National Pharmacy Week: Safely Using Pain Relievers

National Pharmacy Week: Safely Using Pain Relievers

By Mountain-Pacific Quality Health

October 19, 2021

October is American Pharmacists Month, and October 17-23 is National Pharmacy Week. This is a great opportunity to thank our pharmacists for the important role they play in our health and our care. Pharmacists are a readily available resource who can answer questions about medications, vaccinations and much more.

Mountain-Pacific Quality Health sat down with one of our own pharmacists, Pharmacy Manager Tony King, RPh, PharmD, to answer some questions about over-the-counter and prescription pain relievers.

Q: When we talk about over-the-counter pain relievers, we often talk about non-steroidal anti-inflammatory drugs, or NSAIDs. What does that classification mean?

Tony: It is a class of medications that treat inflammation in the body, which is a marker when your body thinks something is going wrong. It activates a system and causes inflammation, so it triggers things in your body that will help treat that problem. The NSAID class really tries to knock down inflammation, so your body doesn’t hurt as much and still lets the body take care of whatever might be bothering it.

Q: What are some common examples of NSAIDs?

Tony: A lot of people think all over-the-counter pain medications are NSAIDs, but they’re not. The most common ones are ibuprofen and naproxen. Ibuprofen you know as Motrin or Advil, and then naproxen is Aleve.

People may think Tylenol or aspirin is an NSAID, but it works a little bit differently.

Q: Okay, so let’s talk about over-the-counter medications that aren’t NSAIDs. What are the differences and what are some of those?

Tony: Tylenol is the one most people take for pain. It is strictly a pain reliever. It doesn’t help any inflammatory response in the body. It triggers something in the brain and tricks the brain into thinking there’s less pain there.

Aspirin is an anti-inflammatory at a higher dose, but we usually take aspirin for platelet or blood clotting issues. You really need to up the dose for it to get that anti-inflammatory response, and most people don’t take it for that anymore.

Q: Why are some pain relievers available over-the-counter and others require a prescription?

Tony: Most often it’s due to the side effects of those prescribed pain relievers. Also, it’s really important that we’re taking the medications correctly and we’re not masking a problem. Over-the-counter medications are really for light pain, not extensive, heavy pain or pain from traumatic injuries. Prescription pain relievers are a little bit higher dose. They come with side effects, and they come with more warnings and precautions.

Q: When it comes to over-the-counter pain medications, what do you typically recommend as far as when those should be used to treat pain?

Tony: We need to take a look at the ailment, what’s causing the issue, to make sure we’re not masking a bigger problem that may need to be seen by a provider. We need to take a look at the person’s medication history to make sure there’s no possibility for interactions there. Generally, ibuprofen works for six to eight hours. Naproxen works eight to twelve hours, depending on what you’re using and what your body does. Those are the two I recommend. If we’re dealing with kiddos, they may need to alternate some Tylenol in there for that added benefit.

Q: When a person is prescribed a pain reliever, what typically is prescribed?

Tony: Again, it depends on the ailment, depends on the issue. A lot of times it’ll just be a higher powered NSAID, and then if it’s really problematic or is going to be really painful, a prescriber will go up to an opioid prescription pain reliever, but it depends on what the issue is, and there can be complications with all of them.

Q: Let’s talk about some of those risks. Can we start with acetaminophen?

Tony: In this country, when we say acetaminophen, we are talking about Tylenol. High doses of acetaminophen can be really bad for your liver, and again, we want to be careful about masking other problems with it. If you’re taking acetaminophen, or Tylenol, on a daily basis, there’s probably something else going on, and we really need to dive dig deeper into the problem.

Q: Does aspirin have different risks than acetaminophen?

Tony: It does. Aspirin is more in line with the NSAID category, and again, higher doses do affect how blood clots in the body. Aspirin can cause ulcers, bleeding, and it also is really tough on the kidneys versus the liver, which the Tylenol warning has.

Q: What about ibuprofen and its potential risks?

Tony: Long-term use can cause ulcers; it can cause stomach problems that then lead to some bleeds. Ibuprofen is also pretty tough on the kidneys if used long-term and in high doses, so you really need to talk to your doctor and make sure that’s an appropriate regimen.

Q: What about some of the risks and side effects with prescribed pain relievers? Let’s talk about opioids, which are causing a lot of concern in our country.

Tony: Common side effects with opioids are nausea, they could cause some constipation, upset stomach, but opioids also suppress the central nervous system, meaning they make you drowsy, make you have a cloudy head.

With opioid medications and all controlled substances, you have the potential to become dependent on them. Your body thinks it needs that opioid all the time, and when you stop taking it, you go through withdrawals and then you have a really tough time.

Q: Our opioid issue in this country has been labeled an epidemic, because so many people are struggling with opioids. What are doctors and pharmacists doing to help?

Tony: It has gotten a lot of attention lately but still not enough. Drug manufacturers really pushed to try and prescribe these without giving enough light to the side effects, so there are a lot of studies going on right now to see what the appropriate dose is, how long people can be on it and how quickly some people can become dependent on it. We are trying to develop good guidelines, get the word out there and just share that knowledge with all medical professionals.

Q: Are there certain people who should be cautious about pain relievers, either over-the-counter or prescription?

Tony: Yes, absolutely.

• Females who are going to become pregnant, because they’re finding NSAIDs used in the 20-to-30-week window during pregnancy could cause some additional problems.
• Folks who have had blood clotting issues in the past, heart attack, stroke, things of that nature.
• If you’re on other medications, there’s always some side effects or interactions that can take place.

It’s just a good idea to talk to your doctor and your pharmacist to figure out what you need and what’s going to be best for you.

Q: When should we use over-the-counter pain medication, and when should we take a prescribed pain reliever?

Tony: The recommendation is to get by with an over-the-counter medication if you can. You know, one thing about the U.S. is we consume 95% of the opioid medications in the world. In other countries, they don’t get opioid medications for things we get them for. If you can get by with an over-the-counter, ice, elevation, maybe some physical therapy and not get into the prescribed products, it’s going to be better for you in the long run.

Q: Any final thoughts or words of advice you would like to provide when it comes to pain relievers and their possible risks?

Tony: It is really important to know all these medications come with side effects, and they all can interact with some other medications. Talk to your doctor and your pharmacist. Tell them what you’re taking, tell them the over-the-counter medications you’re on, any supplements, any nutritional products and even diet. Sometimes folks who are on blood thinning medications need to be wary of their diet and changing their diet. Talk with your doctor. Talk with your pharmacist. They can help you determine what’s best for you.