Archive for the ‘Pain’ Category

How To Tackle an Ingrown Toenail

The last time I was at a family gathering, my sister asked me, “What’s your favorite over-the-counter product?”

That’s easy to answer: it’s New Skin®. Normally used to seal up cuts and scrapes, I love to recommend it for a completely different condition: ingrown toenails.

I ’ve spent years and years fighting the pain of getting ingrown toenails on both of my big toes. Then, as a pharmacy student sitting in class, one of my professors mentioned a product  called Outgrow® that he recommended for avoiding ingrown toenails. “It’s brushed onto the skin where an ingrown toenail likes to form and like magic, it will “toughen up” the tender skin and keep the nail from cutting into it. Eventually, the nail is forced to grow out straight.”

“Aha!” I immediately went out and purchased a bottle and used it very successfully for years, until I misplaced it somehow during a move out of state. I didn’t worry about it at first, thinking I could just buy another one. But alas, when I went to the pharmacy shelf to pick up another bottle, I couldn’t find it anywhere. Further research revealed that the manufacturer had discontinued their original formulation several years back. I was willing to try anything, so I ordered the new version. Unfortunately for me, the “new” formula proved totally useless, and I was again plagued with painful ingrown toenails.

Years and many ingrown toenails later, I renewed my search for something like the original version of Outgrow® that would  toughen up or protect my skin. I’d used New Skin® before on cuts, and wondered, “Could this work to prevent an ingrown toenail?” Another plus is that New Skin® contains an anti-infective compound called 8-hydroxyquinoline which can help heal your ingrown toenail! When I tried it, it worked so well that I happily recommend it to anyone else needing to avoid ingrown toenails.

Here’s how to use New Skin® to prevent or treat an ingrown toenail:

  1. You’ll need a bottle of New Skin®, a toothpick, a place to apply it that you can wipe up the mess if you spill or drip, and at least 15 minutes of drying time.
  2. Soak your toes in warm water to soften your toenail. You can also do this right after a warm bath or shower.
  3. Dry your foot well.
  4. Brush on a thin layer of New Skin® along the skin of the nail that tends to or which is already curling under your tender skin.
  5. While still wet, use the toothpick to lift up the edge of your toenail just a bit and work some of the liquid New Skin® underneath it so that the liquid is between your nail and your skin. You don’t need a thick coat, just enough to spread along the nail where it likes to curl.
  6. Let it dry for at least 5 minutes.
  7. Repeat if needed with a second “coat”, letting it thoroughly dry before putting on socks.

One 2-coat application lasts me several months. You’ll notice that your toenail will grow out nice and straight instead of cutting into your skin. Enjoy the freedom from the pain of pesky ingrown toenails!

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The Best Non-Prescription Pain Relievers

Q:             Which non-prescription pain medicine is the best to use?

There are 4 pain medicines you can buy without a prescription: Tylenol®, Aleve® Advil®, and Motrin-IB®. Which would be best for you to use depends on what type of pain you need it for and whether you have certain kinds of medical conditions.

Tylenol® is oldest of the pain medicines available over-the-counter (OTC). Also known by its generic name acetaminophen, Tylenol® is very safe to use as long you avoid taking too much of it. Taking more than 8 Extra-Strength tablets of 500mg acetaminophen or 12 tablets of regular strength or 325mg Tylenol® in one day can permanently damage your liver, especially if you do it frequently.

The other 3 pain medicines you can buy without a prescription are closely related to each other and all work in the same way. The active ingredient in Aleve® is naproxen and the active ingredient in both Advil and Motrin-IB is ibuprofen. Ibuprofen and naproxen are called non-steroidal anti-inflammatory drugs or NSAIDs for short. NSAIDs are powerful painkillers that are quite effective for certain types of pain associated with inflammation: muscle aches, sprains or strains, tension headache, and dental pain.

Pain medicines with anti-inflammatory action like ibuprofen or naproxen are much better than Tylenol® or acetaminophen for menstrual cramps and especially to prevent swelling and pain after a tooth extraction, but it comes with a price. NSAIDs can cause stomach pain and bleeding, interfere with how your kidneys work, or trigger heart failure from retaining excess water.

I recommend naproxen (Aleve®) over ibuprofen because it lasts longer. Naproxen lasts 8-10 hours while ibuprofen wears off in 6 hours. Years ago I tore a ligament in my right wrist while chopping wood in weather 20 degrees below zero. Some people should NOT be allowed to swing an axe, and I’m one of them! Even taking the most potent prescription strength of ibuprofen three times a day I’d wake up in excruciating pain night after night at exactly 3:25 am. After switching to the OTC strength of naproxen I slept blissfully through the night.

Always take an NSAID with a full glass of water or right after a meal to reduce your risk of stomach problems like burning, cramps, heartburn or bleeding ulcers. The extra water or food will dilute the medicine as it dissolves in your stomach, decreasing your chances of developing pain or bleeding.

When taking naproxen or ibuprofen it’s extremely important to drink plenty of water and avoid them if you are having vomiting or diarrhea. NSAIDs can cause problems with your kidneys, especially if you become dehydrated.

If you have a certain type of heart condition called congestive heart failure (CHF), you should avoid NSAIDs completely. Just ONE DOSE of ibuprofen or naproxen can trigger a deadly build up of fluid in your lungs.

If you have stomach or kidney problems, Tylenol® will be the safest medicine for you to treat mild to moderate pain… unless you take too much of it.

Unfortunately, taking more acetaminophen than you should is MUCH easier than you’d think. Following the dosing recommendations on your bottle of Tylenol® is not enough to prevent problems because acetaminophen is already in many commonly prescribed prescription pain medicines like Vicodin® and Percocet®.

You can also end up taking too much NSAID medicine without realizing it. In addition to OTC formulations, higher strengths of ibuprofen and naproxen along with several other prescription-only NSAIDs are widely prescribed as anti-inflammatory medicines. Taking an OTC and prescription NSAID at the same time increases your chances of having side effects like stomach pain, kidney problems or bleeding ulcers.

 

To choose the best OTC pain medicine for you, follow these guidelines:

  1. For muscle aches, sprains and strains, dental pain or menstrual cramps taking an NSAID like ibuprofen or naproxen will usually work much better for you than Tylenol® or acetaminophen. I recommend naproxen because it lasts 8-10 hours, but either naproxen or ibuprofen should help.
  1. If you have a stomach ulcer, kidney problems, congestive heart failure (CHF), or are taking a blood thinner, you should stick with Tylenol® or acetaminophen regardless of the type of pain you have, because it’s is a safer choice.

 

  1. Don’t double up on painkillers. Although it’s safe to take an NSAID anti-inflammatory medicine at the same time as Tylenol®, you should NEVER take more than one NSAID at a time or more than one medicine with acetaminophen in it at a time. Ask your pharmacist if you’re not sure if your prescription pain medicine has either acetaminophen or an NSAID in it.

 

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Choosing a Medicine for Your Aches and Pains

Q: There are so many choices out there for aches and pains. Which medicine is best for me?

When you have mild to moderate pain like a headache, sore muscles or aching joints there are 4 pain medicines you can buy without a prescription: aspirin, acetaminophen (Tylenol®), ibuprofen (Advil®), and naproxen (Aleve®). Which one should pick?

Aspirin is the oldest of these four options and is available in two strengths: low dose or “baby” aspirin which are 81mg each and the adult dose of 325mg, which is exactly 4 times the 81mg dose. Many Americans take one aspirin a day to prevent heart problems because of how it works as a blood thinner. If you take any prescription blood thinner medicine like Plavix®, warfarin (Coumadin®), or one of the newer ones advertised on the television, don’t take more aspirin for relief of your headache pain. Since aspirin can upset your stomach it’s best to take it with food or a full glass of water.

Whether sold as Tylenol® or by its generic name acetaminophen, Tylenol® is the most popular and common painkiller sold in America. Although it is safe enough for kids to take, Tylenol® has a dark side: taking too much acetaminophen is deadly to your liver. Being available in over 200 different non-prescription products the popularity of acetaminophen makes it dangerous because its so easy to get too much.

If you take a prescription pain medicine you may already be getting acetaminophen. Look for the abbreviations APAP or ACET on the prescription label, or ask your pharmacist. If you have liver disease, don’t take Tylenol® until you talk to your doctor about whether taking it is safe for you and how much you can safely take for pain.

The other two pain relievers available without a prescription are closely related to each other and also to aspirin. Ibuprofen and naproxen were originally only given as prescription medicines, but now they are available in non-prescription products in addition to their stronger prescription doses. Aspirin, naproxen and ibuprofen relieve muscle aches and swelling better than acetaminophen and belong to a group of medicines called NSAIDs, or non-steroidal anti-inflammatory drugs.

When taking ibuprofen, also known as Advil® or Motrin-IB®, or its close cousin, naproxen, sold as Aleve® be careful to take it with food to avoid stomach pain and bleeding. NSAID medicines can also damage your kidneys, especially if you have kidney problems or take it when you are dehydrated.

Taking too much of an NSAID is particularly dangerous because it can cause stomach bleeding and kidney failure. In addition to the non-prescription NSAID remedies there are several prescription NSAIDs commonly prescribed. Ask your pharmacist if you are already taking a prescription-strength NSAID and if you are, avoid taking the non-prescription versions.

7 Tips for Taking OTC (over-the-counter) Pain Relievers Safely:

  1. For aching muscles and swelling, ibuprofen or naproxen usually works better than acetaminophen. Some people get more relief with one or the other. Ask your pharmacist before taking ibuprofen or naproxen to make sure that you’re not already getting a prescription product doing the same thing.
  2. Avoid taking an NSAID if you already take a blood thinner. Taking 81mg of aspirin daily is ok, though. Ask your pharmacist if you aren’t sure if you are on a blood thinner medicine.
  3. Watch out for taking too much Tylenol®. Healthy adults can take up to 4 grams per day, or the equivalent of 8 tablets of extra-strength acetaminophen. Older adults are should limit their Tylenol® use to 3.1 grams daily, or 6 tablets of extra-strength Tylenol®. If you take a prescription pain reliever ask your pharmacist to find out if it has acetaminophen in it, and how much.
  4. If you take aspirin daily for your heart, talk to your doctor o pharmacist before taking it for pain relief. It’s safer to take Tylenol® or another NSAID like naproxen instead.
  5. You can take both acetaminophen and an NSAID for pain at the same time, as long as you don’t take more than is safe for you. Your pharmacist is a medication expert and can advise you as to which one is best for you.
  6. If you have kidney disease avoid taking ibuprofen or naproxen for mild to moderate pain, and make sure that you stay well hydrated when taking either one.
  7. If you have liver disease, ALWAYS check with your doctor before taking Tylenol® or acetaminophen.

 

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Prescription Painkillers Are Killing Us

The non-medical use of prescription medicines continues to increase, and deaths associated with unintentional overdoses of these continue to outpace those of traffic fatalities.
We’re dying from self-medication gone wrong.

According to the Centers for Disease Control and Prevention (CDC), the people most at risk for a fatal overdose from prescription medicines are the approximately 9 million Americans who take opioid analgesics chronically for pain and another 5 million who take these medicines for non-medical reasons, either without a prescription or a specific medical need. Opioid analgesics include narcotic pain medicines like methadone, oxycodone and OxyContin®, and hydrocodone/acetaminophen, which is also known as Vicodin®, Lortab® and Norco®.

Of particular concern to the CDC are people who seek medical care from multiple doctors or who take large amounts of opioid analgesics every day. While these 2 groups represent only 10% of Americans who take opioids regularly they account for 40% of the prescription overdoses that involve an opioid.

How can we stop the carnage?

One way to reduce the deaths from prescription drug overdoses is to get better control over the medicines that are causing them. This includes opioid pain medicines like methadone, oxycodone, hydrocodone with acetaminophen, and anti-anxiety medicines like alprazolam (Xanax®) and lorazepam (Ativan®).

Before these medications get into the hands of the person who will overdose with it, a prescription first has to be generated by a doctor or medical provider who is authorized to prescribe it and then sent to a pharmacy who then dispenses it to the patient or the patient’s agent. As pharmacists, we consider ourselves the guardians of these powerful and potent agents, and take seriously any attempts to procure it for non-medical use.

In some communities, pharmacists used an informal network of phone calls or faxes between their store, other pharmacies and doctor’s offices in order to give others a “heads up” about questionable activities involving prescription medicines. Information was sent along a “grapevine” about patients who were getting multiple prescriptions for the same thing from different physicians, dentists and hospital emergency rooms, who have altered their prescriptions by making 10 tablets into 100, or tried to call in their own refills for pain or anxiety pills.

Pharmacists also encouraged their local physicians to use this informal “drug alert” system to report stolen prescription pads or to inquire whether a patient had received any controlled substance prescriptions from providers other than themselves.

Today, there is even more need to share information between pharmacies and doctors to help identify potential misuse, overuse or diversion of controlled substances, particularly that of opioids and anxiety medications. Opioids which are narcotic analgesics and medications like alprazolam (Xanax®) used for anxiety are also referred to as “controlled substances” because they have a higher level of  “control” on their prescribing and dispensing by the Drug Enforcement Administration (DEA) than other types of prescription drugs, such as those for diabetes or blood pressure.

Prescription drug monitoring programs (PDMPs) are statewide databases that collect information about prescriptions dispensed for controlled substances in order to make that information accessible to pharmacists and physicians to help guide medical care decisions. PDMPs are designed to allow doctors to review which prescriptions for controlled substances have already been dispensed to a particular patient and when, in order to provide better care and avoid overprescribing.

Washington State’s PDMP is an online database called Prescription Review. It includes a person’s name, date of birth, address, each controlled substance prescription dispensed, the medical provider who prescribed it, the date it was written, the date it was dispensed and the pharmacy which dispensed it. For additional information about Prescription Review go to: http://www.doh.wa.gov/PublicHealthandHealthcareProviders/HealthcareProfessionsandFacilities/PrescriptionMonitoringProgramPMP/PublicFAQ.aspx.

The real power of using PDMPs to reduce overprescribing will be seen when all 50 states have online, searchable PDMPs that connect to each other. You can find out more about PDMPs from www.pmpalliance.org or http://www.deadiversion.usdoj.gov/faq/rx_monitor.htm.

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