Pain Relief

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Ms. Terrie is a clinical pharmacy writer based in Haymarket, Virginia.

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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:

1. 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
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: American Pain Foundation at www.painfoundation.org American Chronic Pain Association at www.theacpa.org National Pain Foundation at www.nationalpainfoundation.org National Foundation for the Treatment of Pain at www.paincare.org

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

1. Pain. In: Beers M, ed. The Merck Manual of Diagnosis and Therapy. 18th ed. Rahway, NJ: Merck Publishing; 2006:1769-1770.
2. Chronic Pain. MedicineNet.com Web site. www.medicinenet.com/chronic_pain/article.htm.
3. Chronic Pain. In: Beers M, ed. The Merck Manual of Diagnosis and Therapy. 18th ed. Rahway, NJ: Merck Publishing; 2006:1776.
4. 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.
5. 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.