pain relieving medications
- What pain relieving medications would you prescribe? Defend your choice.
Tylenol (Acetaminophen) would be my recommended first line of therapy if a patient is unable to take NSAIDs due to adverse reaction like GI Bleed (CDC, 2020). Evidence shows that non-opioid treatments like acetaminophen or ibuprofen can be more effective than opioids in managing pain (CDC, 2020). According to the American College of Occupational and environmental medicine practice guidelines (2017), it is not recommended to start patients on opioids for minor injuries like sprains or strains.
- How would you prescribe them?
Tylenol (Acetaminophen) extra strength 500mg 1 to 2 tabs every 8 hours as needed for pain NOT to exceed 3grams in a 24-hour period. Also educate patient on RICE: Rest, Ice, Compression and Elevation for the first 2 days. Ice should be rotated 20 mins on and 20 mins off to prevent decrease in circulation to affected area. Place Affected ankle in brace or ankle stirrup and place patient on light duty or even off work for at least a week. F/u is needed to assess injury- swelling and pain.
- What side effects should you educate the patient about?
DO NOT take more than Rx due to risk of Liver damage and overdose of Tylenol. Educate patient not to exceed more than 3 grams of Tylenol in a 24-hour period. (do not take more than 6 pills of Tylenol extra strength in 24 hours). Monitor for discoloration to Right ankle (different than normal bruising). Numbness or tingling, increased pain that is different than the pain patient has been feeling. Contact Office of NP immediately. s/s of decreased CMS.
Does the age of the patient influence what your choice?
Age influences choice of medication in opioid uses due to likelihood of long-term addiction and misuse (Hudgins et al., 2019). Young adults are more likely to likelihood to misuse opioids and use along with other substances like ETOH (Hudgins et al., 2019). NP should educate patient while opioids are not being Rx- studies show opioid use is only 30% effective in pain management and long-term addiction is always a risk. CDC recommendation is not to Rx Opioids for minor injuries that have shown effective treatment with NSAIDs or Tylenol. “Opioids provide an average of 20-30% pain relief when used for pain lasting less than 3 months” (CDC, 2020).
Centers for Disease Control and Prevention. (2020, May 11). Ankle sprain. Centers for Disease Control and Prevention. Retrieved October 4, 2021, from https://www.cdc.gov/acute-pain/ankle-sprain/index.html.
Hudgins, J. D., Porter, J. J., Monuteaux, M. C., & Bourgeois, F. T. (2019, November 5). Prescription opioid use and misuse among adolescents and young adults in the United States: A national survey study. PLOS Medicine. Retrieved October 4, 2021, from https://journals.plos.org/plosmedicine/article?id=10.1371%2Fjournal.pmed.1002922.