Talking About Pain: OTC & Prescription Medications
You can have me read this article to you instead of reading it yourself…
Or you can read it the old-fashioned way below…
As I mentioned in the opening article on this 5-part series, we have some real treatment options that can help with pain. Those include over-the-counter (OTC) medications, prescription medications, natural alternatives, and even alternative therapies, such as yoga, acupuncture, and more.
It might take a mix of many of these options to find the right fit for a certain individual. But let’s work through our options one category at a time.
First up…
Over-the-Counter (OTC) Medications
I think everyone is pretty familiar with these options. These include the go-to pills and creams for headaches and pulled muscles.
Acetaminophen
Acetaminophen (Tylenol) is one of the standard OTC pain treatment options. It comes in pills containing anywhere from 325 mg to 650 mg. It can work relatively well for certain types of pain, and it’s a great first-line option for certain forms of pain. Unfortunately, most GI pain will probably not respond very well to Tylenol. It doesn’t target the types of mechanisms that seem to cause GI pain most often.
Also, be aware that it is not without its side effects. Taking large doses consistently every 4-6 hours for days or weeks can overwhelm the liver, causing some severe problems. Tylenol is also often found in other products (cough and cold products, sleeping aids, etc), so it is really easy to accidentally double your dosage. If about 650 mg every 6 hours isn’t managing your pain, then it might be time to look at some other options.
NSAIDs
Non-steroidal anti-inflammatory (NSAID) products are the next mainstay on the OTC pain aisle. These include ibuprofen (Motrin) and naproxen (Aleve). These medications are more likely to help with the types of mechanisms that cause GI-related pain because they help to reduce inflammation. Motrin needs to be taken every 4-6 hours in order to work, while Aleve only needs to be taken about every 12 hours. If the over-the counter-doses of NSAIDs aren’t working for you, take a look at the section on prescription NSAIDs further down on this page!
NSAIDs might be a great first-line option to treat some mild GI pain. But make sure that you always take these medications with food. Otherwise, they can start to break down the lining of the stomach, which can cause GI bleeds and ulcers.
Aspirin is another standard product on the OTC shelves. It is technically classified as an NSAID. But in general, aspirin shouldn’t be used to treat pain. The doses that are needed to manage pain can also increase the risk of bleeding, so it is safest to bypass this option.
Topical Products
Some of the other products on the shelf for pain include creams and ointments. Some of the most effective OTC pain treatments are the ones for injury-type pain, including temporary back pain, muscle strains, sprains, etc. You might even recognize these names, such as camphor, Bengay, and Capzasin. Unfortunately, these creams only work where they are placed (on the ankle, on the back, etc), so they are not helpful for GI pain.
“Stomach Medicine”
And then there are the “stomach medicines”. These include things like Pepto-Bismol, which are meant to soothe all kinds of stomach upset. Pepto-Bismol can help to reduce inflammation in the stomach and intestines and can also help to fight off certain types of bacteria. It is best used to treat stomach issues that are acute, not chronic. For instance, a bad case of traveler’s diarrhea.
And finally, we have antacids – some of the most common OTC products for stomach upset. If you want to learn more about managing reflux, throat burning, or GERD, check out this sample chapter from my book. It goes into great detail about how to manage acid issues, including when (if ever) to take antacids.
Prescription Medications
By the time we get to a doctor’s office, many of us are probably looking for a more powerful option to treat pain. That typically comes in the form of a prescription medication. There are actually quite a few different options that can be considered, so let’s take a look.
NSAIDs
Yep – this is the same class of medications that you can find over-the-counter. However, prescription NSAIDs are much stronger. There are also far more options. These include diclofenac (Voltaren), meloxicam (Mobic), Ketorolac (Toradol), and many more. Be aware – just as with OTC NSAIDs, these products can also hurt the stomach lining and should be taken with food.
A doctor may consider prescribing one of these medications to you if some of the OTC NSAIDs worked for you initially but aren’t quite doing the trick anymore. So if you find that the recommended doses of OTC NSAIDs are not working for you, talk to your doctor before increasing your dose. These medications are not without side effects, and its best to have a conversation with your doctor or pharmacist and find out what other options you have before you increase your dose on your own.
GI Muscle “Relaxers”
There is a special class of medications that specifically help to “relax” the muscles in the GI tract. They are called anticholinergics, and they help to stop contractions of the muscles in the stomach and intestines. Two of the most common ones are dicyclomine (Bentyl) and hyoscyamine (Levsin). These can cause genuine relief for many people with pain coming from the intestines. And they can also cause relief for some people with pain coming from the stomach. They are a great option to try before moving on to some heavy-hitting drugs with more side effects. With dicyclomine, it typically takes a couple of weeks to know whether or not it is working for you. Unless, of course, you get it through an IV at the Emergency Room – then you can get very quick relief from a dose of this medication. Hyoscyamine, on the other hand, can be taken only when needed to treat intermittent pain.
But, as usual, no drug is without its downside. Anticholinergics might work well in the GI tract for some people, but they also act on the nervous system. Some side effects include dizziness, dry mouth, blurry vision, and even drowsiness in some people. But if the medications work well for your pain, then these side effects might be worth it.
Antidepressants
There is a known connection between the brain and the gut, which means that treating mental health issues and addressing stress can genuinely improve GI health.
But in this section, I am going to discuss using antidepressants to treat the GI tract directly. It turns out that the chemicals in the brain that antidepressants target are also found in the gut. Too much or too little of these chemicals can cause an array of symptoms, including different types of pain.
At this point, most of the antidepressants on the market have been studied (at least a little bit!) for treating abdominal pain. But some types of antidepressants have much more evidence showing that they can help, and some seem to work better than others. In general, antidepressants need to be taken for a number of weeks before it becomes clear whether or not they are helping. Also, as always, no antidepressants are without their side effects. The more popular antidepressants (SSRIs, such as Prozac or Zoloft) can cause GI side effects in many people, including diarrhea and constipation. So it is always a delicate balance to find the right medication that works well with minimal side effects.
I have an entire chapter in my book about using antidepressants to treat GI conditions if you are interested in learning more.
Opioids
Opioid is the name for a class of medications that bind the opioid receptors in the body. These medications all derive from a molecule that is naturally found in the poppy plant. The prescription versions of this molecule include hydrocodone (Vicodin), oxycodone (Oxycontin), morphine, hydromorphone (Dilaudid), fentanyl, and more. The illegal version of this molecule is known as heroin.
Opioids work very well for treating acute, short-term pain, such as that from a surgery or physical injury. However, research on using these medications in the long-term is lacking. And we know that long-term use of these products is associated with a very difficult obstacle to overcome: tolerance. If a person takes an opioid consistently, they will develop tolerance. This doesn’t only happen in some people, sometimes. It happens in every person, every time. If a person takes the same dose of an opioid for an extended time frame, it will NOT continue to work as well. The dose must be increased, again and again.
As opioid doses get higher, the side effects increase, too. Too much of an opioid can cause a person to stop breathing. Not enough opioid can cause withdrawals, which can be severe.
Continued use of opioids also comes with some very negative GI side effects. For one, it slows gut motility. This is another one of those side effects that happens in every person, every time. There are opioid receptors in our GI tracts. So if someone takes an opioid, it binds to the GI tract receptors, and this slows motility. In the typical person, this causes constipation (which can be severe). In someone with chronic constipation, this is an obvious issue. For someone with gastroparesis, this can cause the GI tract to back up even further.
In addition, opioids can cause stomach upset, including nausea and vomiting, and are not well tolerated by many people. This is important to keep in mind if you are already having trouble keeping things down.
We also don’t have any studies to show that opioids actually work well in treating GI pain. That’s partly because we don’t really have any studies that show that opioids work well in treating any form of chronic pain. Yes – you read that right! For how popular these medications are, the research on them is pretty much limited to short-term use for short-lived pain, only.
One study that we do have was published last year. It shows that Tylenol and NSAIDs work just as well as opioids in treating chronic pain over the course of a year. And have far fewer side effects. This can’t necessarily be applied to chronic GI pain, but it is an interesting finding that is making many people question why we turn to opioids so quickly for every form of pain.
As you can see, opioids are not ideal treatment options for GI pain. However, some people with chronic GI pain are prescribed opioids anyways. For some, this may be the only option that works. But we don’t have any reason to believe that they will work better than the other available options. And it is very important to be cautious about using them at all. They are absolutely addictive, guaranteed to require higher doses, and also guaranteed to worsen certain aspects of GI conditions.
What Else is There?
These are not the only available options to help manage pain! While OTC and prescription medications may be the first options tried by many people, many people benefit most from trying multiple different ‘treatments’ together.
So let’s move on to discussing some of those options…
Alternative therapies for pain
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