so I bought all new ones that hook in the front. These are the worst painful areas. But I offer my pain up to God and ask him to take away my children’s pain….most especially my severely developmentally disabled daughter who has no speech and cannot even tell us where her pain is. That’s it!

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@tyyne21wigwam

Over the counter meds do not help low back pain!

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I am sorry you had think that because lidocaine patches do help me.

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@mandy75

What is the cream called please?

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The patches are called SalonPas. The cream is a rollerball called Hempvana Ultra Strrngth Pain Relief Lotion with 4% Lidocaine.

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@yvie

I am sorry you had think that because lidocaine patches do help me.

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Everyone has different pain. I would be thrilled if lidocaine in any form helped. After 20 years 30 epidurals, surgery etc. The only thing that works for me is Percocet. I guess I should have been more specific and said intractable pain is not always helped by over the counter meds. I tend to over react to the idea at 82 years old, have tried everything I know of,that opioids aren't needed. I sometimes say if drs say you don't need opioids it's because they have never had real pain. Your entire life is controlled.

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