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.

I have pretty much ran the gambit of opioid pain relief medication. Besides having a high tolerance for opium based medication, I have had some side affects, e.g., difficulty urinating. I have tried gabapentin and the spinal stimulator; both to no avail. Now would like to read people's success w/ OTC pain reliever for treating strong rectal area pain, even though I had my rectum removed.

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@kenc

I have pretty much ran the gambit of opioid pain relief medication. Besides having a high tolerance for opium based medication, I have had some side affects, e.g., difficulty urinating. I have tried gabapentin and the spinal stimulator; both to no avail. Now would like to read people's success w/ OTC pain reliever for treating strong rectal area pain, even though I had my rectum removed.

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God bless you thanks for sharing I take 1800 mg of Gabapentin and it's seems to be losing its effect a little bit at a time I have talked to my doctor about it and he says that's part of the neuropathy and he added another 300 mg at night but it seems like it's too much I don't know if it's just me I woke up this morning with as also often my hands and arms asleep are numb and even filled a numbness in my left side of my chest I have I've read that Gabapentin is neurotoxic I'm not sure about that my doctors hasn't mentioned anything about it I got that from CMT website

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In addition I have a stress test scheduled for May 1st which is my birthday I'm kind of afraid to take it the way things are I've had a couple in the past with no problems but I'm a little bit fearful of taking one now because of all the problems that I'm having with neuropathy and and shortness of breath in the morning

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Be careful with gabapentin it’s not an opioid but it’s not harmless

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@ruthblaze

Be careful with gabapentin it’s not an opioid but it’s not harmless

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Just a note....I was prescribed 900 mg in AM and 900 mg in the PM, of Gabapentin. After about 8 months, I stopped taking it bc it made me almost "zombie-like". When I stopped I didn't notice any PN pain or discomfort.
I watch what I eat and drink after researching .
This has helped me more than a pill could have. My main problem is the numbness in my feet. I limit myself to foods with sugar, sodium or preservatives. I also limit myself to soda pop which was something I hated.
I also have CKD ( Chronic Kidney Disease). I have to try to stay away from foods
Fruits and veggies that are higher in sodium, potassium and phosphorous. It's a bummer getting older and noticing ones body start to deteriorate.

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@mandy75

What is the cream called please?

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Mandy: I use Hemp with Lidocaine and it helps me but I have read other people’s comments and not everyone agrees that it helps. To each his own.

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I am very upset that those who
have abused opioids have prevented those who legitimately need them from being prescribed them. With PKD ruptured cysts and infection, Oxy is the only thing that relieves the agonizing pain. I am happy that your regimen works for you but severe, unrelenting pain destroys people physically, mentally and emotionally. I lobby for a more rational approach to opioids.

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I was prescribed Percocet over ten years ago. Surgery, epidurals,blocks have not helped my intolerable pain. Alternative medicine has not worked I would like to see a doctor that could give me frequent advice on how to use the amount of opioids as well as how often in what mgs. I am 82 and some doctors say go ahead and use Percocet. Specialist say we will not continue with opioids of any kind. They do not explain alternatives. This is of concern to me

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@ruthblaze

Be careful with gabapentin it’s not an opioid but it’s not harmless

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And it can disrupt your cognitive abilities, especially with math! So if you have a job that requires calculations, have someone double check your figures until you see if it is disturbing your brain processes

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@cgs

In addition I have a stress test scheduled for May 1st which is my birthday I'm kind of afraid to take it the way things are I've had a couple in the past with no problems but I'm a little bit fearful of taking one now because of all the problems that I'm having with neuropathy and and shortness of breath in the morning

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So get the test done b/c if anything happens, you’ll be in good hands & be treated, IF you are worried about your feet or legs buckling b/c of neuropathy, they can do a chemical stress test which requires no physical use of your legs.

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