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Wed, Jan 30 8:10am · Over-the-counter pain relievers are alternatives to opioids in Adult Pain Medicine

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.


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Dec 18, 2018 · Why are epidural steroid injections for back pain limited to only a few a year? in Adult Pain Medicine

man balancing on a logOriginally posted via MayoClinic.Org

Epidural steroid injections are usually limited to just a few a year because there’s a chance these drugs might weaken your spinal bones and nearby muscles. This isn’t caused by the needle — it’s a possible side effect of steroids.

Steroid injections can also cause other side effects, including skin thinning, loss of color in the skin, facial flushing, insomnia, moodiness and high blood sugar. The risk of side effects increases with the number of steroid injections you receive.

Epidural steroid injections contain drugs that mimic the effects of the hormones cortisone and hydrocortisone. When injected near irritated nerves in your spine, these drugs may temporarily reduce inflammation and help relieve pain.

But steroid injections also disrupt your body’s natural hormone balance. Delaying repeat injections allows your body to return to its normal balance.

It’s important to carefully weigh the potential risks and benefits of long-term epidural steroid injections. If you’re in pain between epidural steroid injections, you might ask your doctor about other treatment options for back pain.

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