Pain Relief

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

Pain is one of the most common reasonsindividuals seek medical care from aphysician.¹ Individuals may characterizepain as sharp or dull, intermittent orconstant, throbbing or steady, and levelsof pain can vary from individual to individual.¹ In general, pain can be classifiedinto 2 broad categories:

• Acute pain is short-lasting pain thatoccurs suddenly and usually manifestsitself as the result of a disease,inflammation, or injury/trauma to tissuesand after surgery. Acute painalso may be accompanied by anxietyor emotional distress.^1,2 In general, thecauses of acute pain usually can bediagnosed and treated. In some rareinstances, acute pain can becomechronic pain.²
• Chronic pain is pain lasting or recurringfor more than 3 months or painthat continues for more than 1 monthafter the resolution of an acute tissueinjury, or accompanies a non-healinglesion.^1-3 Examples of causes ofchronic pain include medical conditions(eg, cancer, arthritis, diabetes)and injuries (eg, herniated disk, tornligament).^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 bythe Centers for Disease Control andPrevention's National Center for HealthStatistics (NCHS), at least 1 of every4 adults in the United States reportedexperiencing at least 1 day of painmonthly, and at least 1 in 10 individualsexperienced pain that persisted at leasta year or more.⁴ NCHS reports thatthe most common cause of pain is lowback pain, accounting for 27% of surveyresponders, followed by severe headacheor migraine pain (15%), neck pain(15%), and facial pain (4%).⁴ Examplesof other causes of pain include neuropathicpain (eg, carpal tunnel syndrome),osteoarthritis/joint pain, musculoskeletalpain (eg, tendonitis/bursitisand sprains/strains), menstrual pain,and oral pain due to toothaches, mouthsores, dentures, etc.⁴

Pain is a common symptom of manymedical conditions. Whereas many individualswill seek medical care, manyothers elect to self-treat pain episodes,⁵placing pharmacists in a pivotal positionto assist these patients in the properselection of the wide array of OTC analgesicscurrently 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 bothsystemic and topical agents in a varietyof dosage forms and as single- and multiple-ingredient products (Tables 1 and2). Patients should be reminded alwaysto check the active ingredients of theseproducts to avoid possible therapeuticduplications, as well as to avoid theunnecessary use of medications.

Pain often affects an individual's abilityto sleep; therefore, some productscontain both an analgesic and a sleepaid such as diphenhydramine. In additionto traditional analgesics, a numberof homeopathic pain relief products areavailable.

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 theseproducts, pharmacists should determineif self-treatment is appropriate and referpatients to seek further medical evaluationwhen warranted, especially if thepatient has episodes of pain that can beclassified as severe, recurring, or prolonged,or if the cause of the pain has notbeen identified. Pharmacists also shouldscreen for potential drug?drug interactions,as well as possible contraindications.Patients should be advised toadhere to administration and dosageguidelines and to not use these productsfor longer than advised, unless otherwisedirected by a physician.

If pain persists after 7 to 10 daysof self-treatment or worsens, patientsshould be encouraged to seek medicalcare. Furthermore, women who arepregnant or lactating, as well as individualswith preexisting medical conditions,should be advised to consult their primaryhealth care provider before using anyof these products. Pharmacists also cansuggest nonpharmacologic measuresthat may help relieve pain, dependingupon 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.