Pain Relief

NOVEMBER 01, 2008

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

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.

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.