Over-the-counter pain relief: Part of your plan?

Pain is familiar to most of us for common reasons, like stubbing a toe or overdoing work in the yard. It often requires no other treatment other than protecting the area from further injury, and possibly, the use of pain medicines that are available without a prescription. These “over-the-counter” (OTC) pain relievers, also called “analgesics,” can sometimes treat pain very well when taken as recommended.

Pain that exists for a longer time (usually 3 months or longer) is called chronic pain. Conditions like cancer pain, back pain, arthritis pain, or migraine headaches, are examples of chronic pain. Unlike simple, every day types of pain, this kind of pain should be treated by a healthcare professional. Sometime healthcare providers may suggest that OTC pain relievers can play a role in treating serious pain conditions, using them combined with other medicines, or in strengths not normally recommended for OTC use.

Walking through a typical drug store reveals what seem to be dozens of choices for OTC pain relievers. While advertisements make them all seem different, there are not as many as there seem to be, as they are sold under various names, and combinations.

Acetaminophenaspirinibuprofen, and naproxen, are a few of the most common OTC pain relievers. Acetaminophen, one of the most commonly used medications in the United States, is sometimes described as a “non-aspirin pain reliever.” Ibuprofen, naproxen, and aspirin are examples of a general class of pain relievers called NSAIDs. These are “non-steroidal anti-inflammatory drugs.” They come as a pill or capsule, and some are available as a powder or liquid.

The Federal Drug Administration (FDA) has judged that OTC pain relievers are safe and effective when used as recommend without a prescription by a healthcare provider. However, like any other type of medicine, they can be dangerous if not used properly. A common pitfall is to take more medicine than directed. This can be especially serious over a long time so if a painful condition exists more than a short period of time, it’s a good idea to seek medical attention.

Other kinds of pain relievers

Topical pain relievers are applied directly to the skin at the painful area, and generally work directly where they are applied. Some are local anesthetics with a very mild numbing effect. Others are medicines or chemicals that may work through the skin. Topical pain relievers may sometimes cause a feeling of heat or cold that can have a soothing effect.

It is important to understand the difference between topical, and another type of medication application, called transdermal medications. Both are applied to the skin. They may seem the same, but they are actually quite different. Topical medications work in the specific area of the body where they are applied, and very little if any of this medication “leaks” into your whole body. However, when transdermal medicine is applied to the skin, is meant to be absorbed into your whole body. Transdermal medicines may have effects far away from the place where they are applied, often with the same potential side effects as oral medications. An example of a transdermal pain medication that is applied to the skin is the lidocaine 5% patch, which is commonly used to treat patients with pain after an episode of Shingles. OTC pain relievers applied to the skin are usually topical, not transdermal treatments, which usually require a prescription. While topical medicines may have less risk of side effects, it is still important to tell your health care provider about them, especially if you are taking other medications.

Patient safety and pain medicine

Recently, the federal government made major changes in how it manages patient safety related to pain medicines. Some of these changes affected OTC pain relievers. For example there are new safety warnings on NSAIDs about the risk of heart problems associated with taking them, especially if used for several months or more. Restrictions have also been placed on how much acetaminophen is safe to take each day due to risk of irreversible liver damage.

Many people think that if a medicine is available without a prescription, it must be safe. In reality, no medication is totally without risk, especially when it is used improperly. Proper use means the right dose, on the right schedule, for the right condition, for the right person. Thousands of people need emergency medical treatment every year because of their improper use of OTC pain medications.

Use OTC pain relievers safely

Be safe when you are taking OTC pain relievers:

  • Don‘t take a medication that is not necessary or for longer than you need it.

  • Don’t take a dose that is not recommended on either the product label, or by your health care provider.

  • Do read the label carefully.

  • Do read the ingredients and ask your pharmacist how to avoid taking other medicines with the same ingredient. Cold medicines, for example, may contain the same ingredients as some pain medicines.

  • Do know how long to wait before taking another dose.

  • Don’t take more medicine than the maximum daily dose listed on the package for adults. Remember, that what is safe for you depends on your age and health.

  • If you have a chronic health problem, ask your healthcare provider before taking any OTC medicine.

  • Ask your pharmacist and healthcare provider whether or not your medical conditions, and the prescribed medications you are taking, will restrict your use of OTC pain relievers.

  • Limit alcohol use when taking acetaminophen or NSAIDs as it may cause serious side effects.

  • OTC pain relievers are usually meant for temporary use, not for chronic pain. Talk with your healthcare provider about how to safely manage pain that lasts more than a few weeks.

References

Forman, J. P., Stampfer, M. J., Curhan, G.C. (2005). Non-narcotic analgesic dose and risk of incident hypertension in US women. Hypertension, 46(3), 500-7

Heard, K., Sloss, D., Weber, S., Dart, R. (2005). Emergency department patients misuse over-the-counter analgesics. Academic Emergency Medicine, 12(5), suppl 1, 156.

Herbal medicines: Newer rules, familiar problems. Proposed regulations may improve quality but still won’t require proof of safety and effectiveness. (2003). Harvard Health Letter, 28(9), 4-5.

Lee, W. M. (2004). Acetaminophen and the U.S. Acute Liver Failure Study Group: Lowering the risks of hepatic failure. Hepatology, 40(1), 6-9.

Whelton, A. (1995). Renal effects of over-the-counter analgesics. Journal of Clinical Pharmacology, 35(5), 454-63.