OTC for mild symptoms
For common, mild symtoms such as aches, strains, and pulled muscles, over-the-counter medicines can be quite effective. Your pharmacist can recommend inexpensive treatments (such as Tylenol®, ibuprofen, or aspirin) designed to alleviate pain, and reduce swelling and inflammation that usually accompany minor injuries.
Non-narcotic Analgesics
Acetaminophen (Tylenol) is a pure analgesic without any anti-inflammatory effects. It works by decreasing PG production in the central nervous system but has no effect on the production of PG in the rest of the body. Acetaminophen is a less-effective analgesic than aspirin, but it has none of the toxic side effects such as stomach ulcers or breathing difficulties associated with the NSAIDs. If you have aspirin sensitivity, acetaminophen should be the first pain therapy you take. It should also be considered if you are older and have osteoarthritis of the spine. It can be used in combination with NSAIDs or narcotic drugs.
Check with your physician to determine the maximum dose of acetaminophen that is appropriate for your clinical condition. Be especially cautious if you drink alcohol on a daily basis and take acetaminophen, because both drugs irritate the liver. If you drink alcohol regularly, you must lower your dose of the drug. In order to decrease the risk of liver damage while on high doses of acetaminophen, you will need blood tests that monitor liver function.
Acetaminophen is available in a variety of doses (325 mg, 500 mg, 650 mg) and forms (tablets, capsules, liquid). Tylenol Arthritis® is special in that the effect of the medicine is prolonged. Where the effect of regular acetaminophen is about four hours, Tylenol Arthritis is released more slowly and has a six- to eight-hour effect. Taken three times a day, this drug is able to offer pain relief around the clock.
Tramadol (Ultram®) is another nonnarcotic, pure analgesic that is as effective as aspirin and ibuprofen. Its action is mediated through activation of narcotic and serotonin receptors in the central nervous system. Like acetaminophen, tramadol has no cross-reaction with NSAIDs, and if you are sensitive to aspirin you can take tramadol without concern about difficulty breathing. This drug also has no effect on stomach lining, although tramadol may cause nausea and dizziness. Do not take tramadol if you have a history of seizures, because it lowers seizure threshold, thereby increasing the risk of seizure occurrence.
Tramadol comes as a 50 mg tablet that can be broken into 25 mg halves. You should start the drug at 25 mg to decrease the risk of nausea. You can increase the dose as tolerated after consultation with your physician. Most people benefit at less than the maximum dose. Like acetaminophen, tramadol is synergistic and can be used with NSAIDs for additional pain relief.
Dosage |
Frequency |
Half-life |
Comment |
|
|
Aleve (naproxen sodium) |
275/550 |
3-4 |
13 |
|
32s |
4 6 |
4 |
||
325 |
4-6 |
4 |
obey package labeling, inexpensive |
|
975 |
4 |
4 |
obey package labeling, less Gl upset |
|
|
Motrin (ibuprofen) |
400-800 |
4 6 |
1-3 |
obey package labeling |
|
Orudis KT (ketoprofen) |
25-75 |
3-4 |
3-4 |
obey package labeling |
Finding the Right NSAID for Your Pain
NSAIDs and COX-2 inhibitors currently available for the treatment of spinal disorders are listed on the Prescription drugs page. The choice and dosage of NSAIDs depend on factors related to your medical condition. Acute mechanical conditions (muscle strain) occurring in young people require NSAIDs with rapid onset of action and pain-relieving properties, such as ibuprofen, naproxen, and ketoprofen. For these acute mechanical disorders, treatment with NSAIDs generally lasts two to four weeks. Concerns about toxicity are less significant if, for example, you are young with a muscle strain that will improve in a short period and you do not have any other medical problem.
NSAIDs available over the counter include ibuprofen (Advil, Motrin Ib, Nuprin), naproxen (Aleve), and ketoprofen (Orudis KT). These same drugs are available in prescription strength: Motrin, Naprelan, and Orudis, respectively. If the OTC products are taken in high doses, they will have the same benefits and toxicities as their prescription counterparts. These over-the counter medications have a lower, but continued, risk of toxicity. Since most adults routinely take these products for minor pain, the best advice I can give you is to follow the instructions on the pill container, but if your symptoms do not subside, see your doctor. Do not take more without your doctor's advice.
Aspirin, a powerful NSAID, improves low back pain and is effective but potentially toxic. The same properties that make aspirin effective for preventing heart attacks and strokes also increase the risk for bleeding. In addition to stomach ulcers, aspirin can cause ringing in the ears, reversible deafness, and death if taken in a high dosage. Never exceed the recommended dose without advice from your doctor.
Use a COX-2 inhibitor if you have a history of stomach ulcer or gastrointestinal bleeding. Concerns have been raised regarding COX-2 inhibitors as well as older NSAIDs. The cardiovascular toxicities of these agents are related to their effects on blood pressure. Prolonged heightened blood pressure, hypertension, is associated with myocardial infarctions and stroke. If you are taking wither a NSAID or COX-II inhibitor on a daily basis, you should have your weight and blood pressure measured regularly. Blood tests also are indicated to monitor for toxicities affecting blood counts and kidney and liver function.