PrepperMed 101: Pain Control Over The Counter (OTC)

Over the counter (OTC) pain medications are an important part of a prepper’s medical kit; but which ones should you have and how should you use them? To help make these decisions, I thought you might like to hear about the recommendations Salty’s surgeon offered. I myself am not a physician, nor do I give medical advice nor does any person reading this article on a podcast. I’m just going to share what the guy who *is* a real physician told us, plus add some background information you should know when making your own plans.

Just because they’re OTC doesn’t mean they’re completely safe.

I recently posted an article on this (you can find it here), so here’s just the main take-home message: If you take OTC meds without careful attention to the dosages and other cautions, bad things can happen. In some cases (I’m looking at You, acetaminophen), it doesn’t take that much over recommended amounts to cause very real trouble. 

Different types of OTC pain meds work in different ways

Turns out, there are a couple of major categories of OTC pain meds, based on how they work. This ends up being a very useful tool — if you understand it. Why? There are two main reasons. First, if the side effects within one group are a problem, you can turn to the other group. Second, because they use very different metabolic pathways, it can be safe to take two different kinds of OTC pain meds at once, but only if they’re in different categories. More on that below, when we get to talking about Salty’s surgeon’s recommendations.

NSAIDs, stars of OTC pain medications

Many of the OTC pain medications are in the category of NSAIDS: Non-steroidal anti-inflammatory drugs.  These not only help reduce pain, but also reduce (you guessed it) inflammation. They do this by working on one of two biochemical pathways. These pathways are used in immune cells to produce the signals that lead to both pain and inflammation. The same pathways are used in other places, including in reactions that stop bleeding, constrict blood vessels, and make stomach mucus.

Popular drugs in the NSAID group include aspirin, ibuprofen, and naproxen. That means you can find them in brand names such as Excedrin, Aleve, Motrin, and Advil, among others. They’re also in lots of combination remedies for colds and flu. Reading labels on those combo drugs is important to avoid ‘hidden doses’. There are others too, including prescription-only varieties.

Main actions of NSAIDs: Well, they’re good pain relievers, for one thing. They’re also pretty good at reducing fevers (aspirin and ibuprofen more so than naproxen). They can reduce swelling, through their anti-inflammatory actions. Naproxen is often used long-term for arthritis, for example.

NSAIDs as OTC clot reducers

Other actions to watch out for: NSAIDs can block the activation of platelets, part of your anti-bleeding system. That can be useful: Many physicians recommend low-dose daily aspirin to reduce the risk of heart attack and stroke in high-risk folks. This works because clot formation is part of the heart attack and stroke development.

Clot blocking can also be a problem. Salty had a very minor skin scrape the other day, but it was sporting a really impressive bandage by the time I saw it. Stupid little scrape just wouldn’t stop leaking blood; and he didn’t know why. I did; I’d been feeding him four low-dose aspirin a day on his surgeon’s orders, to prevent post-surgical clotting in his leg veins. You don’t want any traumatic injury while on these drugs. (This action leads to them being called ‘blood thinners’; but they don’t actually thin blood; only reduce its clotting.) Surgeons (including Salty’s) usually tell you to not take any NSAIDs in the day or two before a surgery, to reduce the chance of excess bleeding.

NSAIDS can do other things

Many people also get stomach irritation, and some bleeding ulcers, when they take aspirin regularly. This is because of the mucus blocking effect. “Enteric coated” aspirin is coated to dissolve later in the gut and get around this problem.

Reye’s syndrome is a rare disorder that can arise, usually in children in teens and usually as they’re recovering from a viral illness like flu or chicken pox. It’s also been linked to aspirin use; so some recommend not using aspirin with kids, especially if it seems to be a viral illness. (1)

OTC non-NSAID pain relief: Acetaminophen

Acetaminophen, in its many forms, is an important OTC pain med and fever reducer that is not an NSAID. How does it work? We don’t really know…but not apparently by inhibiting the same pathways as the NSAIDS. It’s action seems to be more in the central nervous system, whereas the NSAIDs block the pain signals as the immune cells are producing them.

The main brand name for acetaminophen is Tylenol; but the same drug is found in a lot of combination cold remedies and also in combination with opioids in prescription medications like Oxycodone and Norco.

Acetaminophen is good for pain and fever reduction. It doesn’t help with inflammation; nor is it known for interfering with blood clotting or stomach mucus production. On the other hand, it has a reputation for causing liver failure if taken in more than recommended doses. In fact, it’s one of the leading causes of liver failure in the U.S.

An example of a doctor’s recommendations for OTC pain relief

Salty recently had his ankle reconstructed. The surgery’s known for painful recovery periods and he/his doc wanted to minimize opioid use. Here’s what his surgeon recommended for maximum safe pain relief using OTC drugs:

600 mg doses of ibuprofen, every six hours, around the clock (total 2.4 g/day). 1000 mg doses of acetaminophen, every six hours, around the clock (total 3 g/day). Ibuprofen and acetaminophen doses were staggered, so he was taking one or the other every three hours (to avoid a dip in pain and inflammation control just before the next dose was due).

In addition, he recommended 4 ‘baby’ or low-dose aspirin (81 mg each) per day, divided morning and night. This was because the risk for blood clots goes way up when there is both inflammation and not much movement to keep the blood circulating nicely through the legs. Obviously one doesn’t do a lot of leg moving right after a bunch of hardware is installed. We used enteric coated aspirin to avoid the stomach problems.

Key observations: The surgeon was fine with max dosing one of the NSAIDs with acetaminophen. He was also in to have a pretty small dose of aspirin in there too. (200 mg at a time is a common dose of aspirin taken for pain relief; Salty was invited to take just 324 mg/day for clot risk reduction). He was specifically advised not to add in Norco (a non-OTC remedy that conatins some acetaminophen).

Ice is also OTC

We’ll treat this aspect more in another post, but I did want to mention: Don’t overlook the non-drug options for pain relief. Periodic icing, elevation, and appropriate compression are very helpful for inflammation, for example.

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In summary

You do what you decide, but this reminded Salty and I to increase our stock of acetaminophen. We both prefer ibuprofen (and had a reasonable store), but for more serious pain relief we could not choose to do the tag-team routine if we don’t have both on hand.

1) Mayo Clinic staff. (2018) Reye’s Syndrome. https://www.mayoclinic.org/diseases-conditions/reyes-syndrome/symptoms-causes/syc-20377255

2) Vtvu [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)], from Wikimedia Commons