3 Essential Questions to Answer Before Taking An OTC Pain-Relief Medication

How much do you want to bet that there is at least one type of over-the-counter (OTC) pain-relief medication in your house? With such a huge number of available OTC medications on the market, we would bet the odds are in our favor. Drugs such as ibuprofen, aspirin, acetaminophen, and naproxen are some familiar medication names and all fall into the spectrum of OTC pain relievers. But have you done your due diligence and made sure you’re not putting yourself at risk before deciding to take these drugs, or do you know which OTC medication is best for your current condition? Unfortunately, the answer for many people is, “no”; but it’s not their fault! Yes, these are medications that do not require a doctor’s prescription, but they can pose a risk for some, where proper education is needed.

Warnings as well as research done by the U.S. Food and Drug Administration (FDA) have often called over-the-counter pain-relief medications’ safety into question. For example, the FDA disseminated a warning that non-steroidal anti-inflammatory drugs (NSAID’s) may raise the risk of heart attack and stroke. Unless you’re an avid FDA news savant, studied pharmacology, or spent years in medical school; the general public is just not equipped with the knowledge to determine if they can safely take these medications. But you’re in luck! We would like to go over three essential questions you should be able to answer before you head to the nearest Walgreens for some Tylenol®; however, please talk to your doctor before taking an OTC pain-reliever. He or she knows you best and will help guide you in the appropriate direction in reaching pain-relief.

Why have you turned to a pain-relief medication?

The cliché, “more bang for your buck” is appropriate here. Anyone taking a medication wants to take the lowest dose possible with the minimum risk of side effects while having the most therapeutic effect possible. Let’s say you are dealing with osteoarthritis. Research has found that acetaminophen has been shown to be favorably effective at relieving osteoarthritis symptoms. Studies have also found that acetaminophen is effective at treating headaches while avoiding side effects regarding cardiovascular or digestive diseases. We must note that this is assuming acetaminophen is the only medication you are taking (we’ll go into further detail later). On the other hand, NSAID’s may pack a punch against dysmenorrhea (painful menstrual cramps) and muscle aches for some patients.

Do you currently suffer from other conditions?

Before considering what medication to take, have in mind if you also have conditions other than the chief complaint. For example, NSAID’s like Aleve® & Advil® can be hard on the digestive system where long-term use of these medications cannot only upset your stomach but may pose a risk for severe stomach ulcers. If you suffer from digestive diseases, consult a doctor before taking Advil® or Aleve®. The same goes for those who have kidney disease, because NSAID’s can decrease blood flow to the kidneys.

Recently, the FDA released a warning about NSAID’s identifying those who have had a recent bypass surgery or heart attack, specifically. If you fit into these categories, it is all the more reason to consult your doctor before taking a pain medication. For instance, acetaminophen might be a better choice for you. To drive home how OTC pain-relief drugs can exacerbate multiple conditions, if you suffer from liver disease, avoiding acetaminophen (e.g. Tylenol®) is in your best interest because of the potential negative symptoms acetaminophen can have on the liver. These are just a few examples among many. If you’re in good health, such concerns may not apply to you. But any chronic condition will play a part in drug safety.

Are there other medications you are currently taking?

Polypharmacy, or rather taking more than one medication concurrently, contributes significantly as to if you should be taking an OTC pain-relief medication or not. Most drugs undergo metabolism by the same enzymes in the liver. These interactions between drugs, also known as drug-drug interactions (DDI’s), can influence the overall effect of a given medication. Some drugs may synergize the response of other drugs while some drugs can inhibit the reaction of others. For example, if you are taking a blood thinner such as warfarin, adding NSAID’s for pain-relief significantly increases your risk of hemorrhaging (bleeding), while acetaminophen in higher doses may have a mild interaction with warfarin, it may be a better choice if your doctor advises it.

What we would like you to take away from this article is that if you are suffering from a chronic condition such as rheumatoid arthritis or degenerative disc disease, it is entirely ok to ask for your doctors’ and pharmacists’ advice. The package inserts that come with prescription medications can be a lot to process and so can the labels on over-the-counter drugs. A little expert advice on drug interactions can help you get the pain-relief you need while avoiding unwanted side effects. Once you and your healthcare team have decided on an over-the-counter medication that works best for you, remember to take it with caution considering the minor side effects that are mentioned on the package. Even then, take it only when needed and take the least amount that controls your symptoms. Which over-the-counter drugs have worked for you? Let us know!

Tags: painkiller, pain reliever, NSAID’s, adverse side effects, pain management

References:

  1. FDA Consumer Health Information. COX-2 Selective (includes Bextra, Celebrex, and Vioxx) and Non-Selective Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). fda.gov/consumer. April 2005.
  2. FDA Consumer Health Information. FDA Strengthens Warning of Heart Attack and Stroke Risk for Non-Steroidal Anti-Inflammatory Drugs. www.fda.gov/consumer. July 2015.
  3. Lenzer J. FDA advisers warn: COX 2 inhibitors increase risk of heart attack and stroke. BMJ 2005;330:440.
  4. Moling O, Cairon E, Rimenti G, Rizza F, Pristera R, Mian P. Severe hepatotoxicity after therapeutic doses of acetaminophen. Clin Ther 2006;28:755–760.
  5. Rampal P, Moore N, Van Ganse E, Le Parc JM, Wall R, Schneid H, Verriere F. Gastrointestinal tolerability of ibuprofen compared with paracetamol and aspirin at over-the-counter doses. J Int Med Res 2002;30:301–308.

Making The Pain Scale Work For You

Physical pain is one of the few incidents that are experienced virtually by all living creatures. Nonetheless, unlike animals we as human have the existential ability to apprise and be consciously aware of what we are feeling. Although pain, whether acute or chronic, can be very difficult to describe especially when trying to convey the feeling to a physician. This is why numerous subjective pain scales have been developed in the hopes that doctors may better understand a patient’s current level of pain. As mentioned, there are a variety of pain scales such as the Pain Quality Assessment Scale (PQAS), the Visual Analog Scale (VAS), the Numeric Rating Scale (NRS), and the Wong-Baker FACES® Pain Rating Scale (WBFPRS); to name a few. But for our conversation, let’s view pain scales as either a Verbal Rating Scale (VRS) or a Nonverbal Rating Scale (NVRS). Research has shown that patients prefer the VRS; unfortunately, it lacks sensitivity and the data it produces can be easily misunderstood. This misunderstanding is largely due to the fact that everyone tolerates pain differently, where someone’s “5” could be an “8” for another person based on a 1 to 10-pain rating scale. Thus, patients and doctors alike can find it difficult to arrive at an appropriate prognosis when someone’s pain is not easily defined or relatable.

Diabetic Neuropathy Vignette

Treating patients based solely off a pain scale would not only be difficult, it would also be a disservice to the patient. Let’s use two patients both with diabetic neuropathy as an example. Dr. Smith has two diabetic neuropathy patients; patient #1’s pain is a “10” and patient #2’s pain is a “7”. Given only this subjective information, Dr. Smith places patient #1 on a higher dose of Lyrica® for pain-relief while Dr. Smith puts patient #2 on a lower than average dose. Three weeks later for each patient’s follow-up appointment, patient #1, unfortunately, presents with similar diabetic foot pain and labored breathing, confusion, and difficulty in bowel movements. Patient #2 presents with similar (if not slightly worse) foot pain subsequent to being prescribed Lyrica®. Ostensibly something is wrong. Not only did both patients receive slim-to-no pain-relief because of a dose that did not fit their level of foot pain, but also unwanted side effects resulted that could have been avoided. Being provided with a subjective explanation of pain does not allow a physician to tailor a precise prognosis. So what’s the best way to convey as to how you’re truly feeling?

Sharing is Caring

It is clear that pain scales need accompanying objective context. For example, the National Institutes of Health (NIH) do use a numeric pain scale, but also ask questions that bring a more reasonable, albeit imperfect, assessment. Below we have provided some example questions that your doctor may ask. Note, although your doctor may not ask you these exact questions, still be sure to talk about these points of reference; for the more your healthcare practitioner knows about your current pain, the better chance you have of a pain-free (or reduced pain) outcome.

  1. Elaborate on what was the worst pain you have ever experienced. Maybe it was when you broke your arm or during childbirth. Whatever, the case, make it known that it is your worst pain ever felt. This can be used as a metric for what your “10” feels like and can be compared to the pain you are currently experiencing.
  2. Elaborate on your mental state. Let your doctor know if you are feeling anxious, depressed, irritated, hopelessness, etc. By identifying your feelings and emotions, it will give your doctor a better picture on how pain is affecting you overall.
  3. Show your doctor exactly where the pain is located. Instead of giving an overall-general pain level, try to pinpoint where on your body the pain is located. If the pain is radiating away from the focal point, be sure to tell your doctor the varying intensity you may be experiencing.
  4. Tell your doctor what makes the pain go away or what makes it worse. Are you taking any over-the-counter (OTC) medications once a day, or every few hours? Are you having to turn to stronger medications (e.g. opioids) for pain-relief? Does your pain get worse when doing normal daily activities, or is your pain only worsened by strenuous activity?
  5. Elaborate as to how frequent your pain is occurring. If you are struggling with chronic pain, let your doctor know the frequency and length of a pain episode. Be sure to describe a chronic pain episode that parallels how you are feeling when talking to your doctor. That way your doctor will get a “feel” as to how you are feeling on a regular basis.

Any subjective diagnostic tool that a doctor may use is always going to have its drawbacks; and yes, a pain scale is subjective. Use the five examples we mentioned as objective evidence that you can provide your doctor; but solely see our examples as a guide for communicating your current pain level. You of course can come up with your own points of reference to convey to your doctor how you are feeling. Look at your pain management regimen as a team between you and your doctor. Communication is key in any team and the more you and your doctor understand one another, the more effective you will be in reaching the goal you both are striving for, complete pain-relief. What’s the best way you have found to communicate your level of pain with your doctor? Please let us know!

Tags: pain scale, acute pain, chronic pain, diabetic neuropathy

References:

  1. de C Williams AC, Davies HT, Chadury Y. Simple pain rating scales hide complex idiosyncratic meanings. Pain. 2000 Apr;85(3):457–463.
  2. Jensen MP, Karoly P, Braver S. The measurement of clinical pain intensity: a comparison of six methods. Pain. 1986 Oct;27(1):117–126.
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  4. Paice JA, Cohen FL. Validity of a verbally administered numeric rating scale to measure cancer pain intensity. Cancer Nurs. 1997 Apr;20(2):88–93.
  5. Robinson-Papp J. Barriers to Chronic Pain Measurement: A Qualitative Study of Patient Perspectives. Pain Med. 2015 Jul;16(7):1256-64