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Pearls & Perils of OTC Analgesics

The Pharmacist’s Role in the Appropriate Selection of a Nonprescription Product for Pain Relief

W. Steven Pray, PhD, DPh. US Pharmacist, September 2008.

Go to article: http://www.uspharmacist.com/index.asp?page=ce/105845/default.htm (14 pp)

This ACPE-approved continuing education program for pharmacists should be of interest to all healthcare providers. Patients with acute or persistent pain often seek relief on their own. There are many potential non-prescription, over-the-counter (OTC) options for self-care, ranging from internal analgesics to external analgesics, cryotherapy, and thermotherapy.

Each of these OTC products has specific guidelines regarding who may or may not use it, as well as warnings that must be followed to help ensure patient safety. Research has verified that most patients fail to read the labels of these products prior to purchase. Therefore, this article stresses that an informed pharmacist – or any other healthcare provider, for that matter – can be vital in helping patients to weigh the pros and cons of each product and in facilitating their choice of the safest product that best fits the particular pain situation.

NSAIDs: Rx Considerations, Concerns, and Cautions

Use of Nonsteroidal Antiinflammatory Drugs. An Update for Clinicians. A Scientific Statement From the American Heart Association

Antman EM, et al. Circulation 2007, published online February 26, 2007.

PDF available here for download: AHA_NSAID_Statement_Feb07.pdf  (674 KB, 10 pp)

In this statement from the American Heart Association (AHA), healthcare providers are cautioned to change their approach in prescribing pain relievers for patients at risk of heart disease. Non-pharmacological approaches -- physical therapy, exercise, weight loss, orthotics, and heat or cold therapy -- should be considered for initial treatment of musculoskeletal symptoms that result from tendonitis or bursitis, degenerative joint problems (osteoarthritis), and inflammatory joint problems (rheumatoid arthritis). When choosing medications, the least risky should be tried first, usually acetaminophen or aspirin, at the lowest effective dose. Despite potential for abuse, a role remains for opioid analgesics in providing short-term pain relief. Long-term, high-dose medication therapy is more complex, and risks of gastrointestinal and/or cardiovascular or cerebrovascular complications associated with certain NSAIDs must be considered. A stepped-care approach to pharmacologic therapy is described.

Choosing Non-Opioid Analgesics for Osteoarthritis: Clinician's Guide

U.S. Agency for Healthcare Research and Quality; January 2007.

PDF available here for download: NonOpioids_Osteoarth_Clin.pdf  (389 KB, 4 pp)

This concise guide from a very reputable source summarizes clinical evidence on the effectiveness and safety of non-opioid analgesics for osteoarthritis. The most common OTC products and prescription NSAIDs are described, taking into account benefits, risks, and costs. The document does not address non-pharmacologic therapies such as diet, exercise, acupuncture, surgical interventions, or others.

Also available, a companion booklet for patients....
Choosing Pain Medicine for Osteoarthritis: A Guide for Consumers. See details...>

Medication Guide for Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)

U.S. Food & Drug Administration, February 2007

PDF available here for download: NSAID_med_guideFDA.pdf  (558 KB, 3 pp)

This FDA-approved sample Medication Guide for patients discusses, in question and answer format, concerns regarding the use of NSAIDs. Side effects are listed, and the document advises that NSAIDs may increase chances of a heart attack or stroke that can lead to death, or may cause gastrointestinal ulcers and bleeding at any time during treatment. A list of prescription NSAIDs is included, and precautions for patients to follow are provided.

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