By: Shital Mars, Chief Executive Officer of Progressive CareWe now fully comprehend the negative impact that opioids can have, both on an individual’s health and our society. However, we are only now beginning to realize that, in many cases, opioids are not even the most effective treatment for pain. As a society, we depend on painkillers to treat pain, but very few people truly understand how they work, what they are effective at treating, the involved risks, and what’s inside of what we are taking.For instance, a study published in the Journal of the American Medical Association showed that taking 400mg of ibuprofen and 1000 mg of acetaminophen (Tylenol) produced the same levels of pain relief as taking opioids with 300mg of acetaminophen.1In previous posts, we have discussed many of the prescription medications used to treat pain, but there are numerous therapies that do not require a physician prescription and can be effective at treating minor to moderate pain for acute and chronic conditions. Even some acute severe pains can be effectively managed with non-prescription grade pain therapies. Below we will discuss some of these treatments to provide a more thorough and nuanced menu of options for patients and healthcare providers looking for effective solutions.OTC Oral Pain Relievers
All common oral pain relievers have harmful gastrointestinal effects, especially on the liver and kidneys after prolonged use. NSAIDS can cause stomach and intestinal ulcers. Patients should not use OTC pain relievers more than the recommended doses and should consult a doctor when taking these medications routinely throughout the day for pain management for more than seven days, as extended use can have harmful long-term side effects. OTC pain relievers are not interchangeable. Each has specified efficacies and risks. If you are unsure which medication to use, consult a pharmacist or your doctor.Topical Anesthetics
Topical anesthetics should only be used for localized pain where the affected area is clearly discernable. Do not mix anesthetics and do not apply more than the recommended doses. Patients with cardiac problems and/or allergies to anesthesia should avoid topical numbing agents. Only apply to clean, dry skin for optimal absorption.Marijuana and Cannabidiol (CBD) Oil**NOTE: Marijuana is illegal at the federal level and in many states. Before considering marijuana for pain treatment, refer to your state’s cannabis laws and a physician with experience in prescribing cannabis for pain management. More clinical studies are necessary to ascertain the therapeutic effects of cannabis and CBD oil.Marijuana and CBD are two different substances. Marijuana contains up to 30% of a psychoactive compound known as Tetrahydrocannabinol, or THC. Although marijuana is still illegal on the federal level and in 19 states, 31 states have approved marijuana for medicinal purposes. Of these 31 states, 22 have legalized or decriminalized marijuana for recreational use. In states where marijuana is legal for medical use, a prescription is required to purchase the product at a licensed dispensary. Medical marijuana products are not available over-the-counter at traditional retail facilities or pharmacies. However, if you live in a state where adult use is legal, you can simply register at the door and make purchases without a doctor’s prescription.Marijuana – Common pain uses include neuropathic pain such as diabetic neuropathy, fibromyalgia, shingles, Multiple Sclerosis, herniated discs, spinal arthritis, etc. Cannabis acts on neuro receptors to alleviate nerve pain, as well as provide relief from pain caused by inflammation.CBD products are derived from hemp, a cannabis family plant, containing contain less than 0.3% THC. Its legality can be murky depending on the state and federal agency. Hemp-derived CBD and marijuana-derived CBD are treated differently, and their legal status can differ. You should consult your physician before using CBD for pain management.CBD – Common pain uses include arthritis, Multiple Sclerosis, and muscle and joint pain. CBD does not contain enough psychoactive compounds to produce a “high” like effect and has a low risk tolerance buildup. Its anti-inflammatory properties have shown some clinical effectiveness for the treatment of localized pain. More studies are necessary to conclusively determine therapeutic uses and standardized dosing recommendations.When using any medicine to treat pain we must understand the difference between strength and effectiveness. When looking for a pain reliever, many of us seek out the “strongest” when we really should be looking for the most effective. When we think about pain relief in terms of strength, we leave ourselves at risk of abusing or misusing a medication that simply isn’t effective at treating the pain we feel. If you feel like you need to take a medication beyond its recommended dosage instructions to increase potency, it may not mean that the medication is “weak,” but simply that the medication you’re taking is not the right medication for your pain. Before you increase your doses or use a medication more frequently than what has been recommended, consult a pharmacist or physician about whether an alternative solution would work better. If you are taking an over-the-counter medication for longer than a week, you may need an evaluation to determine the root cause of your pain, whether you are taking the right medications, and to monitor any side effects that may come as result of extended use.Therapeutic Pain TreatmentsFor many patients, medicinal therapies may not be right choice or even an option. For those with certain injuries, pain that flares due to stress or anxiety, intolerance to oral pain medication, or even just for people who hate taking medication, non-medicinal pain treatments can be beneficial.
The TakeawayPain can come in many forms and there’s not a one-size-fits-all medication for pain relief. There are a variety of treatment options for different types of pain, including OTC oral medications, topical anesthetics, cannabis, therapeutic treatments, and even water! Rarely are opioids the solution and should only be taken when necessary and prescribed by a doctor. If you are using a pain treatment that isn’t working, consult with a doctor or your local pharmacist to find a better option. I hope you were able to take something away from this and learn more about the many options to relieve pain. Thank you for reading!1. Journal of the American Medical Association, “Effect of a Single Dose of Oral Opioid and Nonopioid Analgesics on Acute Extremity Pain in the Emergency Department” – November 7, 2017https://jamanetwork.com/journals/jama/article-abstract/2661581
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