Over-the-Counter Medications. Non-prescribed analgesics may be used for mild pain.
- Nonsteroidal Anti-Inflammatory Drug (NSAIDs): Ibuprofen. Most common side-effects: abdominal pain, nausea, diarrhea, occasionally constipation. Hematuria, proteinuria, and marrow suppression can also occur. Rarely, tinnitus, blurred vision, mood changes, drowsiness, and mouth ulcers are seen. These side-effects almost always resolve after discontinuance of the medication.
These medications are prescribed for moderate to severe pain or pain refractory to non-opioid analgesics.
Acetaminophen with Codeine - schedule III controlled substance and does not require triplicate to prescribe
Tramadol - schedule IV controlled substance and does not require triplicate to prescribe. This is a weak opioid related to codeine and is less likely to be associated with respiratory depression than stronger opioids. It is not recommended for patients under 17 years of age. Tramadol can also lower seizure threshold. It should not be used in patients on antidepressants.
Oxycodone or Hydrocodone - schedule II narcotics which require triplicate to prescribe. These are stronger opioids related to codeine and contain acetaminophen.
Liquid formulations available Lortab elixir (7.5mg hydrocodone/325mg acetaminophen)
Opioids - If opioids are needed for breakthrough pain, continue for 72 hours. Re-evaluation is warranted.