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.

@cgs

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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Every drug can be toxic if the dose is to high or if you’ve taken it to long & all drugs affect your liver at some point ~ your MD should be watching your liver function throughout treatment w any medication

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@sommerreign

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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Thanks for encouragement appreciate your prayers I'm going to go ahead and try and get that done

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It always seems to me that dr.s are not giving opioids to patients who don't need it. If ibuprofen helped 18 percent of people, they didn't have real pain. I do not think dr.s are giving them opioids in error.

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Correction of my message about 18 percent. Of patients. I meant, not them, but the. Rest of the 104 patients that were helped with ibuprofen , probably don't need opioids. I do not think that drs. Give opioids to patients who don't need it. Where did that idea come from?

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How much nasid .how often

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@jackboatj9p

can I get help here to to start getting off hydromophone and the doctors are now giving me escitalopram oxalate 10 mg and clonazepam .5 mg I WAS ON OXYCODONE FOR 10 YEARS WHEN THEY SWITCHED ME TO HYDROMORPHONE AND i THINK i WAS HAVING BAD WITHDRAWALS SO THEY PUT ME ON THE CLONAZEPAM AND ESCITALOPRAM AND i HAVE HAVE HAVE BAD LUNGS AND AM ON OXYGEN AND MY BREATHING IS GETTING VERY BAD no strength to do anything without getting severely out of breath, will cbd help in withdrawals if I cut back on them myself

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These days, many drs seem to be swayed by popular opinions, over what's best for the patients. It truly cause much sadness , even suicide, for many, the last few years. I think you need a different dr. A brave dr, like I have. Many pain Dr's lie, and say, that they are not allowed to write prescriptions for quality pain meds. It's not true. Like being in school, it's about peer pressure. I know. I searched for the right Dr. She gets negativity over the good pain meds. She writes them anyways, cuz she cares more about her patients. I'm sorry that you are suffering with this. I would search for a good dr...

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@kenc

Seems as if there is no effective treatment for severe, chronic pain.

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My own experience. For year's, nothing helped me. Then, I finally found a good pain dr. in 2007. She sent me in to, recieve nerve blocks, in my neck. She put me on good pain meds. I was severely injured by a chiropractor in 1996. For year's I was not believed, or helped. I was bullied by drs. The one good pain dr, that I finally found, helped change my life. I still have pain, but I'm much better. I swim, which I could not do, for years. Physical therapy helped, but b4 I had good pain dr, Physical therapy made me worse, not better. Finding the right dr, is key. It's not easy, these days.

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I am currently in pain due to the need for a right shoulder surgery. I also have a pancreatic cyst being watched by my gastroenterologist. He wants me on a minimum of pain meds, specifically Tylenol and just one or two at bedtime. I am afraid to take anything so I am in pain most of the time, especially at night and it wakes me up, getting around four hours sleep each night. For a long time I have taken Gabapentin, up to four a day if that, it is my go to med at bedtime. I don't know if Gabapentin is bad for me, primary care doc says ok. Opiates make me itch so I avoid them. What else is there for pain control? NSAIDS are out because of pancreas cyst concerns.

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Oh how I wish those OTC meds could help, but sadly I cannot take them, thus opiates which do help. At this point in my life I am less concerned about drug dependence than I am about being able to function, and that I do on many levels. One often needs to accept that narcotics may be the only option for any kind of "quality of life."

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@lilarose1941

I am currently in pain due to the need for a right shoulder surgery. I also have a pancreatic cyst being watched by my gastroenterologist. He wants me on a minimum of pain meds, specifically Tylenol and just one or two at bedtime. I am afraid to take anything so I am in pain most of the time, especially at night and it wakes me up, getting around four hours sleep each night. For a long time I have taken Gabapentin, up to four a day if that, it is my go to med at bedtime. I don't know if Gabapentin is bad for me, primary care doc says ok. Opiates make me itch so I avoid them. What else is there for pain control? NSAIDS are out because of pancreas cyst concerns.

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Opioids only make you itch when you've taken a little too much. Try cutting a pill in 1/2 or 1/4. There is nothing OTC except NSAIDS, aspirin, and Tylenol. You can try voltaren gel (Diclofenac sodium) OTC, but it will be non-Rx strength.

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