Author: Yvette C. Terrie, BSPharm, RPh
Ms. Terrie is a clinical pharmacy writer based in Haymarket, Virginia.
Pain is one of the most common reasons
individuals seek medical care from a
physician.1 Individuals may characterize
pain as sharp or dull, intermittent or
constant, throbbing or steady, and levels
of pain can vary from individual to individual.1 In general, pain can be classified
into 2 broad categories:
- Acute pain is short-lasting pain that
occurs suddenly and usually manifests
itself as the result of a disease,
inflammation, or injury/trauma to tissues
and after surgery. Acute pain
also may be accompanied by anxiety
or emotional distress.1,2 In general, the
causes of acute pain usually can be
diagnosed and treated. In some rare
instances, acute pain can become
chronic pain.2
- Chronic pain is pain lasting or recurring
for more than 3 months or pain
that continues for more than 1 month
after the resolution of an acute tissue
injury, or accompanies a non-healing
lesion.1-3 Examples of causes of
chronic pain include medical conditions
(eg, cancer, arthritis, diabetes)
and injuries (eg, herniated disk, torn
ligament).1-3
Table 1 |
Examples of OTC Systemic Analgesics |
Drug Class | Active Ingredient | Brand Name |
N-acetyl-para-aminophenol | Acetaminophen | ? Tylenol Regular Strength
? Tylenol Extra Strength
? Tylenol Arthritis |
Salicylates | Acetylsalicylic Acid | ? Genuine Bayer Aspirin
? Extra Strength Bayer
? Extra Strength Bayer Plus
? Ecotrin Maximum Strength
Arthritis Relief
? Ecotrin Regular Strength |
Propionic acid derivatives | Ibuprofen | ? Motrin IB
? Advil
? Nuprin |
|---|
Naproxen | Aleve |
|
According to statistics compiled by
the Centers for Disease Control and
Prevention's National Center for Health
Statistics (NCHS), at least 1 of every
4 adults in the United States reported
experiencing at least 1 day of pain
monthly, and at least 1 in 10 individuals
experienced pain that persisted at least
a year or more.4 NCHS reports that
the most common cause of pain is low
back pain, accounting for 27% of survey
responders, followed by severe headache
or migraine pain (15%), neck pain
(15%), and facial pain (4%).4 Examples
of other causes of pain include neuropathic
pain (eg, carpal tunnel syndrome),
osteoarthritis/joint pain, musculoskeletal
pain (eg, tendonitis/bursitis
and sprains/strains), menstrual pain,
and oral pain due to toothaches, mouth
sores, dentures, etc.4
Pain is a common symptom of many
medical conditions. Whereas many individuals
will seek medical care, many
others elect to self-treat pain episodes,5
placing pharmacists in a pivotal position
to assist these patients in the proper
selection of the wide array of OTC analgesics
currently on the market.
Table 2 |
Miscellaneous Combination Systemic Analgesics |
Brand Name | Active Ingredients |
Advil PM | Diphenhydramine citrate 38 mg, ibuprofen 200 mg |
Arthriten Maximum Strength Coated Tablets | Magnesium salicylate 310 mg, acetaminophen 250 mg, caffeine anhydrous 32.5 mg |
Arthritis Strength BC Powder | ASA 742 mg, salicylamide 222 mg, caffeine 38 mg |
Ascriptin Tablets | ASA 500 mg, aluminum hydroxide 33 mg, magnesium hydroxide 33 mg, calcium carbonate 237 mg |
Bayer Extra Strength Back & Body Pain | ASA 500 mg, caffeine 32.5 mg |
Bufferin Tablets | Available in 325 or 500 mg, ASA buffered with calcium carbonate, magnesium oxide, and magnesium carbonate |
Percogesic | 325 mg APAP, phenyltoloxamine citrate 30 mg |
Tylenol | PM APAP 500 mg, diphenhydramine 25 mg |
Vanquish Extra Strength Pain Reliever Caplets | APAP 194 mg, 227 mg ASA, 33 mg caffeine |
APAP = N-acetyl-para-aminophenol; ASA = acetylsalicylic acid. |
|
For any individual experiencing pain,
achieving adequate relief is a top priority.
OTC analgesics are available as both
systemic and topical agents in a variety
of dosage forms and as single- and multiple-ingredient products (Tables 1 and
2). Patients should be reminded always
to check the active ingredients of these
products to avoid possible therapeutic
duplications, as well as to avoid the
unnecessary use of medications.
Pain often affects an individual's ability
to sleep; therefore, some products
contain both an analgesic and a sleep
aid such as diphenhydramine. In addition
to traditional analgesics, a number
of homeopathic pain relief products are
available.
For more information on pain relief, please visit the following Web sites: |
Prior to recommending any of these
products, pharmacists should determine
if self-treatment is appropriate and refer
patients to seek further medical evaluation
when warranted, especially if the
patient has episodes of pain that can be
classified as severe, recurring, or prolonged,
or if the cause of the pain has not
been identified. Pharmacists also should
screen for potential drug?drug interactions,
as well as possible contraindications.
Patients should be advised to
adhere to administration and dosage
guidelines and to not use these products
for longer than advised, unless otherwise
directed by a physician.
If pain persists after 7 to 10 days
of self-treatment or worsens, patients
should be encouraged to seek medical
care. Furthermore, women who are
pregnant or lactating, as well as individuals
with preexisting medical conditions,
should be advised to consult their primary
health care provider before using any
of these products. Pharmacists also can
suggest nonpharmacologic measures
that may help relieve pain, depending
upon the nature of the pain.
Table 3 |
Examples of OTC Topical Agents |
Category/Class | Brand Name |
Capsicum, capsicum oleoresin, capsaicin | ? ArthriCare Cream for Women
? Capzasin P Cream
? Capzasin HP Cream
? Capzasin Arthritis Pain Relief Back and Body Patch
? Cura-Heat Penetrating Pain Relief - Arthritis Formula with Liquid Capsaicin
? Salonpas-Hot Capsicum Patch
? Zostrix Arthritis Pain Relief Cream
? Zostrix HP Arthritis Pain Relief Cream |
Counterirritants (contain camphor, menthol, or methyl salicylate) | ? ActivOn Ultra Strength Backache Topical Analgesic
? Bengay Pain Relieving Patch
? Biofreeze Pain Relieving Gel
? Eucalyptamint Arthritis Pain Relief Ointment
? Flexall Pain Relieving Gel
? Icy Hot Extra Strength Medicated Patch
? Icy Hot Knee and Ankle Sleeve
? Joint Flex-Out Pain Relieving Cream
? Joint-Ritis Maximum Strength Arthritis Pain Reliever Roll-On
? Mentholatum Deep Heating Extra Strength Pain Relieving Rub
? Mineral Ice Original Therapeutic Pain Relieving Gel
? MyoRx Arthritis and Muscle Pain with Omega Oils Cream
? Thera-Gesic Maximum Strength Pain Relief Cream
? Therapeutic Mineral Ice
? Well Patch Arthritis Pain Relieving Patch |
Salicylates (contain trolamine salicylate 10%) | ? Aspercreme Analgesic Cream
? Aspercreme Medicated Back and Body Patch
? Joint-Ritis Arthritis Strength Pain Reliever, Vanishing Cream
? Mobisyl Maximum Strength Pain Relieving Creme
? Myoflex Creme
? Sportscreme |
Combination products | ? Activon Topical Analgesic
? Arth-Rx Topical Analgesic
? Arthritis Hot Pain Relief Cream
? Bayer Muscle & Joint Cream
? Bengay Arthritis Formula Cream
? Bengay Pain Relieving Cream
? Bengay Ultra Strength Cream
? Blue-Emu Ice Spray
? Blue-Emu with Menthol
? Icy Hot Balm
? Icy Hot Chill Stick
? Sloan's Liniment
? Stopain Extra Strength Pain Relief Spray with Glucosamine and MSM |
MSM = methylsulfonylmethane. |
|
Table 4 |
Examples of Homeopathic Pain Products |
Brand Name | Ingredients |
Arnica Pellets | Arnica montana HPUS |
Arnicare Gel | Arnica montana 1x HPUS 7% |
Hyland's Arnicaid First Aid Relief Tablets | Arnica montana 30x HPUS, hypericum perfoliatum 6x HPUS, ruta graveolens 6x HPUS, ledum palustre 6x HPUS, bellis perennis 6x HPUS |
Hyland's Arthritis Pain Formula Natural Relief Tablets | Arnica montana 6x HPUS, cimicifuga racemosa 3x HPUS, guaiacum 3x HPUS, bryonia 3x HPUS, rhus toxicodendron 6x HPUS |
NatraBio Arnica Relief Tablets | Arnica montana 4x, belladonna 4x, bellis perennis 4x, calendula officinalis 4x, chamomilla 4x, hamamelis virginica 4x, hypericum perforatum 4x, rhus toxicodendron 6x, ruta graveolens 6x, mercurius solubilis 8x |
Neuragen PN | Hypericium 3x oil extracts from geranium, lavender, bergamot, eucalyptus, tea tree |
HPUS = Homeopathic Pharmacopoeia of the United States. |
|
References
- Pain. In: Beers M, ed. The Merck Manual of Diagnosis and Therapy. 18th ed. Rahway, NJ: Merck Publishing; 2006:1769-1770.
- Chronic Pain. MedicineNet.com Web site. www.medicinenet.com/chronic_pain/article.htm.
- Chronic Pain. In: Beers M, ed. The Merck Manual of Diagnosis and Therapy. 18th ed. Rahway, NJ: Merck Publishing; 2006:1776.
- New Report Finds Pain Affects Millions of Americans [press release]. Centers for Disease Control and Prevention National Center for Health Statistics Web site. www.medicinenet.com/chronic_pain/article.htm.
- Wright, Eric. Musculoskeletal Injuries and Disorders. In: Berardi R, Newton G, McDermott JH, et al, eds. Handbook of Nonprescription Drugs. 15th ed. Washington, DC: American Pharmacists Association; 2006:109-129.