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Report: Over-the-Counter Analgesics in the Management of Acute Pain

Older nurse with female patient

Editor's note: Content sponsored by Johnson & Johnson Consumer Inc.

Patients in pain have various options to help them find relief.

[caption id="attachment_57339" align="alignleft" width="231"]over-the-counter analgesics, Susan Pendergrass, APRN Susan Pendergrass, APRN[/caption]

But nurses caring for these patients may have concerns about balancing the risks and benefits of all pain treatment options, including opioid and non-opioid therapies. A report published in Pain Medicine News, "Special Report: Over-the-Counter Analgesics for The Management of Acute Pain -- Clinical Experience in the Era of the Opioid Crisis," takes a look at multimodal pain management and reviews the successful use of over-the-counter (OTC) pain relievers as part of this type of pain relief therapy.

The report includes over-the-counter remedies (e.g., acetaminophen, nonsteroidal anti-inflammatory drugs) backed by research and further discusses evidence-based practice with real-life case studies from three healthcare experts. We spoke with one of those experts, Susan Pendergrass, MSN, MED, APRN, FNP-BC, an independent family nurse practitioner and pain consultant in Fernandina Beach, Fla., to learn more about this special report.

Q: Which three key points should nurses learn from the report?

A: The three takeaways from the report for nurses include:

The healthcare community is shifting to multimodal treatment for patients in acute and chronic pain.

There is a role for over-the-counter analgesics in multimodal pain management.

We need to emphasize educating health professionals and patients on the use of multimodal, personalized pain management as it relates to each patient's specific needs and history.

These three factors are important because incorporating evidence-based practice -- when implementing multimodal pain management -- leads to better patient outcomes.

Q: What should nurses know about using over-the-counter analgesics, such as acetaminophen or NSAIDs, for multimodal pain management?

A: Nurses involved in multimodal pain management will want to assess if the regimen is appropriate for each patient. We need to determine what other medications patients are taking including prescription, over-the-counter and herbal supplements. When prescribing and administering medications, and after conducting a thorough patient assessment, I've always done five things. They are:

  1. Tell the patient the name of the medication(s).
  2. Explain the reason why they are taking the medication.
  3. Describe the dosing regimen for each medication.
  4. Discuss the side effect profiles of their medications.
  5. Review the storage and disposal instructions of each medication.

over-the-counter analgesics - Senior man in a hospital bed looking up at his doctor with a positive expression

Q: What can nurses do to help educate patients about multimodal pain management?

A: We need to educate ourselves to be able to educate patients about this type of approach. Maintain an awareness of evidence-based practices and guidelines. Advocate for your patients. Understand that it's our ethical responsibility to manage pain responsibly.

Multimodal pain management can include multiple medications and techniques, including opioid, non-opioid (prescription or over-the-counter analgesics), and topical medications, as well as nonpharmacologic therapies.

We'll want to also educate patients, nurses and other members of the healthcare team about the use of integrative and complementary therapies that may be options to incorporate into a multimodal pain management plan of care. A multimodal approach may also result in less reliance on pain medications overall, while reducing the side effect risk profile and drug-to-drug interactions.

Q: Which risk factors play a role in which over-the-counter analgesics a patient should or shouldn't take that you'd like nurses to be aware?

A: A history of GI bleed, gastric reflux disease, cardiac, renal and hepatic function. Assessing the patient's history is essential in addition to following the dosing guidelines for acetaminophen and NSAIDs. The other concern is drug-to-drug interactions. You want to ensure any new medications you prescribe and administer are compatible with their current medications. And you want to remind them to take only one medication with the same active ingredient at one time. For example, some prescription opioids also include acetaminophen. Patients should not take an acetaminophen-containing opioid with an OTC acetaminophen product at the same time. Other questions to ask your patients:

What is their current alcohol intake?

Do they have any diagnoses that place them at risk for adverse effects from the new medication?

What additional questions does the patient (or caregiver) have?

Q: Are there any other points you'd like to discuss that I have not asked you yet?

A: It's important to understand the current climate and changes happening in pain management. Sometimes when the pendulum swings, patients' pain may not be well-controlled in that kind of environment. We still need to address, assess and manage pain safely, appropriately and effectively for our patients.

Also, consumers will want to be aware of their pain medication options by asking their healthcare providers and pharmacists questions as they arise. Consumers can find helpful information here.

They also can use an interactive tool at to outline their goals, concerns and the pain treatment options they're interested in. Then they can bring the outline to an appointment and discuss it with their healthcare professional.

For healthcare professional resources:

Editor's note: Susan Pendergrass, MSN, MED, APRN, FNP-BC, has been compensated for her services by Johnson & Johnson Consumer Inc.