Pain Management Over-The-Counter
MedicineNet.com:
Welcome to Doctors Dialogue,
featuring the doctors of MedicineNet.com. This segment features
Dr.
Dennis Lee, Board certified in Internal Medicine and Gastroenterology,
and Dr.
William Shiel, Board certified in Internal Medicine and Rheumatology.
Dr. Lee will be asking Dr. Shiel pertinent viewer submitted pain
management-related questions.
Dr. Lee: Many pain medications are available over-the-counter
(without a prescription, or OTC) in the U.S. for short-term relief of
joint pain, muscle aches, headache, menstrual cramps, and fever. These OTC
analgesics are generally well tolerated and safe when used properly. But side
effects do occur and in some instances can be serious. Today, we will ask Dr.
William Shiel how to use these analgesics properly in order to minimize risks
and side effects. We will also ask him to compare traditional pain relievers with the newer pain relievers, the selective COX-2
inhibitors.
What pain medications are available in
this country without a doctor's prescription?
Dr. Shiel: There are two major classes of
pain relievers available in this country without prescription; they are
acetaminophen (Tylenol) and
Non-steroidal anti-inflammatory drugs
(NSAIDs).
Dr. Lee: What are Non-steroidal
anti-inflammatory drugs?
Dr. Shiel:
Non-steroidal anti-inflammatory drugs
are medications that impair the production of prostaglandins in the body. Prostaglandins
are natural compounds that are responsible for producing fever, pain, and
inflammation.
Dr. Lee:
Why are they called non-steroidal
anti-inflammatory drugs?
Dr. Shiel:
They are called
non-steroidal anti-inflammatory drugs because they reduce inflammation without the
side effects of steroids. Steroids (Prednisone, Cortisone, Medrol,
etc.) are potent medications that reduce inflammation, but steroids
have predictable and potentially serious side effects, especially with long-term
use. Non-steroidal anti-inflammatory drugs do not have these steroid side
effects.
Dr. Lee:
Can you give me some examples of non-steroidal anti-inflammatory drugs that
are available OTC?
Dr. Shiel:
Yes, examples of OTC
NSAIDs include ibuprofen (Advil, Motrin) and
naproxen sodium (Aleve).
Dr. Lee:
Are steroids such as Medrol,
Prednisone, and Cortisone pain relievers?
Dr. Shiel:
No, steroids
are not pain relievers. But this is a common misconception
Dr. Lee. Steroids, including Cortisone, are potent medications that reduce
inflammation. And reducing inflammation can cause the pain to gradually subside.
But steroids are not used specifically for quick pain relief.
Dr. Lee:
How are over-the-counter NSAIDs
different from NSAIDs that need prescriptions from the doctor?
Dr. Shiel:
In fact, many over-the-counter
NSAIDs have the same active ingredients as prescription NSAIDs. The difference
is in the amount of active ingredient contained in each tablet or capsule,
and in the dosing requirements (how often one has to take these per day).
For example, Aleve is available over-the-counter and contains 220mg of naprosen sodium per
pill, while Naprosyn needs a doctor's prescription and may contain 375mg or
500 mg per pill.
Dr. Lee:
Let me get back to the over-the-counter pain relievers. How
is acetaminophen different from NSAIDs?
Dr. Shiel:
Acetaminophen
reduces pain and fever by acting on
the brain. NSAIDs reduce pain and fever by reducing prostaglandin production and inflammation at
the site of pain (ankle, knee, shoulder, etc.) Acetaminophen is
generally considered easier on the stomach than NSAIDs.
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