Doctor’s top picks for short-term pain relief

Posted on: April 25, 2016 Posted by: Michele Lee Comments: 0

Pain comes from many different sources — arthritis, headaches, low back pain, inflammation, menstrual cramps, fever and flu, nerve, cancer, and more. If you must use a medication, I recommend you do all you can with safer medications before resorting to narcotic or other problematic pain relievers.

But, in the short term — and for short-term types of pain — most people reach for some sort of medicinal pain reliever.

Let me give you my step-wise approach if you’re considering medications for pain control, beginning with over the counter and topical formulations.

Non-prescription pain relief

Effective non-prescription pain relievers include:

Acetaminophen: (e.g. Tylenol^®), is harmless at usual doses, but can affect your liver at high sustained dosing over weeks. ¹
Motrin and Aleve: NSAIDs (non-steroidal anti-inflammatory drug) help mild to moderate pain. I encourage these for the first 3-5 days after an injury to slow inflammation, and to discontinue them as soon as possible to encourage healing. Also be aware that you increase your risk for increased stomach acid and even death from stomach bleeding: It was reported in 1999 that NSAIDs were the 15th leading cause of deaths in the U.S, directly causing more than 16,000 deaths and 100,000 hospitalizations annually. ² NSAIDs can be problematic for people with heart conditions.
Arnica (Arnica montana): an herbal pain reliever cream, ointment, salve, or tincture used to soothe muscle aches, reduce inflammation, and even help heal skin wounds. Its use for medicinal purposes goes back to the 1500s.
White willow bark (Salix alba): contains salicin (similar to acetylsalicylic acid of Aspirin) and also polyphenols and flavonoids that have antioxidant, fever-reducing, antiseptic, and immune-boosting effects. ³
Turmeric (Curcuma longa): at high doses is safe and quite effective to relieve various sources of pain: joint, head, and more. It has been studied and found to be as effective as Ibuprofen for arthritis pain, yet safer on the stomach. ⁴ One patient of mine used 2400 mg daily with great headache pain relief. It can be taken in capsules or in food, like golden milk. Read another doctor’s impressive case history about turmeric found online here.

Safe, effective topical prescriptions

For stronger pain relief there are also prescription topical pain relievers. These are quite safe because it is estimated that only 2-3% of the medicine actually gets into your blood stream.

A pharmacist must be specially trained in compounding these in their lab, so they are not found at your typical pharmacy chain stores (CVS, Rite-aid, Walgreens, etc.). They are mixed into a lipoderm base and applied to an area where you experience pain, and absorbed through the skin.

Compounded topical pain relief ingredients consist of one or more of the following:

Ketoprofen, Diclofenac, or Ibuprofen: in creams these give good pain relief and anti-inflammatory effect for sprains, strains and overuse injuries—similar to oral NSAIDs. ⁵
Lidocaine: a well-known topical anesthetic. At 5%-10% it can be quite effective even to deeper tissues.
Ketamine: when applied on your skin absorbs into your blood circulation and reduces pain by central nervous system sensitization and also through peripheral nerve action at opioid and sodium-potassium channels. ⁶ In one small study, pain rated on a 1-10 scale was on average 8.8 before application of ketamine gel and fell to 1.6 at fifteen minutes after application of the gel; all subjects reported significant pain relief. ⁷
Gabapentin: a nerve modulator that blunts pain, also known as Neurontin.
Clonidine: In a placebo-controlled trial of 179 subjects using 0.1% topical clonidine gel applied 3 times a day to their feet for 12 weeks it significantly reduced foot pain in painful diabetic neuropathy subjects. ⁸
Capsaicin: at 8% this topical cream has been closely compared to Lyrica for neuropathy pains. ⁹ In a March 2016 report, the 8% capsaicin patch and the 5% topical lidocaine patch were reported to be significantly more effective than oral gabapentin, opioid narcotics, Lyrica^® and tricyclic anti-depressants (e.g. Amitriptyline) for post-herpetic neuralgia. ¹⁰
Tramadol: Studies show this to be equally effective as ketamine in for post-surgical mouth/throat pain. ¹¹ ²
Amitriptyline: tricyclic antidepressant. In a small 21-subject study using 2% topical amitriptyline plus 1% ketamine cream showed this was safe and effective for neuropathy. At the end of 12 months 89% of subjects rated their satisfaction in pain reduction as 3 out of 5 or greater and two of the subjects were pain free; there were no serious adverse events.

Really severe pain is almost always very short-lasting. And there is a psychology that universally develops with chronic pain. In my next article I would like to discuss my discoveries regarding severe or prolonged pain relief management and the new opioid guidelines from the CDC (Centers for Disease Control).

To feeling good in health!
Michael Cutler, M.D.