Complementary, Alternative OTC Drugs Pivotal in the Treatment of Acute Pain
As pharmacists move away from opioids in pain management, researchers present the use of supplemental OTC products to assist patients’ acute pain.
Over-the-counter (OTC) complementary and alternative medications (CAMs) were safe and effective in treating acute pain, according to an article published in US Pharmacist.1 With new evidence regarding the use of CAMs in pain management, researchers stressed the importance of pharmacists’ continued knowledge of this medication class as more research is conducted on safe and effective analgesics.
“Acute pain, which affects millions of Americans annually, becomes a major health care burden when it is poorly managed,” wrote authors of the study.
Two of the most notable products used to treat acute pain in the US are acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. Since their inception, NSAIDs and acetaminophen have stood out as easily accessible OTC options to relieve pain. However, these medication classes have been known to significantly risk patients of experiencing adverse events despite their reported efficacy.
Researchers present the use of CAMs as pharmacists move away from opioids in pain management. | image credit: Ricardo M.G. / stock.adobe.com
When it comes to the toxicity of NSAIDs as well as acetaminophen, these drugs garner increased risk of emergency department (ED) visits, hospitalizations, and death. Indeed, NSAIDs are known to be responsible for around 25% of all adverse drug reactions—with the most common being gastrointestinal symptoms.2
READ MORE: What Does the Future of Pain Medicine Look Like?
Acetaminophen toxicity, on a similar note, impacts a significant portion of the 60 million Americans that take it on a weekly basis. It is known to be responsible for around 56,000 ED visits, 2600 hospitalizations, and 500 deaths every year in the US.3
With such uncertainty because of varied and sometimes unreliable evidence, researchers attempted to simply further their understanding of evolving technologies for the treatment of pain, such as OTC products and CAMs.
“Supplementation with OTC adjuvant medications in the form of phytochemicals, minerals, vitamins, herbals, amino sugars, and healthy fats may enhance pain relief and spare the use of OTC analgesics as well as prevent escalation to opioid therapy,” they continued.1 “However, further evaluation of the safety and efficacy of these OTC supplements is necessary. This article will discuss the analgesic efficacy as well as the potential risks of the complementary and alternative medications (CAMs) used to manage acute pain.”
Indeed, researchers explored a plethora of CAMs with the potential in making a real impact on pain management. From some of the most commonly referred OTC pharmacy products to everyday household items, the researchers discussed CAMs of all kinds, including caffeine, magnesium, rose hips, vitamin C, ashwagandha, fish oil, evening primrose oil, ginger, glucosamine, green tea, and turmeric.
A majority of the explored products in this study either showed minimal efficacy or will require significantly more data to confirm their effects. However, after conducting their review, researchers highlighted the benefits of turmeric and caffeine as superior CAMs used to assist pain management.1
Starting with caffeine, this alkaloid compound stimulates the central nervous system (CNS) and has a slew of properties that assist in the efficacy of other medications like acetaminophen, aspirin, and ibuprofen. With evidence of both safety and efficacy, caffeine was recommended as a supplemental CAM as long as daily doses don’t exceed 400 mg.
Turmeric, however, is a natural substance that is derived from the Curcuma longa plant, belonging to the ginger family.
“Curcumin, an active compound of turmeric, displays strong anti-inflammatory properties in its inhibition of proinflammatory enzymes and signaling pathways,” continued authors of the study. “This action reduces the production of proinflammatory prostaglandins in [osteoarthritis] (OA) and [rheumatoid arthritis]. Curcumin also influences CNS pain processing by beneficially modulating pain receptors and neurotransmitter levels.”
In their search to find CAMs with proper safety and efficacy profiles, turmeric’s role in treating pain also stood out. In a systematic review, researchers discovered 10 studies out of 13 total where turmeric demonstrated significant pain improvement for OA. While it may be known to cause drug-drug interactions, turmeric was also used with no significant adverse events.
“Several natural products purportedly elicit analgesia. Although CAMs are considered harmless by the general public, product information may come from unreliable sources. Furthermore, supplements are not required to adhere to quality-assurance standards mandated by the FDA. Pharmacists are poised to educate patients about the benefits and risks of supplements, especially those with questionable efficacy, to ensure safety and mitigate complications,” concluded authors of the study.1
READ MORE: Pain Management Resource Center
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