Pain Relief

Pain relief is sought by many patients presenting to both the emergency department and primary care settings.  Optimal patient outcomes are achieved by utilizing a combination of pharmacologic and nonpharmacologic therapies.  Pharmacologic approaches are the most widely used treatment modality to ease persistent pain. Non-opioid analgesics include acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and aspirin.  Gastric irritation may occur with both NSAIDs and aspirin and limits the dose that may be given.  Ulceration of the gastric mucosa may occur, leading to bleeding or perforation.  Patients who use NSAIDs on a chronic basis are also at risk for nephrotoxicity.  Aspirin is now infrequently used for the treatment of pain and inflammation.  Unlike other NSAIDs, aspirin irreversibly inhibits platelet functioning for the life of the platelet, thus altering the coagulation of the blood.  Acetaminophen lacks the anti-inflammory effects of NSAIDs and may cause hepatic damage in patients with underlying liver disease or at higher doses. Opioids are the most potent pain-relieving drugs currently available.  These drugs include: Tylenol with codeine (Tylenol 3), tramadol (Ultram), hydrocodone available with acetaminophen (Norco, Vicodin, Lortab), oxycodone available with acetaminophen (Percocet), and hydromorphone (Dilaudid).  Side effects are common and may include nausea, vomiting, constipation, sedation, and pruritus.  When patients experience nausea and pruritus the treatment consists of antiemetics and antihistamines, respectively.  In the case of opioid overdose, the side effects can be reversed rapidly with the narcotic antagonist naloxone.