Especially when referring to opioid medications, it has been claimed to be an epidemic in the medical world. With back pain and arthritis being two of the top reasons why people see their doctors, easing pain and improving our ability to move is a big deal. Over the counter pain medications like Tylenol and Ibuprofen are often the first line of treatment when people have an injury. But is it safe? How much is too much? Can you recognize some of the negative side effects of these meds?
Imagine you are walking along and you hit a pothole. You fall and twist your knee. You curse and swear and your knee gets all puffy. At night, you’re trying to sleep and it is just THROBBING. For most people, pain medications are their go to. When people go to their doctors about muscle aches and pains, these medications are often what they’re looking for.
**Disclaimer… in my humble physiotherapist opinion, pain medications can help get you back to your activity but they can also block the pain signals that are letting you know what is irritating your injury! Often these bring down the pain but they don’t improve healing. Having a discussion with your doctor or physiotherapist about this can be extremely beneficial.
**Disclaimer 2. If you are taking pain medications, you should tell your physiotherapist when the last time you took them was. If you are having less pain because of the medications, you could be progressed quicker or have more rebound pain if you get pushed a little bit more in your physiotherapy session. Just my two cents. Now back to our originally scheduled programming.
In this article, we are going to scratch the surface on these medications. Just starting talking about WHAT they are and WHEN to take them plus some of the SIDE EFFECTS.
Some of the most common types of pain meds are non-steroidal anti-inflammatory drugs (NSAIDS), acetaminophen, steroid medications and opioids. The NSAIDS you might know better as ibuprofen, Naproxen or Celebrex. Acetaminophen is Tylenol. Some steroid medications include cortisone and prednisone. The opioids are the big hitter pain medications such as morphine, codeine, and oxycodone.
We are going to focus on the NSAIDs. They are the most commonly prescribed and used. Future articles we can deep dive into some of the other classifications of meds.
For most muscular injuries, an NSAID is usually the first line of defense. These medications work on chemicals in our bodies that stop inflammation from occurring. When you have just hurt yourself, the swelling can sometimes be the source of the pain.
Most people do see a benefit when they use NSAIDS especially for mild to moderate amounts of pain in the short-term. NSAIDS can be oral or topical (applied directly to the skin). For osteoarthritis pain, topical NSAIDS like Voltaren are often recommended first.
The issue with some of these medications is that they are non-selective. What that means is that they don’t only work on the area you hurt. They travel throughout the body and work on those chemicals throughout the body. Some NSAIDS stop some of the processes in your stomach. That is what leads to people having upset stomachs, ulcers and other GI issues because of medications. The risk for this is 4-5x higher for people over the age of 60 than for younger persons.
Continuous use of NSAIDS are also not recommended for persons with heart issues such as a previous heart attack or stroke, heart surgery or heart failure. If you are concerned about using these medications because of your heart, make sure you talk to your doctor or pharmacist. They will know the best dosage for you.
The risk for side effects goes up the more you take. So it is really important to try to take only the amount you need. Combining pain medications can also be dangerous so talk to your healthcare team before doing it.
There are different types of pain and they need different types of pain medication. For people who have tissue or muscle injuries, NSAIDs can take some of the pain away. For people with nerve pain, NSAIDs appear to be of very little benefit. Neuropathic pain often requires a different class of medications. Your doctor will be able to give you more guidance if you feel like this is you.
Masking the pain doesn’t mean that the injury is gone. You hope to avoid long-term use of pain medications like NSAIDs. There is also some research to suppose that use of NSAIDs can actually DELAY healing. So you may have less pain but your time to heal will be longer. This seems to be especially true for people who have broken bones.
In the end, NSAIDs are a tool to help you function in the short-term and often shouldn’t be relied on. Taking as little as possible, talking to your doctor about side effects and letting your physiotherapist know the last time you took medications will all be extremely beneficial. Like any medication, side effects are present. Knowing what they are and how to spot them is an important part of your management plan.
Biederman, R. E. (2005). Pharmacology in rehabilitation: Nonsteroidal anti-inflammatory agents. The Journal of Orthopaedic and Sports Physical Therapy, 35(6), 356-367.
Loveless, M. S., & Fry, A. L. (2016). Pharmacologic therapies in musculoskeletal conditions. The Medical Clinics of North America, 100(4), 869-890.