Dealing With Pain The OTC Way!

Posted on Jun 20, 2016 by William J. Claiborne, DDS MS

As a periodontist, a priority with each patient is to make every appointment as comfortable as possible. For patients with problems that have become painful, my goal is to get them out of pain as quickly as possible.

While I’d like to think that everything we do is painless, the periodontal specialty often involves procedures that require penetrating tender gum tissues.

We offer sedation options and use technology and techniques designed to speed healing and minimize discomfort. However, once the patient leaves our office, post-surgical or post-treatment discomfort may occur as the tissues heal.

For example, when we place Dental Implants, we sedate patients so they will be relaxed and comfortable throughout the process. Once the patient returns home and the numbness wears off, they may experience some swelling and tenderness for a day or so.

During the healing period, we make prescription strength medications available to our patients for pain relief. Most tell us they did not need them and only took over-the-counter (OTC) medications (if any).

Although we make recommendations as to which OTC medications will be most effective for pain relief and swelling, I thought it would be helpful to explain the variations between the long list of drug store pain relief.

Once upon a time, if you had pain, you took aspirin. Drug options have greatly expanded. For most mild to moderate pain, over-the-counter pain relievers (analgesics), like non-steroidal anti-inflammatory drugs (non-steroidal anti-inflammatory drugs – commonly known as NSAIDs) or acetaminophen are the first choice.

When medications do not require a prescription, we typically assume they are safe. Yet, analgesics can have side effects and interact with other medicines, dietary supplements, and alcohol. Too, they contain the same ingredients found in many prescription drugs. This means if you’re taking several medications, you could be getting more of a particular pain reliever than you realize.

NSAIDs (aspirin, ibuprofen (Advil, Motrin, others), naproxen sodium (Aleve, Naprosyn, others), and ketoprofen (Orudis, others) are non-steroidal anti-inflammatory drugs. They reduce pain, inflammation, and fever by inhibiting production of the prostaglandins (hormone-like substances) that cause them. The down side is that they also block other prostaglandins that protect the stomach lining, regulate blood flow to the kidneys, and initiate blood clotting.
Stomach inflammation, peptic ulcers, and intestinal bleeding are major hazards for NSAID users. People who take high doses for an extended time are at greater risk, older adults especially. NSAIDs also slightly increase the risk for hemorrhagic stroke (bleeding in the brain).

Acetaminophen (Tylenol, Anacin-3, others) relieves pain and fever by affecting the parts of the brain that receive pain signals. Although acetaminophen reduces pain and fever, it has no effect on inflammation, but neither does it cause the bleeding and clotting problems associated with NSAIDs.
Acetaminophen is metabolized by enzymes in the liver. Taking too much can lead to liver damage in susceptible people, such as those who drink alcohol regularly. Taking two or more acetaminophen-containing products at the same time, or taking doses too close together, can cause overdose.
Closely read the labels of all medications to ensure you’re not exceeding the maximum recommended dose of acetaminophen — 4,000 mg per day, for people with no liver problems.

If you don’t fall into a specific risk group, taking nonprescription pain relievers as directed is generally safe. The potential for trouble emerges when you add the following:
• Some NSAID and acetaminophen products, as well as cold, sinus, and allergy remedies, contain a combination of pain relievers. Regular and long-term use of painkillers that combine analgesics can damage the kidneys.
    • Many prescription painkillers contain acetaminophen (Darvocet, Vicodin, others) or NSAIDS (Celebrex, Percodan, others). Do not take both prescription and over-the-counter painkillers without checking first with your doctor. A chart of prescription drugs containing acetaminophen and NSAIDs is available on the American Academy of Family Physicians’ website: www.familydoctor.org/otc/knowmeds.html.
    • NSAIDs can interact with many drugs, including ACE inhibitors, anticoagulants, beta blockers, lithium, and methotrexate. Aspirin interacts with anticonvulsants, corticosteroids, insulin, and sulfa antibiotics. If you take any of these prescription medicines, check before using NSAIDs.
    • Herbal supplements such as garlic, ginger, feverfew, ginkgo, and ginseng can thin blood and should be avoided when taking an NSAID.
    • NSAIDs can interfere with absorption of folic acid. If taking NSAIDs regularly, take a multivitamin daily.

It is important that your treatment and recovery result in a positive outcome without undue complications or discomfort. By understanding the advantages as well as potential adverse reactions of NSAIDs and acetaminophen, you can minimize the amount needed while gaining the most comfort from your chosen brand.