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Chronic Pain: OTC or Prescription Medicine?

By Jim Brown
WebMD Feature

If you are one of the millions of Americans who suffers from chronic pain, you have more options than ever to treat the pain. Your choices range from simple remedies such as an ice pack or heating pad to more complex treatments like surgery.

Somewhere in between these pain management options are medications: over-the-counter (OTC) medication and prescription drugs. And while an aspirin or two might be the best way to knock out a headache or ease low back pain, a stronger prescription drug may be needed to relieve long-term, severe pain.

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More choices mean more decisions. Should you always use an OTC drug first? Should you get a prescription for something stronger? Or should you call your doctor and get his or her input first?

When Should You Use an OTC?

The answer to the first question depends on a few factors, according to Beth Minzter, MD, a pain management specialist at Cleveland Clinic.

"An over-the-counter drug might make sense if a person has osteoarthritis of the knee and it occasionally hurts more than usual. But it might also be appropriate for that same person to take a stronger prescription drug," she says. The decision depends on if the drug is helping, how regularly you are using it, and the severity of side effects, Minzter tells WebMD.

OTC pain relievers are commonly used for arthritis pain, headaches, back pain, sore muscles, and joint pain. Aspirin, ibuprofen (Advil, Motrin IB), and naproxen sodium (Aleve) are nonsteroidal anti-inflammatory drugs (NSAIDs).

"Nonsteroidal drugs are extremely effective because they reduce swelling and relieve pain," Minzter says. "If you have a bad shoulder that occasionally gets to the point where you cannot sleep, a NSAID might be great on a short-term basis. But if that shoulder hurts all the time, it is reasonable to ask your doctor -- in a non-urgent manner -- about switching to a long-acting drug that would give you around-the-clock pain relief."

"Just because one NSAID doesn’t work, it doesn’t mean a different NSAID won’t work, either," says Minzter. "Nonsteroidals are very patient-specific. Different people have different reactions."

Although doctors don’t fully understand how acetaminophen works, it belongs to a class of painkillers called non-opioid analgesics. Also used as a fever reducer, acetaminophen is thought to relieve pain by affecting the part of the brain that receives pain messages and controls body temperature. It often helps relieve pain due to headaches, back pain, sore muscles, and joint pain.

Acetaminophen may also be used in combination with opioid medications. For example, a doctor may prescribe a combination of acetaminophen and a narcotic medication such as codeine or hydrocodone for moderately severe pain.

Don’t Underestimate Side Effects

NSAIDs can cause stomach irritation and bleeding. The chances are higher if you are age 60 or older, have had stomach ulcers, take a blood thinner, have three or more alcoholic drinks a day, or take them for longer than recommended.

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