OTC Pain Medications: The Pros and Cons

OTC medications are vital to our health care system and are the most prevalent method used to treat the majority of common health problems in the United States.¹ OTC pain medications are, by far, the most widely used of the OTC medications.² According to a white paper released by the National Safety Council on October 6, 2014, the combination of OTC pain medications ibuprofen and acetaminophen is more effective than opioid pain medications when treating acute pain.³

General benefits of using OTC pain medications include direct, rapid access to medications. These medications can be found at pharmacies and grocery stores around the clock, seven days a week. The benefits also include fewer physician visits, resulting in reduced health care system costs.¹

General risks associated with OTC pain reliever use can include incorrect self-diagnosis, resulting in serious illness, increased risk of drug—drug interactions and adverse effects, and a potential for misuse and abuse.¹ Many patients using OTC pain medication are ill-informed about their use and adverse effects.⁴

One aspect of using OTC pain medications that can be both a risk and a benefit is that patients can take charge of their own health care.

MAKING THE RIGHT CHOICE

Two types of OTC pain medications are available. The first is acetaminophen (N-acetyl-p-aminophenol, or APAP), and the second is nonsteroidal anti-inflammatory drugs (NSAIDs), which include ibuprofen, naproxen, and aspirin.

Acetaminophen works by inhibiting the synthesis of prostaglandins, which help transmit pain signals and induce fever, thereby easing pain and lowering fever. Acetaminophen will not, however, reduce swelling and inflammation.⁵ Acetaminophen may be a good choice to treat headaches, arthritis pain, and fever.⁵ Certain patients should not take APAP, including those with liver disease, individuals taking blood thinners, people drinking three or more alcoholic beverages daily, and those with an allergy to APAP.⁶

Ibuprofen also works by inhibiting the synthesis of prostaglandins. Ibuprofen also potentially inhibits the enzyme cyclooxygenase and prevents the formation of thromboxane A2 by platelet aggregation. Ibuprofen may be a good choice for the treatment of menstrual cramps, headaches, toothaches, backaches, arthritis, muscle sprains, and gout.⁵

Naproxen acts similarly to ibuprofen and is a good treatment for the same conditions as well as colds.

Aspirin, also an NSAID, works in the same way as other NSAIDs but has the bonus of inhibiting platelet aggregation, thereby lowering the risk of strokes and heart attacks in certain people. Aspirin is a good option for the same conditions treated by other NSAIDs.

Patients should avoid NSAID use if they have a history of stomach problems such as heartburn, ulcers, and bleeding. They should also avoid NSAIDs if they have kidney or liver disease, heart disease or high blood pressure, asthma; take certain medications, such as blood thinners, aspirin, diuretics, or steroids; are 60 or older; or are allergic to any ingredients in NSAIDs.⁶

UNDERSTANDING THE RISKS OF NSAIDS

Per the American Gastroenterological Association (AGA), more than 30 million people in the United States use NSAIDs for pain from headaches, arthritis, and other conditions every day.⁷ That said, the AGA also reports that NSAIDs are responsible for more than 100,000 hospitalizations and 16,500 deaths of Americans each year, commonly due to bleeding stomach ulcers.⁷

For most individuals, OTC NSAIDs are used for occasional headaches, backaches, or other acute conditions. For most patients, this kind of use is both appropriate and safe. The bigger risk is in patients who use NSAIDs long term for chronic conditions. This can damage the gastrointestinal (GI) tract. More than half of reported bleeding ulcers are caused by NSAIDs.⁷ Long-term use may also lead to heart risks, high blood pressure, and kidney damage.⁷

UNDERSTANDING THE RISKS OF ACETAMINOPHEN

Acetaminophen is the most widely used pain reliever in the world and is the World Health Organization’s first line of treatment for pain.⁸ Like NSAIDs, APAP seems perfectly safe when taken occasionally and in moderate doses.⁸ Acetaminophen taken in large doses can cause liver failure and possibly death.⁹

A small group of studies have raised questions about the safety of using APAP when taken long term and at high doses to treat chronic pain.⁸ Heavy APAP use has been associated with kidney disease, GI bleeding, an increased risk of stroke or heart attack, and high blood pressure.⁸

PUTTING SAFETY FIRST

Patients should know the active ingredient in their OTC pain medications. This will reduce the risk of taking more than one medication with the same ingredient.¹⁰

Communication with the physician is important if a patient is taking an OTC pain reliever for more than 2 weeks. This communication may lead to the discovery of an underlying issue that is being untreated.

Patients should read the directions on the drug facts label carefully to ensure that they understand how much of the medication to take and how often.¹⁰ Patients should take only the amount recommended on the label. Pharmacists can inform patients that taking more than the recommended amount of medication will not result in faster or better results but will only lead to increased adverse and possibly lethal effects.¹⁰

All medications should be stored in original containers. Bottles should have child safety caps in all households where children live or visit often. Medications should be stored high in an unreachable place for children and in cool, dry areas, not the bathroom medicine cabinet.

Expiration dates are on all medication bottles. Pharmacists can educate patients about the importance of disposing of medications appropriately after they expire. Expired drugs can be ineffective and potentially dangerous. Safe disposal of drugs should be done in such a way that the drug is not able to enter the environment. Direct patients to a local hazardous waste disposal site or have them dissolve the pills in water and mix them in kitty litter or coffee grounds and put them in an impermeable container to throw away.

Pharmacists can play a key role in educating patients about the appropriate OTC pain reliever and inform them of the correct way to take it and the correct timing between doses. Pharmacists can also help keep the environment clean by educating patients about proper disposal procedures.

Dr. Kenny earned her doctoral degree from the University of Colorado Health Sciences Center. She has more than 20 years of experience as a community pharmacist and works as a clinical medical writer based out of Colorado Springs, Colorado. Dr. Kenny is also the Colorado Education Director for the Rocky Mountain Chapter of the American Medical Writers Association and a regular contributor to Pharmacy Times.

References

• Over-the-counter medications time tool clinical reference. American College of Preventive Medicine website. http://acpm.org/?OTCMeds_ClinRef. Accessed April 15, 2017.
• Medscape. Educating the older adult on over-the-counter medication use. The Medscape website. http://medscape.com/viewarticle/705665_2. Accessed April 15, 2017.
• Over-the-counter pain medications are more effective for acute pain than prescribed painkillers [news release]. Itasca, IL: National Safety Council white paper; October 6, 2014. http://nsc.org/learn/about/Pages/Over-the-counter-pain-medications.aspx. Accessed April 15, 2017.
• Cah, E, Hall L, Ernst AA, Weiss SJ. Awareness and use of over-the-counter pain medications: a survey of emergency department patients. South Med J. 2002;95(5):529-535
• WebMD. Your guide to over-the-counter pain relief. The WebMD website. http://webmd.com/drug-medication/otc-pain-relief-10/choosing-an-otc-pain-reliever. Accessed April 15, 2017.
• Understanding over-the-counter pain medication (infographic). Arthritis Foundation website. http://arthritis.org/living-with-arthritis/treatments/medication/otc-pain-medicine-infographic.php. Accessed April 15, 2017.
• WebMD. Are anti-inflammatory pain relievers safe for you? The WebMD website. http://webmd.com/arthritis/features/are-anti-inflammatory-pain-relievers-safe-for-you#2. Accessed May 12, 2017.
• WebMD. Long-term acetaminophen use and health risks. The WebMD website. http://webmd.com/drug-medication/news/20150302/does-long-term-acetaminophen-use-raise-health-risks?print=true. Published March 2, 2015. Accessed May 12, 2017.
• WebMD. 8 ways your doctor can help you with OTC medications. The WebMD website. http://webmd.com/pain-management/features/8-ways-your-doctor-can-help-you-with-otc-drugs#1. Accessed May 12, 2017.
• A guide to safe use of pain medicine. Food and Drug Administration website. https://fda.gov/ForConsumers/ConsumerUpdates/ucm095673.htm. Accessed May 12, 2017.