Ibuprofen for plantar fasciitis

Contents

Plantar Fasciitis Treatment

Home Remedies for Plantar Fasciitis

Many of the conservative treatment options for plantar fasciitis are things you can do at home. They involve a combination of resting the foot, avoiding activities that can aggravate the condition, therapies to manage the pain, and techniques to strengthen foot muscles during recovery.

Resting the Foot

Roughly one quarter of patients with plantar fasciitis cite rest as the treatment that works best. (6) Avoiding weight-bearing activities and pressure applied to the foot helps relieve pain during the healing process.

Still, rest can be especially difficult for athletes and people whose jobs require a lot of walking and standing. Active individuals can achieve “relative rest” by choosing activities that minimize impact and pressure on the plantar fascia, such as swimming and upper body weight machines. (7)

Icing the Foot

Like certain medicines, ice can be an effective anti-inflammatory. Typically, cold is applied to the area that hurts or is inflamed for intervals of 15 to 20 minutes.

Cold therapy can be achieved by applying an ice pack to the painful heel or by soaking the heel in an ice bath for 10 to 15 minutes. Icing can be especially helpful after exercise or at the end of a workday.

Stretching and Strengthening Exercises

Exercise can help relieve plantar fasciitis pain, while also loosening tight muscles, increasing flexibility, and building muscle strength in the foot.

Simple stretching techniques may incorporate stairs, walls, boards, and objects that the arch of the foot can be rolled over. Strengthening exercises may involve picking up small objects like marbles or coins with the toes. A physical therapist can show you how to perform specific exercises to stretch and strengthen your lower leg and foot muscles, which will help stabilize your ankle and heel.

Studies have shown that many plantar fasciitis patients cite stretching and strengthening exercises as the most helpful part of their treatment. (6)

Orthotics, Arch Taping, and Night Splints

Orthotics, or orthoses, are devices that are worn in a shoe or on the foot to manage pain and walking problems. They include foot pads or heel cups that cushion a sensitive area on the foot like a callus, and shoe inserts that provide support and correct ankle or heel movement.

Arch taping involves applying athletic tape to the foot to reduce stress on the ligament by keeping the fascia from moving too much. Some people tape their arch only before physical activity, while others apply the tape to reduce strain throughout the day.

Night splints are devices that gently stretch your calf and the arch of your foot. They are worn at night and work by supporting your foot with the toes pointing upwards while you sleep.

Physio Works – Physiotherapy Brisbane

Article by J. Miller, Z. Russell

What is Plantar Fasciitis?

Plantar fasciitis is one of the most common sources of heel pain.

Your plantar fascia is a thick fibrous band of connective tissue originating on the bottom surface of the calcaneus (heel bone) and extending along the sole of the foot towards the toes. Your plantar fascia acts as a passive limitation to the over flattening of your arch. When your plantar fascia develops micro tears or becomes inflammed it is known as plantar fasciitis.

What Causes Plantar Fasciitis?

Plantar fasciitis is one of those injuries that magically seems to appear for no apparent reason. However, plantar fasciitis is caused by one of two methods. They are either traction or compression injuries.

Plantar fasciitis is most often associated with impact and running sports, especially those that involve toe running rather than heel running styles.

It is also commonly diagnosed in individuals with poor foot biomechanics that stress the plantar fascia. Flat feet or weak foot arch control muscles are two common causes of plantar fasciitis.

Traction Plantar Fasciitis

Plantar fasciitis symptoms are usually exacerbated via “traction” (or stretching) forces on the plantar fascia. In simple terms, your plantar fascia is repeatedly overstretched. The most common reason for the overstretching is an elongated arch due to either poor foot biomechanics (eg overpronation) or weakness of your foot arch muscles.

Compression Plantar Fasciitis

Compression type plantar fascia injuries have a traumatic history. Landing on a sharp object that bruises your plantar fascia is your most likely trauma.

The location of plantar fasciitis pain will be further under your arch than under your heel, which is more likely to be a fat pad contusion if a single trauma caused your pain.

The compression type plantar fasciitis can be confused with a fat pad contusion that is often described as a “stone bruise”.

What are the Symptoms of Plantar Fasciitis?

You’ll typically first notice early plantar fasciitis pain under your heel or in your foot arch in the morning or after resting.

Your heel pain will be worse with the first steps and improves with activity as it warms up.

How Does Plantar Fasciitis Progress?

As plantar fasciitis deteriorates, the pain will be present more often. You can determine what stage you are in using the following guidelines:

  1. No Heel Pain – Normal!
  2. Heel pain after exercise.
  3. Heel pain before and after exercise.
  4. Heel pain before, during and after exercise.
  5. Heel pain all the time. Including at rest!

This symptom progression is consistent with the four stages of a typical overuse injury.

Ultimately, further trauma and delayed healing will result in the formation of calcium (bone) within the plantar fascia. When this occurs adjacent to the heel bone it is known as heel spurs, which have a longer rehabilitation period.

How is Plantar Fasciitis Diagnosed?

Plantar fasciitis is usually diagnosed by your physiotherapist or sports doctor based on your symptoms, history and clinical examination.

After confirming your plantar fasciitis they will investigate WHY you are likely to be predisposed to plantar fasciitis and develop a treatment plan to decrease your chance of future bouts.

X-rays may show calcification within the plantar fascia or at its insertion into the calcaneus, which is known as a calcaneal or heel spur.

Ultrasound scans and MRI are used to identify any plantar fasciitis tears, inflammation or calcification.

Pathology tests (including screening for HLA B27 antigen) may identify spondyloarthritis, which can cause symptoms similar to plantar fasciitis.

Risk Factors for Plantar Fasciitis

You are more likely to develop plantar fasciitis if you are:

Active – Sports that place excessive stress on the heel bone and attached tissue, especially if you have tight calf muscles or a stiff ankle from a previous ankle sprain, which limits ankle movement eg. Running, ballet dancing and aerobics.

Overweight – Carrying around extra weight increases the strain and stress on your plantar fascia.

Pregnant – The weight gain and swelling associated with pregnancy can cause ligaments to become more relaxed, which can lead to mechanical problems and inflammation.

On your feet – Having a job that requires a lot of walking or standing on hard surfaces ie factory workers, teachers and waitresses.

Flat Feet or High Foot Arches – Changes in the arch of your foot changes the shock absorption ability and can stretch and strain the plantar fascia, which then has to absorb the additional force.

Middle-Aged or Older – With ageing the arch of your foot may begin to sag – putting extra stress on the plantar fascia.

Wearing shoes with poor support.

Weak Foot Arch Muscles. Muscle fatigue allows your plantar fascia to overstress and cause injury.

Arthritis. Some types of arthritis can cause inflammation in the tendons in the bottom of your foot, which may lead to plantar fasciitis.

Diabetes. Although doctors don’t know why plantar fasciitis occurs more often in people with diabetes.

The good news is that plantar fasciitis is reversible and very successfully treated. About 90 percent of people with plantar fasciitis improve significantly within two months of initial treatment.

If your plantar fasciitis continues after a few months of conservative treatment, your doctor may inject your heel with steroidal anti-inflammatory medications (corticosteroid). Cortisone injections have been shown to have short-term benefits but they actually retard your progress in the medium to long-term, which usually means that you will suffer recurrent bouts for longer.

What is the Best Treatment for Plantar Fasciitis?

Due to poor foot biomechanics being the primary cause of your plantar fasciitis, it is vital to thoroughly assess and correct your foot and leg biomechanics to prevent future plantar fasciitis episodes or the development or progression of a heel spur.

Your physiotherapist is highly-skilled in foot control assessment and its dynamic biomechanical correction. Depending upon your specific clinical assessment, your physiotherapist may provide you with manual therapy techniques such as joint mobilisations to loosen stiff joints, soft tissue massage or release, muscle flexibility or stretches, foot taping, foot, and lower limb strengthening exercises and occasionally night splints. The treatment of plantar fasciitis does vary from person to person so please seek the advice of your foot care practitioner.

They may recommend that you seek the advice of a podiatrist, who is an expert in the prescription on passive foot devices such as orthotics. Foot orthosis have been shown to potentially assist some sufferers of plantar fasciitis.

Active foot stabilisation exercises are an excellent long-term solution to prevent and control plantar fasciitis that may be prescribed by your physiotherapist.

Researchers have concluded that there are essentially 8 stages that need to be covered to effectively rehabilitate plantar fasciitis and prevent recurrence. These are:

  1. Early Injury Protection: Pain Relief & Anti-inflammatory Modalities
  2. Regain Full Range of Motion
  3. Restore Foot Arch Muscle Control
  4. Restore Normal Calf & Leg Muscle Control
  5. Restore Normal Foot Biomechanics
  6. Improve Your Running and Landing Technique
  7. Return to Sport or Work
  8. Footwear Analysis

Treatment of heel spurs is similar to plantar fasciitis treatment. Your physiotherapist will select the most appropriate treatment modalities for you.

Ultimately, biomechanical correction is the aim. Foot intrinsic muscle strengthening (including tibialis posterior and peroneus longus) and calf (gastrocnemius and soleus) stretches are almost always required.

Cases of moderate to severe biomechanical deformity should be referred for physiotherapy or podiatric assessment to prevent chronic recurrence. NSAID’s and corticosteroid injection is most effective when combined with biomechanical correction.

Mechanical treatment that involves taping and orthoses has been shown to be more effective than either anti-inflammatories or accommodative modalities.

Plantar fascia night splints can sometimes work to provide short-term pain relief. The splints essentially overstretch the plantar fascia, which may provide you with some short-term relief, but ultimately elongates your passive arch structures. The medium and long-term benefits make no sense of this rationale. To the contrary, permanent elongation will predispose you to flatter arches and more likelihood of recurrent heel pain. Based on this we do NOT currently recommend plantar fascia night splints in most instances.

Weight loss and load management are an important influence upon the initiation and duration of plantar fasciitis and heel spurs. Your weight may be impacting upon your plantar fascia or heel spurs, so weight loss should be a priority for those patients who are carrying excess weight.

Researchers have concluded that there are essentially 8 stages that need to be covered to effectively rehabilitate plantar fasciitis and prevent recurrence. These are:

Phase 1 – Early Injury Protection: Pain Relief & Anti-inflammatory Tips

As with most soft tissue injuries the initial treatment is Rest, Ice, and Protection.

In the early phase, you’ll most likely be unable to walk pain-free. Our first aim is to provide you with some active rest from pain-provoking foot postures. This means that you should stop doing any movement or activity that provoked your foot pain in the first place.

Ice is a simple and effective modality to reduce your pain and swelling. Please apply for 20-30 minutes each 2 to 4 hours during the initial phase or when you notice that your injury is warm or hot. A frozen water bottle can provide you with an ice foot roller that can simultaneously provide you with some gentle plantar fascia massage.

Anti-inflammatory medication (if tolerated) and natural substances eg arnica may help reduce your pain and swelling. However, it is best to avoid anti-inflammatory drugs during the initial 48 to 72 hours when they may encourage additional bleeding. Most people can tolerate paracetamol as a pain reducing medication.

To support and protect your plantar fascia, you may need to wear a plantar fascia brace, heel cups or have your foot taped to provide pain relief. As mentioned earlier, the cause of your plantar fasciitis will determine what works best for you. Your physiotherapist will guide you.

Your physiotherapist will guide you and utilise a range of pain relieving techniques including joint mobilisations for stiff joints, massage, electrotherapy, acupuncture or dry needling to assist you during this painful phase.

Phase 2: Regain Full Range of Motion

If you protect your injured plantar fascia appropriately the injured tissues will heal. Inflammed structures will settle when protected from additional damage, which can help you avoid long-standing degenerative changes.

Plantar fasciitis may take from several weeks (through to many months) to heal while we await Mother Nature to form and mature the new scar tissue, which takes at least six weeks. During this time period, you should be aiming to optimally remould your scar tissue to prevent a poorly formed scar that may become lumpy or potentially re-tear in the future. It is important to lengthen and orientate your healing scar tissue via massage, gentle stretches, and light active exercises.

In most cases, your physiotherapist will identify stiff joints within your foot and ankle complex that they will need to loosen to help you avoid plantar fascia overstress.A sign that you may have a stiff ankle joint can be a limited range of ankle bend during a squat manoeuvre. Your physiotherapist will guide you.

Phase 3: Restore Foot Arch Muscle Control

Your foot arch is dynamically controlled via important foot arch muscles, which be weak or have poor endurance. These foot muscles have a vital role as the main dynamically stable base for your foot and prevent excessive loading through your plantar fascia.

Any deficiencies will be an important component of your rehabilitation. Your physiotherapist is an expert in the assessment and correction of your dynamic foot control. They will be able to help you to correct your normal foot biomechanics and provide you with foot stabilisation exercises if necessary.

Phase 4: Restore Normal Calf & Leg Muscle Control

You may find it difficult to comprehend, but all of your leg (calf, thigh and hip) muscles play an important role in controlling your foot arch and its normal function. Your physiotherapist will assess your leg muscle function and provide you with the necessary treatment or exercises as required.

Phase 5: Restore Normal Foot Biomechanics

Your foot biomechanics are the main predisposing factor for plantar fasciitis. After a biomechanical assessment, you may be recommended a soft orthotic or a custom-made orthotic prescribed by a podiatrist.

Phase 6: Improve Your Running and Landing Technique

If your plantar fasciitis has been caused by sport it is usually during repetitive activities, which place enormous forces on your plantar fascia.

In order to prevent a recurrence as you return to your sport, your physiotherapist will guide you with technique correction and exercises to address these important components of rehabilitation to both prevent a recurrence and improve your sporting performance.

Depending on what your sport or lifestyle entails, a speed, agility, proprioception and power program will be customised to prepares you for light sport-specific training.

Phase 7: Return to Sport or Work

Depending on the demands of your chosen sport or your job, you will require specific sport-specific or work-specific exercises and a progressed training regime to enable a safe and injury-free return to your chosen sport or employment.

Your PhysioWorks physiotherapist will discuss your goals, time frames and training schedules with you to optimise you for a complete return to sport or work. Work-related injuries will often require a discussion between your doctor, rehabilitation counsellor or employer.

Phase 8: Footwear Analysis

Often it is poorly designed footwear that can predispose to the injury. Seek the professional advice of your healthcare practitioner.

What about Plantar Fasciitis Night Splints?

Boatwright et al. (2016) reviewed six studies to investigate the effectiveness of night splints in plantar fasciitis. They found the evidence to support the use of night splints as weak in all six research papers. Based on this evidence, it suggests that while night splints may be helpful treating plantar fasciitis there is little scientific proof recommending their use. Patient compliance is another issue, with anterior splints being better tolerated than posterior splints. Roos et al. (2006), Attard and Singh (2012).

Plantar fascia night splints essentially maintain an overstretch on the plantar fascia, which may provide you with some short-term relief. Ultimately this elongates your passive arch structures and the medium and long-term benefits fail to make sense to support this rationale. To the contrary, permanent elongation will most likely predispose you to flatter arches and more likelihood of recurrent heel pain. Based on this we do NOT recommend plantar fascia night splints in most instances. Active foot control exercises, which aim to dynamically support your foot arch, and thereby reduce the passive elongation of your plantar fascia, does seem to be the better approach in the medium to long-term management of plantar fasciitis.

For more specific advice about your plantar fasciitis, please contact your PhysioWorks physiotherapist.

Call PhysioWorks

Book Online

Helpful Products for Plantar Fasciitis

Related Injuries

General Information

  • Heel Pain
  • Ankle Pain
  • Foot Pain

Heel Pain

  • Heel Spur

Traumatic Ankle Ligament Injuries

  • Sprained Ankle
  • High Ankle Sprain

Tendinopathies/Fasciopathies

  • Achilles Tendon Rupture
  • Achilles Tendinopathy
  • FHL Tendinopathy
  • Peroneal Tendinopathy
  • Tibialis Posterior Tendinopathy
  • Plantar Fasciitis

Foot Injuries

  • Bunion
  • Metatarsalgia
  • Morton’s Neuroma

Bone Injuries

  • Ankle Fracture (Broken Ankle)
  • Stress Fracture
  • Stress Fracture Feet
  • Severs Disease
  • Heel Spur
  • Shin Splints

Degenerative Conditions

  • Ankle Arthritis

Soft Tissue Inflammation

  • Retrocalcaneal Bursitis

Biomechanical Conditions

  • Anterior Ankle Impingement
  • Posterior Ankle Impingement
  • Pes Planus (Flat Feet)

Nerve-Related Sources

  • Tarsal Tunnel Syndrome
  • Sciatica
  • Pinched Nerve
  • Restless Leg Syndrome

Muscle Injuries

  • Cramps
  • Muscle Strain

Systemic Conditions

  • Fibromyalgia
  • Lupus
  • Rheumatoid Arthritis
  • Psoriatic Arthritis
  • Heel Pain
  • Ankle Pain
  • Foot Pain

Plantar Fasciitis Treatment Options

  • Early Injury Treatment
  • Avoid the HARM Factors
  • Soft Tissue Injury? What are the Healing Phases?
  • What to do after a Muscle Strain or Ligament Sprain?
  • Acupuncture and Dry Needling
  • Sub-Acute Soft Tissue Injury Treatment
  • Active Foot Posture Correction Exercises
  • Gait Analysis
  • Biomechanical Analysis
  • Balance Enhancement Exercises
  • Proprioception & Balance Exercises
  • Agility & Sport-Specific Exercises
  • Medications?
  • Orthotics
  • Soft Tissue Massage
  • Walking Boot
  • Brace or Support
  • Dry Needling
  • Electrotherapy & Local Modalities
  • Heat Packs
  • Joint Mobilisation Techniques
  • Kinesiology Tape
  • Neurodynamics
  • Physiotherapy Instrument Mobilisation (PIM)
  • Prehabilitation
  • Running Analysis
  • Strength Exercises
  • Stretching Exercises
  • Supportive Taping & Strapping
  • TENS Machine
  • Video Analysis
  • FAQs about Plantar Fasciitis

  • Common Physiotherapy Treatment Techniques
  • What is Pain?
  • Physiotherapy & Exercise
  • When Should Diagnostic Tests Be Performed?
  • Massage Styles and their Benefits
  • What Causes Post-Exercise Muscular Pain?
  • Barefoot Running: Your MUST READ Guide to the Pro’s and Con’s.
  • Can Kinesiology Taping Reduce Your Swelling and Bruising?
  • Heat Packs. Why Does Heat Feel So Good?
  • How Can You Prevent a Future Leg Injury?
  • How Do You Improve Your Balance?
  • How Much Treatment Will You Need?
  • Post-Run Soreness: Should You Be Concerned?
  • What are the Common Massage Therapy Techniques?
  • What are the Early Warning Signs of an Injury?
  • What is a TENS Machine?
  • What is Chronic Pain?
  • What is Nerve Pain?
  • What is Sports Physiotherapy?
  • What’s the Benefit of Stretching Exercises?
  • When Can You Return to Sport?
  • Why Kinesiology Tape Helps Reduce Swelling and Bruising Quicker
  • Call PhysioWorks

    Book Online

    Understanding Opioid (Narcotic) Pain Medications

    Medically reviewed by L. Anderson, PharmD Last updated on Apr 1, 2019.

    • Health Guide
    • Care Notes
    • Medication List
    • Q & A

    Narcotics, also called opioids, are a necessary and important part of medical care. Painkillers, medically known as narcotic analgesics, contain some type of opioid medication to ease the discomfort from conditions such as a sprained ankle, after wisdom tooth extraction, or after major surgery.

    Opioids are also used as a cough suppressant, to treat diarrhea and to help combat narcotic addiction itself. However, the use of prescription opioids for pain is now a highly controversial topic in the U.S. due to a growing epidemic of prescription narcotic addiction, overdose, and death.

    We’ve all been prescribed opioid prescription painkillers from time-to-time, and the choices are many. You’ve heard of their names: oxycodone (Oxycontin) , hydrocodone, Lortab, tramadol (Ultram ER), Vicodin, Tylenol with Codeine, and many others.

    Fentanyl is a growing problem as well, often used to lace drugs on the street. Fentanyl may be produced illegally in China or Mexico and shipped across the border.

    But what are opioids and what if we need to take them for a legitimately painful condition? Here’s some detailed history and facts about prescription narcotics to help you better understand painkillers, their prescribing information, and the current concerns about addiction.

    • A Brief History of Narcotics
    • What Is a Narcotic Medication?
    • How Do Narcotics Work?
    • What Kind of Pain Does a Narcotic Treat?
    • Is My Drug a Narcotic?
    • List of Prescription Narcotic Drugs (Single Agents)
    • List of Prescription Narcotic Drugs (Combination Agents)
    • Common Uses for Prescription Narcotics
    • Common Side Effects of Narcotics
    • Narcotics for Pain: The Current Controversy
    • The FDA Response to Narcotic Addiction
    • Rescheduling of Narcotics to Ease Misuse and Diversion
    • Can I Become Addicted to a Prescription Narcotic Painkiller?
    • What is Naloxone (Narcan)?
    • Popular Culture and Drug Use
    • Drug Testing for Narcotics

    History of Opioids

    Ancient Times

    Narcotics, also known as opioids, date back to 3400 B.C. Narcotics from ancient times all had a common source: the red opium poppy. The earliest records of the opium poppy being cultivated was in Mesopotamia by the Sumerians. The Sumerians referred to opium as the “joy plant” and passed it on to the Egyptians. Around 400 B.C. the first medical references to opium came from Hippocrates, also known as the Father of Medicine.

    The Middle Ages

    Oddly, opium disappeared from the European records up until around 1500, so documentation is sparse. However, in the early 1500’s Paracelsus, the first toxicologist, created an opium pill also using citrus juice and gold. Paracelsus also made a specific tincture (alcoholic extract) of opium called “laudanum”, from the latin meaning “to praise”. Laudanum contains roughly 10 percent powdered opium by weight, equivalent to 1 percent morphine. Laudanum can still be ordered via prescription in the U.S. today, although it is rare.

    The 19th and 20th Century

    In the 1800’s opium was recognized as a standard painkiller when morphine was isolated from the poppy. German chemist Friedrich Wilhelm Adam Serturner dubbed the isolate “morphine” after the Greek god of dreams, Morpheus. Opiuim, morphine and heroin addiction had become a major problem by the early 1900’s and during the civil war. Congress starting imposing regulations to restrict opium.

    • The Opium Exclusion Act of 1909: Barred importation of opium for purposes of smoking
    • The Harrison Narcotics Tax Act of 1914: Required physician and pharmacist registration for distribution of opiates
    • The Heroin Act of 1924: Heroin importation, manufacture and possession was outlawed in the U.S.

    Bayer stopped the production of heroin but in 1916 oxycodone was developed in hopes it would be less addictive. In 1938, the Food, Drug and Cosmetic Act was passed that required all medications to be proven as safe by the FDA; however, older opioid-derived drugs such as morphine, codeine, and oxycodone were “grandfathered” meaning they were automatically allowed without further review. Fast-forward to the 1950’s, 1960’s, and 1970’s and that’s where the more familiar opioids like Percodan (oxycodone/aspirin) start to gain hold in the U.S. market. Since this time, the illegal abuse of semi-synthetic and synthetic narcotics has been a growing problem in the U.S.

    With the passage of the Controlled Substances Act (CSA) in 1970, greater regulation and scheduling of drugs based on abuse potential occurred. Within the CSA there are five schedules (I-V) that are used to classify drugs based upon their potential for abuse, valid medical applications, and public safety. The schedules range from I to V, with schedule I being the highest for potential abuse and with no current medical use. Heroin and marijuana fall into schedule 1; oxycodone, hydrocodone and morphine are in schedule 2.

    The Drug Enforcement Agency was created in 1973, and President Nixon declared ‘The War on Drugs’ noting the high incidence of heroin addiction in the U.S.

    The 21st Century

    In the first decade of 2000, a new emphasis on medical control of pain was emphasized by healthcare policy makers and pharmaceutical industry, leading to an explosion in opioid prescribing. Brands such as:

    • Percodan
    • Percocet
    • OxyContin
    • Lortab
    • Vicodin

    were overprescribed, leading to millions of addicted patients and emergency department visits due to painkillers and overdose. The pharmaceutical industry began research into development of abuse-deterrent formulations of opioid medications, many of which are now available on the U.S. market.2,3 However, none of these forms prevent abuse by simply taking the medication by mouth.

    The true effect of abuse-deterrent opioids on the reduction of narcotic overdose and death is not yet known. In fact, it will probably take a multi-pronged approach to defeat the epidemic of narcotic abuse in this country, including availability of naloxone (Narcan) for overdose, patient and provider education, effective legislation, and easily available treatment options for addiction.

    What Is a Narcotic Medication?

    It’s important to define narcotic in a medical sense. The word “narcotic” often denotes a negative connotation associated with illegal drugs and addiction. While this can be true, “narcotic” is also a standard term used in medicine. A narcotic drug, also called a narcotic analgesic or opioid, is a medication prescribed by a doctor to relieve moderate to severe pain, either acute (short-term) or chronic (longer-term or continuous) pain. Narcotic analgesics differ in their ingredients, strengths, dosage forms, and cost. Many are available as oral tablets, capsules, or liquids, while some come as an injection, and others are provided as a patch to provide extended-release control for severe pain.

    How Do Narcotics Work?

    Overall, narcotic painkillers work by reducing nerve excitability that leads to the sensation of pain. Narcotics bind to special receptors in the brain (central nervous system) and in other areas of the body (peripheral nervous system, like the gastrointestinal tract) called opioid receptors. There are four types of opioid receptors: mu, delta, kappa, opioid receptor like-1 (ORL1).

    These receptors either aid with the opening of potassium channels (causing hyperpolarization) or block calcium channel openings and the release of excitatory neurotransmitters like substance P that are involved with pain.

    Sometimes a painkiller drug may be referred to as a “narcotic-like” medicine, but any true narcotic medication will have action at one of these opioid receptors.

    For example, tramadol is often referred to as a “narcotic-like” medication suggesting it may be safer, but this is a misnomer, as it has centrally-acting analgesic action at the opioid mu receptors, blocking pain pathways like regular opioids. Tramadol is also thought to act via weak reuptake inhibition of norepinephrine and serotonin, and this may add to its pain effects. In addition, tramadol pain relief is partially blocked by the opiate antagonist naloxone in animal studies.4,5

    What Kind of Pain Does a Narcotic Treat?

    There are literally hundreds of pain conditions where narcotic analgesics could be used to lessen discomfort. Opioids for acute pain should only be used short-term to help prevent dependence and addiction. Once the severe acute pain subsides other non-narcotic medications such as acetaminophen or ibuprofen may be suitable. The physician and patient should develop a plan for pain control early in the treatment course, and agree on timeline to stop the opioid for acute pain syndromes, while transitioning to non-opioid options .

    A pain treatment plan should also be initiated early in the course of chronic (long-term) pain management. Longer-term options, combined with alternative treatments such as exercise, physical therapy, TENS therapy, meditation, and or neuropathic drugs for pain may be helpful. Often, if pain is worse at night and interferes with sleep, an opioid pain medication can be used only at bedtime, taking other non-narcotic methods, such as NSAIDs, during the daytime.

    Many of the extended-release formulations of opioid pain medications are only to be used in opioid “tolerant” patients (meaning they have already been using other opioids) and for chronic pain that requires 24-hour, around-the-clock pain management, such as severe cancer pain.

    Opioid medicines such as methadone (Dolophine, Methadose), buprenorphine, buprenorphine combined with naloxone (Suboxone) and naltrexone (Depade, ReVia) are also used in the treatment of opioid dependence, either from prescription drugs or illicit narcotics such as heroin.

    Is My Drug a Narcotic?

    Below is a list of narcotic drugs (opioid analgesics) available on the U.S. market. The generic names are listed first, with brand name products in parentheses. Follow the link for specific prescription information about dosing, side effects, and drug interactions.

    List of Common U.S. Prescription Opioids (Single Agents)

    • alfentanil
    • buprenorphine injectable (Buprenex)
    • buprenorphine transdermal (Butrans)
    • butorphanol nasal
    • codeine sulfate
    • fentanyl (Abstral, Actiq, Duragesic, Fentora, Lazanda, Sublimaze, Subsys)
    • hydrocodone (Hysingla ER, Zohydro ER)
    • hydromorphone (Dilaudid, Dilaudid HP, Exalgo)
    • levorphanol (Levo-Dromoran)
    • meperidine (Demerol)
    • methadone (Dolophine; Methadose)
    • morphine (Kadian, MS Contin, MorphaBond ER)
    • morphine liposomal
    • nalbuphine
    • opium tincture, USP (Deodorized)
    • oxycodone (Oxaydo, OxyContin, Roxicodone, RoxyBond, Xtampza ER)
    • oxymorphone (Opana, Opana ER)
    • pentazocine
    • remifentanil (Ultiva)
    • sufentanil
    • tapentadol (Nucynta, Nucynta ER)
    • tramadol (Conzip, Ultram)

    List of Common U.S. Prescription Opioids (Combination Agents)

    Narcotic analgesic combinations are drugs containing a narcotic analgesic with another class of analgesic, such as acetaminophen, ibuprofen or aspirin. They are used to treat moderate to severe pain. Propoxyphene, contained in products such as Darvocet-N 100 (propoxyphene and acetaminophen) was taken off the U.S. market in 2010 due to safety and effectiveness concerns.

    Follow the links below for specific information about dosing, side effects, and drug interactions for each drug. The generic drug names are listed first, with brand name products in parentheses.

    • belladonna alkaloids and opium (B & O Supprettes)
    • aspirin butalbital caffeine and codeine (Fiorinal with Codeine)
    • acetaminophen butalbital caffeine and codeine (Fioricet with Codeine)
    • buprenorphine and naloxone* (Cassipa, Bunavail, Suboxone, Zubsolv)
    • acetaminophen and oxycodone (Endocet, Percocet, Roxicet)
    • ibuprofen and oxycodone
    • hydrocodone and ibuprofen (Vicoprofen, Ibudone, Reprexain)
    • acetaminophen and pentazocine
    • acetaminophen and hydrocodone (Lortab, Lorcet, Norco, Vicodin)
    • acetaminophen caffeine and dihydrocodeine (Trezix)
    • acetaminophen and tramadol (Ultracet)
    • naloxone and pentazocine (Talwin NX)
    • morphine sulfate and naltrexone (Embeda)
    • aspirin and oxycodone (Percodan)
    • acetaminophen and codeine (Tylenol with Codeine)
    • aspirin and caffeine and dihydrocodeine (Synalgos-DC)

    *Buprenorphine and naloxone is a combination medicine used for treatment of opioid (narcotic) dependence. Buprenorphine and naloxone is not for use as a pain medication.

    Common Uses for Opioids

    • Acute Pain
    • Anesthesia

    • Anesthesia adjunct

    • Arthritis pain

    • Back pain

    • Bone break or fracture

    • Breakthrough pain (for example, cancer pain)

    • Cancer pain

    • Cough

    • Herniated disc

    • Headache

    • Kidney stones

    • Light sedation

    • Migraines

    • Opiate dependence and withdrawal

    • Postoperative pain

    • Wisdom tooth extraction

    Common Side Effects of Opioids

    Morphine and its derivatives are classified as narcotics analgesics. Narcotics like morphine may cause many different types of side effects, but all cause drowsiness, sedation, and can lead to respiratory depression (difficulty breathing), especially when combined with alcohol or other CNS depressant drugs (which can be fatal).

    • Drowsiness and impaired judgment; do not drink alcohol, drive, or operate heavy machinery
    • Pruritis (itching)
    • Opioid-induced constipation
    • Nausea or vomiting
    • Withdrawal symptoms upon discontinuation; your doctor may suggest to slowly stop your narcotic to lessen withdrawal side effects
    • Tolerance to the pain relief effect can occur over time (meaning you may need a higher dose to get an equal amount of pain control)
    • Dizziness, confusion; may be worse in the elderly

    Learn More: Search for a complete list of your opioid side effects

    Heroin Use and the Opioid Epidemic

    Recent statistics from the National Institute of Drug Abuse (NIDA) reveal that prescription drug use can be a risk factor for heroin use, but only a small fraction of people who abuse pain relievers actually switch to heroin use. A survey from the National Survey on Drug Use and Health showed that less than 4% of people who had abused prescription opioids started using heroin within 5 years. In addition, results find that those who transition to heroin use tend to be frequent users of multiple substances of abuse.

    The crackdown on prescription narcotics, and the rescheduling of hydrocodone from CIII to the more restrictive CII, has led many to believe rescheduling may cause a spike in heroin use due to lower availability of prescription painkillers. In 2014, there were more than 914,000 reported users of heroin, an increase of 145 percent since 2007. In addition, there were over 10,500 heroin overdose deaths in 2014.

    However, in a letter in the New England Journal of Medicine6, experts state that the heroin epidemic is not the direct result of the crackdown on prescription painkillers like OxyContin and Vicodin. In fact, the authors state that heroin use among people who use prescription opioids for nonmedical reasons is rare, and the transition to heroin use appears to occur at a low rate. The timing of rescheduling and policy shifts do not coincide with the spikes in heroin use. Instead, increased access to heroin, a lower street price than many other drugs of abuse, and higher purity of heroin seem to be the major factors leading to increases in rates of heroin use.

    Fentanyl Abuse

    Fentanyl is now a major factor in opioid overdose deaths. In 2018, fentanyl was noted as being the number one drug leading to opioid overdose deaths in America. While prescription fentanyl is a useful and potent pain medication with legitimate medical uses, illicit forms of fentanyl and an analog, carfentanil, are being laced into streets drugs such as heroin and tablet forms of opioids like Oxycontin. Much of this dangerous fentanyl is brought in from China and Mexico.

    Related: Fentanyl Abuse: Top 11 Facts About This Potent and Deadly Opioid

    Guidelines on Safe Opioid Use

    Tackling the opioid epidemic requires a multi-pronged approach. Industry, patients, prescribers, and insurance payers all need to work together to address this pressing problem.

    The American Medical Association (AMA) has developed “End the Epidemic” an online, evidence-based resource that can help to treat patients effectively with pain and substance use disorders.8

    The Centers for Disease Control and Prevention (CDC) has developed educational programs for prescribers on the dangers of opioids and overprescribing entitled CDC Guideline for Prescribing Opioids for Chronic Pain.9

    The Veterans Administration has also implemented a Clinical Practice Guideline for Opioid Therapy for Chronic Pain.10

    In September 2018, the FDA announced the release of the final Opioid Analgesic Risk Evaluation and Mitigation Strategy (REMS)11

    • The new REMS plan better communicates the serious risks of opioid pain medications to patients and health care professionals.
    • The news REMS applies to immediate-release (IR) opioid analgesics intended for use in an outpatient setting as well as extended-release and long-acting (ER/LA) opioid analgesics, which have been included in previous REMS plans.

    Learn More: What Are Abuse-Deterrent Opioids?

    Rescheduling of Opioids to Ease Misuse and Diversion

    Tramadol

    Tramadol, a common pain medication, has been linked with drug abuse and misuse, dependence, and even fatal overdoses. To address these concerns, in 2014 the DEA placed all forms of tramadol into schedule IV of the Controlled Substances Act (CSA).

    Previously, tramadol was thought to be a lower risk drug for abuse and overdose and was a controlled substance in only a few U.S. states. Tramadol prescriptions may now only be refilled up to 5 times in a 6 month period after the date the prescription was first written. After 5 refills or 6 months, whichever occurs first, a new prescription is required from the physician.

    Even though tramadol may have other pain mechanisms in addition to a narcotic effect, people with a history of drug abuse may be at a greater risk of addiction. Tramadol is related to other opioids like codeine and morphine and can lead to psychological and physical dependence, drug-seeking behavior, addiction, and withdrawal symptoms. Withdrawal symptoms may occur if tramadol is abruptly stopped. Dose reduction of long-term tramadol use should be directed by a doctor.

    Hydrocodone

    Hydrocodone and oxycodone have been among the most common prescription painkillers abused in the U.S., and they are frequently prescribed in higher amounts than needed for minor pain. Hydrocodone is also used in cough suppressants. These drugs also may contain some other analgesic, like acetaminophen or ibuprofen, or a cough and cold product. Well-known brand names include Vicodin, Lortab or Tussionex.

    In October 2014, hydrocodone was rescheduled from schedule III to schedule II of the Controlled Substances Act. Patients now need a new prescription from their doctor each time they renew their medication for any hydrocodone product; refills are no longer allowed to be ordered for hydrocodone. The DEA put this rule into place to help curb abuse, diversion, and encourage patients and healthcare providers to consider other, more safe ways to combat pain.

    Can I Become Addicted to an Opioid?

    If and how quickly you become addicted depends on many factors. Addiction is a multi-faceted condition that involves:

    • Personality and behaviors
    • Brain chemistry
    • Age
    • Environmental and family surroundings
    • Types of drug abuse
    • Past personal and family history of drug abuse

    While one individual may use a drug once or many times and not become addicted, another person may overdose with the first use, or become addicted quickly. Each person varies in their susceptibility to drug addiction.

    Any opioid-based painkiller can lead to addiction. Narcotics often involved in prescription painkiller addiction and overdose include:

    • morphine
    • oxymorphone (Opana ER)
    • oxycodone (Oxycontin, Oxecta)
    • hydrocodone (Zohydro ER)
    • codeine
    • methadone
    • fentanyl

    Also concerning is that many of these medications (such as Lorcet, Tylenol with Codeine, Vicodin) may also contain acetaminophen (Tylenol) which in itself can be toxic to the liver at excessive doses. Codeine is also found in headache combinations such as Fioricet with Codeine.

    • Always store prescription narcotics safely in your home away from children, pets and teenagers. If needed, lock them up securely.
    • Most adults should not exceed 3,000 to 4,000 milligrams (3 to 4 grams) of acetaminophen over a 24-hour period.
    • All combination pain prescription products now only contain 325 mg acetaminophen per tablet (down from 500 mg per tablet).
    • Do not exceed the recommended 24 hour dose of acetaminophen (maximum of 4 grams) from all products (prescription and over-the-counter).
    • Drinking alcohol while you are taking acetaminophen may be toxic to your liver. Talk to your doctor.

    What Is Naloxone (Narcan)?

    A narcotic reversal agent called naloxone (Narcan, Evzio) can be a life-saving drug for patients who overdose on narcotics.

    All narcotic painkillers will produce various levels of central nervous system (CNS) depression like drowsiness and sedation. One of the most serious concerns with excessive opioid use is slowed breathing (respiratory depression). When narcotics are combined with other CNS depressants, like alcohol or benzodiazepines, severe, possibly fatal respiratory depression can occur.

    If you believe someone has overdosed on narcotics, call 911 immediately. Naloxone can be kept by family members or caregivers for administration in emergencies. It is available at most US pharmacies without a prescription. Be sure you learn how to use it before an emergency and discuss this with your healthcare provider, if needed.

    Popular Culture and Drug Use

    The use of illicit and prescription drugs is pervasive throughout pop culture. From music stars, to TV personalities, college and professional sports, to prime time television and blockbuster cinema — drug and alcohol use is frequently highlighted in the news. Youth are often the recipients of these disturbing forms of media.

    Television shows such as Jersey Shore, Breaking Bad, House, Narcos, and Weeds promote, highlight or glamorize the use of illicit or prescription drugs, marijuana and alcohol as the main topic. Sports figures, such as cyclist Lance Armstrong have been the center of controversial substance abuse investigations. Sean Penn conducted an interview with notorious Mexican drug lord El Chapo leading to a publication in Rolling Stone magazine. Musical pop stars are frequently involved in drug abuse scandals.

    Impressionable teens may find these messages about drug use and misuse confusing or alluring. Presenting drug use in popular culture and mainstream media may result in substance abuse imitation instead of rejection by today’s youth.12,13 According to to 2016 data from the US Health and Human Services, an estimated 3.6 percent of adolescents ages 12 to 17 reported misusing opioids over the past year.14 This number is double that for older adolescents and young adults ages 18 to 25, and the primary opioids being abuse are prescription drugs.

    Drug Testing for Narcotics

    Prescription and illicit opioids are a regular component of workplace drug testing in the U.S. Urine drug screening may also take place in the clinic during management of pain therapy.

    Physicians who manage pain may engage some patients in a treatment plan that includes urine drug screening to monitor their opiate management. These laboratory results can provide the doctor with objective data on which to make therapeutic and diagnostic decisions, identify misuse or diversion, and assess compliance. Doctors should describe the screening and frequency at the initial evaluation. Patients must be willing to participate in the screening to help manage their pain.

    Which drug test is used for workplace drug screening is dependent upon the private employer, federal requirements, or other workplace guidelines that may be in place. Patients should inform the lab of the prescription, over-the-counter, and herbal medications they currently take.

    Employers may use a standard five-panel test of commonly abused drugs such as marijuana (THC), cocaine, PCP, opiates (e.g., codeine, morphine, methadone) and amphetamines like methamphetamine. Employers may also elect to use a multi-drug panel test that also includes other prescription drugs, such as hydrocodone, oxycodone, hydromorphone, benzodiazepines, or barbiturates. They may also select to screen for alcohol in the sample. Other more recent drugs of abuse or designer drugs, such as MDMA (Ecstasy) may be included.

    Drug Detection Time in Urine

    Note: All times are approximate and may vary based on patient-specific drug metabolism, drug half-life, patient’s medical conditions, other drug treatments, and frequency of drug ingestion.15

    Drug Approximate Retention Time
    Amphetamines 48 hours
    Barbiturates Short acting, such as secobarbital: 24 hours
    Long acting, such as phenobarbital: up to 3 weeks
    Benzodiazepines Roughly 3 days if short-term dose
    Up to 6 weeks after 12 months or longer dosage
    Cocaine
    Metabolite
    2 to 4 days
    Ethanol (alcohol) 2 to 4 hours
    Methadone Up to 3 days
    Opiates Up to 3 days
    Cannabinoids Moderate smoker (3-4 times/week): 5 to 6 days
    Heavy smoker (smoking daily): 10 days
    Retention time for chronic smokers may be 20 to 28 days
    Phencyclidine Roughly 8 days
    Chronic use: up to 30 days

    Source: Helt H, Gourlay D. Philosophy of Urine Drug Testing in Pain Management. Prescribe Responsibly. 2015.

    • Tramadol – Top 8 Things You Need To Know
    • Top 11 Truths About Narcotic Painkiller Meds
    • Drug Testing FAQs
    • Prescription Drug Addiction: Top 18 Facts for You and Your Famly
    • Identify Your Painkiller: The Drugs.com Pill Identification Wizard

    See Also

    • Pain Management 101 – Types of Pain and Treatment Options

    Sources

    Further information

    Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

    Medical Disclaimer

    More News Resources

    • Health Guide
    • Care Notes
    • Medication List
    • Q & A

    26 Commonly Used Opioid Medications

    These products contain only opioids:

    Buprenorphine

    This drug is a long-acting opioid. Generic buprenorphine comes in a sublingual tablet, transdermal patch, and injectable solution. The generic and brand-name injectable solutions are only given by a healthcare provider.

    Examples of brand-name buprenorphine products include:

    • Belbuca, a buccal film
    • Probuphine, an intradermal implant
    • Butrans, a transdermal patch
    • Buprenex, an injectable solution

    Some forms are used for chronic pain that requires around-the-clock treatment. Other forms of buprenorphine are available to treat opioid dependence.

    Butorphanol

    Butorphanol is only available as a generic drug. It comes in a nasal spray. It’s an immediate-release product and typically used for acute pain. Butorphanol is also available in an injectable solution that must be given by a healthcare provider.

    Codeine sulfate

    Codeine sulfate is only available as a generic drug. It comes in an immediate-release oral tablet. Codeine sulfate isn’t commonly used for pain. When it is, it’s typically used for mild to moderate acute pain.

    Fentanyl

    Generic fentanyl comes in oral lozenges, extended-release transdermal patches, and an injectable solution that’s only given by a healthcare provider. Brand-name fentanyl products include:

    • Fentora, a buccal tablet
    • Actiq, an oral lozenge
    • Lazanda, a nasal spray
    • Abstral, a sublingual tablet
    • Subsys, a sublingual spray
    • Duragesic, an extended-release transdermal patch

    The transdermal patch is used for chronic pain in people who need around-the-clock treatment and who already regularly use opioid pain medications.

    The other products are used for breakthrough pain in people who already receive around-the-clock opioids for cancer pain.

    Hydrocodone bitartrate

    Hydrocodone bitartrate, as a single ingredient, is available as the following brand-name products:

    • Zohydro ER, an extended-release oral capsule
    • Hysingla ER, an extended-release oral tablet
    • Vantrela ER, an extended-release oral tablet

    It’s used for chronic pain in people who need around-the-clock treatment. However, it’s not commonly used.

    Hydromorphone

    Generic hydromorphone comes in an oral solution, oral tablet, extended-release oral tablet, and rectal suppository. It’s also available in an injectable solution given by a healthcare provider.

    Brand-name hydromorphone products include:

    • Dilaudid, an oral solution or oral tablet
    • Exalgo, an extended-release oral tablet

    The extended-release products are used for chronic pain in people who need around-the-clock treatment. The immediate-release products are used for both acute and chronic pain.

    Levorphanol tartrate

    Levorphanol is only available as a generic drug. It comes in an oral tablet. It’s typically used for moderate to severe acute pain.

    Meperidine hydrochloride

    This drug is typically used for moderate to severe acute pain. It’s available as a generic drug and as the brand-name drug Demerol. Generic versions are available in an oral solution or oral tablet. Both are also available in an injectable solution that’s given by a healthcare provider.

    Methadone hydrochloride

    Methadone hydrochloride is available as a generic drug and the brand-name drug Dolophine. It’s used for chronic pain in people who need around-the-clock treatment.

    The generic version is available in an oral tablet, oral solution, and oral suspension. It’s also available in an injectable solution given by a healthcare provider. Dolophine is only available in an oral tablet.

    Morphine sulfate

    Generic morphine sulfate is available in an extended-release oral capsule, oral solution, oral tablet, extended-release oral tablet, rectal suppository, and solution for injection.

    It also comes in an opium tincture, which is dried opium poppy latex containing morphine and codeine that’s mixed with alcohol. This form is used to reduce the number and frequency of bowel movements and can treat diarrhea in certain cases.

    Brand-name morphine sulfate products include:

    • Kadian, an extended-release oral capsule
    • Arymo ER, an extended-release oral tablet
    • MorphaBond, an extended-release oral tablet
    • MS Contin, an extended-release oral tablet
    • Astramorph PF, a solution for injection
    • Duramorph, a solution for injection
    • DepoDur, a suspension for injection

    The extended-release products are used for chronic pain in people who need around-the-clock treatment. Immediate-release products are used for acute and chronic pain. Injectable products are only given by a healthcare provider.

    Oxycodone

    Some forms of oxycodone are available as generic drugs. Some are only available as brand-name drugs. Generic oxycodone comes in an oral capsule, oral solution, oral tablet, and extended-release oral tablet.

    Brand-name versions include:

    • Oxaydo, an oral tablet
    • Roxicodone, an oral tablet
    • Oxycontin, an extended-release oral tablet
    • Xtampza, an extended-release oral capsule
    • Roxybond, an oral tablet

    The extended-release products are used for chronic pain in people who need around-the-clock treatment. The immediate-release products are used for acute and chronic pain.

    Oxymorphone

    Generic oxymorphone is available in an oral tablet and extended-release oral tablet. Brand-name oxymorphone is available as:

    • Opana, an oral tablet
    • Opana ER, an extended-release oral tablet or crush-resistant extended-release oral tablet

    The extended-release tablets are used for chronic pain in people who need around-the-clock treatment.

    However, in June 2017, the Food and Drug Administration requested that manufacturers of extended-release oxymorphone products discontinue these drugs. This was because they found that the benefit of taking this drug no longer outweighs the risk.

    The immediate-release tablets are still used for acute and chronic pain.

    Oxymorphone is also available in a form that’s injected into your body as the brand-name product Opana. It’s only given by a healthcare provider.

    Tapentadol

    Tapentadol is only available as the brand-name versions Nucynta and Nucynta ER. Nucynta is an oral tablet or oral solution used for both acute and chronic pain. Nucynta ER is an extended-release oral tablet used for chronic pain or severe pain caused by diabetic neuropathy (nerve damage) in people who need around-the-clock treatment.

    Tramadol

    Generic tramadol comes in an extended-release oral capsule, oral tablet, and extended-release oral tablet. Brand-name tramadol comes as:

    • Conzip, an extended-release oral capsule
    • EnovaRx, an external cream

    The oral tablet is typically used for moderate to moderately severe acute pain. Extended-release products are used for chronic pain in people who need around-the-clock treatment. The external cream is used for musculoskeletal pain.

    The Best Non-Narcotic Pain Meds For Addicts In Recovery

    August 3, 2018 | Adrian Blotner | Drug Information

    Pain is among the primary reasons why many people seek medication across the globe. With the on-going prescription opioid epidemic in the United States, it is imperative for public health to educate and inform what the potential options of non-opiate pain killers and medications are, especially for those suffering from addiction. Before getting into the options of non-opiate pain killers, we need to understand pain. Pain is a predisposing factor for disability and other problems and is classified into two categories; acute and chronic pain. Acute pain is defined as having an onset that is readily associated with an underlying cause, and whose resolution tends to be associated with the resolution of the underlying condition, lasting no more than 3 months. Chronic pain, however, is defined as pain that lasts at least 3 months, usually beyond the acute healing of the underlying condition, which often has underlying structural or physiologic abnormality that persists (i.e., arthritis, diabetic neuropathy or nerve pain). Unlike acute pain, chronic pain is not just a symptom – chronic pain is a disease unto itself that usually requires assessment and treatment if it is to improve. More than 100 million Americans suffer from chronic pain, publishes the NIH. The condition is treated as a disease and it affects optimal body function, the nervous system, and it generally makes life less enjoyable. In fact, according to a report by the Washington Post, around 25 percent to 75 percent of individuals suffering from chronic pain also experience depression, which means effects like insomnia, loss of appetite, anxiety, and fatigue are inevitable. Among the prescription drugs, people suffering from pain get include opioid medications. According to an independent report of self-reported data for Lakeview Health patients from September 2007 – March 2018, 45% of our patient population has suffered from back problems, many addicted to opioid pain medications. In 2017, Dr. Adrian Blotner developed our Pain Recovery Program, an integrative, multi-modal program designed specifically for patients in recovery from alcohol and substance use disorders who are also managing a chronic pain condition.

    Are Opioids More Effective Than Non-Opiate Pain Medication?

    There is a little evidence to show that long-term treatment with opiate (narcotic) pain medication is any more effective than treatment with non-opiate medications, especially when combined with non-medication treatments. So when considering treatment options for chronic pain, it’s important to know about the limited benefits of long-term opiate therapy, as well as the potential for serious adverse effects and withdrawal symptoms of opiates. In a study published by the Journal of the American Medical Association, it was found that all the groups depicted similar reduction levels of pain. This study sought to establish whether prescribed opioids are appropriate for the treatment of acute pain in four groups of participants with mild to severe pain. Three groups took opioids (either hydrocodone, codeine, or oxycodone) with 300 mg of acetaminophen, a non-opiate pain killer, and another group took 400 mg of the non-opioid pain killer, ibuprofen with 1000 mg of acetaminophen. Although the opioids group showed positive levels of pain relief, they were no better than non-opioid pain killers combined. In 2017, the opioid epidemic was a hot topic in the media and according to Google, the query, “What are opioids” is searched over 40,000 times in America. Education on alternative, non-opiate pain medications is imperative for public health.

    Non-Opiate Pain Killers Alternatives for Recovering Addicts

    Although opioids are normally prescribed for acute and chronic pain, the following non-narcotic pain meds are also effective for several kinds of pains, even those that seem to be perpetual.

    Non-steroidal anti-inflammatory drugs (NSAIDs)

    Non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve), are sold over the counter and are often the first choice for the treatment of acute pain. Prescribed NSAIDs include Meloxicam (Mobic), Celecoxib (Celebrex), and others. Despite their effectiveness in relief of chronic pain conditions such as headaches, osteoporosis, and rheumatoid arthritis, long-term use of these drugs may have serious side effects such as stomach discomfort, stomach ulcers, clotting abnormalities, and other serious systemic side effects.

    Acetaminophen

    Acetaminophen (Tylenol) is a non-opiate that is sold over the counter and used by itself or in combination with other medications used for pain relief. Patients with arthritis, headaches, and cancer-related pains find this drug very useful. Acetaminophen (Tylenol) has not been associated with stomach problems or bleeding problems. It has, however, been associated with liver toxicity when used in high dosages for ongoing chronic pain, especially when the person has other contributing factors for liver problems, such as regular alcohol use or Hepatitis C.

    Muscle Relaxants

    There are several non-habit-forming muscle relaxants that reduce muscle tension and spasm, which are the great “amplifiers” for many chronic pain conditions. Commonly used agents (from less strong to more strong) include Methocarbamol (Robaxin). Metaxalone (Skelaxin), Cyclobenzaprine (Flexeril) and Tizanidine (Zanaflex). The stronger agents have more risk of causing daytime drowsiness, so some people take them only at bedtime. Carisoprodol (Soma) is an old agent that is metabolized to Meprobamate (Equanil, or Miltown), which can be very addictive, so many prescribers today avoid prescribing this.

    Antiseizure and Anticonvulsant Medication

    There are several antiseizure or anticonvulsant medications that are effective for chronic pain, as well as chronic migraine headaches. Most people ask, “What do seizures, migraine headaches, and chronic pain all have in common?” They all happen because, somewhere in the brain or spinal cord, bundles of nerve cells are firing a lot faster than they should be. If that bundle of nerve cells is in the motor cortex – the part of the brain that controls muscle movement – then it results in a seizure. If the bundle of nerve cells is in a place called the trigeminal nerve nucleus, then the result is a migraine headache. And if the bundle of nerves is in the spinal cord, or a damaged nerve outside the spinal cord (such as diabetic neuropathy, or shingles), then the rapid firing causes a burning sensation, often with muscle pain, tension, or spasm. Gabapentin (Neurontin) and Pregabalin (Lyrica) are FDA approved for different types of chronic pain and fibromyalgia. Topiramate (Topamax) and Divalproex (Depakote) are FDA approved for a chronic migraine headache prevention.

    Antidepressants

    Several antidepressants are safe and effective for chronic pain, for those who are able to tolerate these medications without having side effects. They act on the nerves that are transmitting the pain because some of the same neurotransmitters, or brain hormones, that are in the depression pathways are also in the pain pathways in the brain and spinal cord. They are known as serotonin and norepinephrine reuptake inhibitors (SNRI) and are prescribed by many primary care physicians, as well as psychiatrists. The newest SNRI is Duloxetine (Cymbalta). It is approved by the FDA (U.S. Food & Drug Administration) for osteoarthritis and chronic back pain due to its pain relieving properties. It is also FDA approved for generalized anxiety disorder and clinical depression. Tricyclic antidepressants (TCA) have been shown to be effective for chronic pain since the early 1980’s. For most individuals, they also have other benefits, such as improving sleep, reducing anxiety, and improving mood. The more common agents in this category include Amitriptyline (Elavil), Imipramine (Tofranil), and Doxepin (Sinequan). TCA’s commonly cause dry mouth and at least a mild degree of constipation (which can be treated), but can also lower blood pressure and have the potential to cause heart rhythm problems, particularly in those who already have heart disease. The elderly can be particularly sensitive to these adverse effects. TCA’s are potentially lethal if taken in overdose. desipramine (Norpramin), and nortriptyline (Pamelor) are a few examples of TCAs. Usage of these drugs should be kept in check since they may have serious side effects on the elderly or some individuals. If started at a low dose and gradually increased antidepressants tend to have minor and transient side effects in most individuals. But some individuals experience serious emotional and behavioral side effects, including insomnia, restlessness, agitation, worsening of mood, and suicidal thoughts. As always: after starting a new medication notify your prescriber immediately if you feel worse in any way. Other types of antidepressants known to relieve pain include selective serotonin reuptake inhibitors (SSRI) However, there is not enough research to support this claim.

    Non-Medication treatments

    Non-medication treatments are usually effective for pain that is less severe, short term, and less chronic. They can also be effective when utilized along with non-habit forming medication. But the more severe the chronic pain, and the longer the duration of chronic pain, the more limited will be the benefit of non-medication treatments alone. Examples include:

    • Nutritional Supplements: A good multivitamin with minerals, as well as a Vitamin B Complex, are often helpful in the reduction of chronic pain and chronic headache conditions. It may also be helpful to speak with your healthcare provider to have your Vitamin D blood level checked, to see if there is a deficiency here. Nutritional deficiencies are rarely the sole cause of pain, but can often amplify pain and cause medications and other treatments to be less effective. Supplements such as glucosamine and chondroitin are also helpful for many who suffer from chronic joint pain.
    • Herbal treatments: Herbs are nature’s medications. They should be respected as having the potential for interactions with medications and side effects, in addition to their potential benefits. For most who suffer from chronic pain, their benefits are very limited due to the severity of the pain.
    • Physical therapy: This is an essential component of recovery from chronic pain that is due to problems with joints, bones, muscles, and intervertebral discs. It can also be very helpful with pain that is due to nerve damage. Think of physical therapy not just as “treatment,” but also as “education.” Understanding physical activities that will reduce your pain and improve your functioning is essential to adjust your lifestyle. It is equally important to recognize activity that will damage your body and cause a setback.
    • Acupuncture: This technique involves placing needles at specific pressure points to improve the micro-circulation, impacting the functioning of peripheral nerves, sometimes having an impact on the functioning of spinal nerves. The Chinese believe it enhances a positive flow of energy referred to as chi.
    • Chiropractic support: this is a form of physical technique that entails the manipulation of one’s body for relief. It can only be done by a professional.
    • Massage therapy: They facilitate relaxation, get rid of tension, stress, and many types of pain.
    • Yoga: It is a meditative technique believe to work wonders. One learns to have control of breathing resulting in alleviated pain. It is often incorporated with another technique referred to as mindful meditation that allows an individual to become fully aware of their body, which helps in relieving pain.
    • Cognitive & Behavioral techniques: Learning techniques that reduce the impact of stress on your mind and body can be very effective and reducing the great amplifier of chronic pain. Most people are aware that stress causes the severity of their pain to get worse, and that the physical limitations that are caused by their chronic pain are a great cause of stress in their lives. Fortunately, there are techniques that a person can learn to interrupt this cycle, reducing the amplifying effect of stress on chronic physical pain, as well as insomnia & emotional suffering – anxiety, irritability, and loss of pleasure and motivation for one’s usual activities. These techniques involve learning new thought patterns and behaviors that can reverse the cycle of stress & chronic pain, to enhance relaxation, quality of sleep, and improve one’s ability to do the things that are sources of pleasure & fulfillment.

    Physical exercise and behavioral therapy are both effective in treating chronic pain. These treatment methods are also known as complementary and alternative medicine (CAM). The journal Practical Pain Management says that these alternative methods significantly improve one’s quality of life. Most often, these forms of treatment are used with other techniques in an effort to find what works best. They are not universal and may not work for everyone. If you want to get results that are better than what you’ve accomplished before, it is important to be willing to consider trying treatment methods and techniques that you have not tried before, with the guidance of your treatment providers. Speak with your primary care physician to discuss those treatment options that are most likely to be safe and effective for your particular conditions.

    Benefits of Non-Opiate Pain Killers

    Due to the potential for physical, emotional, and behavioral side effects, including addiction, the risk of overdose, and adverse effects on physical and social functioning, including relationships with friends and loved ones. Long-term opioid treatment should be a treatment of last resort. Benefits tend to gradually decrease and side effects tend to gradually increase as the months and years go by. If a treatment trial with long-term opiates is to be undertaken, it should be very closely monitored by a qualified and experienced prescriber. In the long term, non-opiate treatments tend to be more effective as well as safer.

    Are You Suffering From Opioid Addiction?

    If you or a loved one is suffering from an opioid addiction or a physical dependence to pain meds, it’s important to seek addiction treatment. At Lakeview Health, we will address it properly with a medically monitored detox or other treatment options, depending on the level of substance use disorder treatment you need.

    Plantar Fasciitis: Exercises to Relieve Pain

    How to do exercises for plantar fasciitis

    • Warming up before and stretching after sports or exercise may make your plantar fascia more flexible and may decrease the chance of injury and inflammation.
    • You may want to take a pain reliever such as a nonsteroidal anti-inflammatory drug (NSAID), including ibuprofen or naproxen, to relieve inflammation and pain. Some people take NSAIDs at least 30 minutes before doing recommended exercise, to relieve pain and allow them to do and enjoy the exercise. Other people take NSAIDs after they exercise. Be safe with medicines. Read and follow all instructions on the label.
    • After you exercise, ice your heel to help relieve pain and inflammation.

    Stretching exercises before getting out of bed

    Many people with plantar fasciitis have intense heel pain in the morning, when they take their first steps after getting out of bed. This pain comes from the tightening of the plantar fascia that occurs during sleep. Stretching or massaging the plantar fascia before standing up can often reduce heel pain.

    • Stretch your foot by flexing it up and down 10 times before standing.
    • Do toe stretches to stretch the plantar fascia.
    • Use a towel to stretch the bottom of your foot (towel stretch).

    Other steps can help reduce heel pain when you take your first steps after getting out of bed. You can:

    • Wear a night splint while you sleep. Night splints hold the ankle and foot in a position that keeps the Achilles tendon and plantar fascia slightly stretched.
    • Massage the bottom of your foot across the width of the plantar fascia before getting out of bed.
    • Always wear shoes when you get out of bed, even if it is just to go to the bathroom. Quality sandals, athletic shoes, or any other comfortable shoes with good arch supports will work.

    Stretching exercises should create a pulling feeling. They should not cause pain. Ask your physical therapist or doctor which exercises will work best for you.

    Exercises to do each day

    Stretching and strengthening exercises will help reduce plantar fasciitis.

    It’s best to do each exercise 2 or 3 times a day, but you do not need to do them all at once.footnote 1

    • Use a rolling pin or tennis ball. While seated, roll the rolling pin or ball with the arch of your foot. If you are able to, progress to doing this exercise while you are standing up.
      • Toe stretch
      • Towel stretch
      • Calf stretch
      • Plantar fascia and calf stretch
      • Towel curls for strengthening
      • Marble pickups for strengthening

    Naproxen vs ibuprofen: What’s the difference?

    Ibuprofen is short acting, while naproxen is long acting and more likely to cause an upset stomach.

    Naproxen and ibuprofen are both NSAIDs so they are similar in many ways, but there are important differences.

    Effectiveness of Naproxen And Ibuprofen Similar

    Naproxen and ibuprofen are called nonselective NSAIDs because they block COX-2 enzymes (involved in pain signalling and inflammation) and also COX-1 enzymes (associated with a protective effect on stomach lining). This makes them effective at relieving pain and reducing inflammation, but there is a risk of stomach-related side effects. As far as effectiveness goes, a dose of 440mg naproxen is approximately equivalent to a dose of 400mg ibuprofen.

    Naproxen is Long Acting and Ibuprofen is Short Acting

    One of the most important differences is the length of time they act for. Ibuprofen is considered a short-acting NSAID, with a relatively quick onset of action. It is better suited for the treatment of acute pain and is the most appropriate NSAID for children. Ibuprofen tablets or capsules (such as Advil, Motrin) need to be given every four to six hours. Naproxen is considered long-acting, and can be given twice daily. It has a slower onset of effect and is better suited for the treatment of chronic conditions.

    Naproxen is More Likely to Cause Gastrointestinal Side Effects Because it is Long Acting

    Research has discovered that the risk of gastrointestinal (GI) side effects such as stomach ulcers and stomach bleeding increases the longer somebody takes NSAIDS. Naproxen is more likely than ibuprofen to cause GI side effects because it is longer acting. To reduce the risk of GI side effects, NSAIDS should only be taken at their lowest effective dose, for the shortest possible time. Doubling up on NSAIDs (for example taking naproxen and ibuprofen at the same time) is unnecessary, and to be avoided as it increases the risk of both GI and cardiovascular side effects. If you are prescribed low-dose aspirin to reduce your risk of a heart attack or stroke, then talk to your doctor BEFORE taking NSAIDs, as these may negate the protective effects of aspirin.

    NSAIDs Increase the Risk Of Cardiovascular Side Effects

    Another worrying side effect of some NSAIDs is an increased risk of cardiovascular events such as a heart attack. Research has identified that those NSAIDs that have more of a tendency to block COX-2 compared to COX-1 have an increased risk of thrombosis (blood clotting). Naproxen (at dosages up to 1000mg per day) does not appear to be associated with an increased risk of detrimental vascular events, and experts tend to prefer naproxen for this reason. Low-dose ibuprofen (dosages up to 1200mg per day) is considered an alternative to naproxen; however, higher dosages of ibuprofen (up to the recommended maximum of 2400mg/day) are associated with a higher risk of cardiovascular events. People who have already had a heart attack or stroke must use NSAIDs with caution. One study showed that even one or two doses of ibuprofen or diclofenac (another NSAID) increased the risk of another event. During the 14 weeks of the study, naproxen did not appear to increase this risk. However, NSAIDS should not be used after coronary artery bypass graft (CABG) surgery and all NSAIDS carry a warning that they can increase the risk of cardiovascular events, so should only be used under a doctor’s supervision, particularly in people with a history of heart disease. Reassuringly, the risk of a cardiovascular event such as a heart attack, stroke, or death is extremely small when NSAIDs are prescribed for short periods of time – such as for a musculoskeletal injury – in people at low cardiovascular risk.

    Other Side Effects Common to all NSAIDs

    All NSAIDs have been associated with kidney toxicity and allergic-type reactions. NSAIDs also interact with other medications including angiotensin converting enzyme (ACE) inhibitors, angiotensin-II receptor blockers (ARBs), diuretics, clopidogrel, warfarin, dabigatran, and aspirin.

    In summary, naproxen (in dosages up to 1000mg/day) or low-dose ibuprofen (in dosages up to 1200mg/day) are preferred if NSAIDs are deemed necessary in adults. At these dosages, risk of cardiovascular events in people with no pre-existing risk factors is low, although risk of GI side-effects may be higher with naproxen.

    Important Guidance

    When taking any NSAID, the following guidance is given:

    • Acetaminophen is preferred over NSAIDs, when appropriate
    • If a NSAID is deemed necessary, take only the lowest possible dose for the shortest possible time
    • Naproxen (in dosages up to 1000mg/day) and ibuprofen (in dosages up to 1200mg/day) are the preferred NSAIDs. Ibuprofen is the most appropriate NSAID for children
    • Avoid using long-acting formulations of NSAIDs as these have a higher risk of GI side effects
    • Do not take any other NSAID-containing products while being treated with a NSAID
    • Doctors should review the need for continued NSAID administration at each consultation
    • In people with pre-existing heart disease or who have suffered a heart attack or stroke, NSAIDS should only be used with caution and only under a doctor’s supervision
    • Older patients, patients with type 2 diabetes or with a history of stomach ulcers, kidney problems or at risk for heart disease are more likely to suffer from NSAID-related complications such as GI side effects, cardiovascular events, and kidney toxicity. NSAIDS should be avoided, but if deemed necessary, their usage should be monitored by a doctor.

    Ibuprofen May Not Be As Safe As You Think

    Over-the-counter and prescription drugs that control inflammation, like Advil, Aleve and Motrin, are among the most popular drugs people take. Without a prescription, they can relieve short-term pain from backaches and headaches, and at higher doses can reduce the inflammation behind chronic conditions like osteoarthritis or rheumatoid arthritis. But recent studies have questioned their safety, enough so that in 2015, the Food and Drug Administration (FDA) strengthened warnings on the drugs’ labels about their risk of heart attack and stroke.

    But most concerning were the heart risks linked to a new class of these so-called nonsteroidal anti-inflammatory drugs (NSAIDs), the COX-2 inhibitors. These drugs were supposed to be kinder to the stomach and intestines, since NSAIDS typically activated chemicals that compromised the protective lining of these organs, leading to bleeding and pain. It turned out that the benefit for the intestines, however, came at a price to the heart. Two of the COX-2 inhibitors were removed from the market because studies showed they were linked to higher risk of heart attack and stroke.

    That left one—celecoxib, or Celebrex—on the market, but the heart concerns led the FDA to require its maker, Pfizer, to pay for additional studies to ensure that celecoxib did not put people at increased risk of heart trouble. Now the results of the study show that contrary to what doctors and regulators expected, celecoxib does not lead to any higher rates of heart events than ibuprofen or naproxen. In fact, celecoxib may even cause fewer kidney problems than the other two NSAIDs.

    Get our Health Newsletter. Sign up to receive the latest health and science news, plus answers to wellness questions and expert tips.

    Thank you!

    For your security, we’ve sent a confirmation email to the address you entered. Click the link to confirm your subscription and begin receiving our newsletters. If you don’t get the confirmation within 10 minutes, please check your spam folder.

    “I would never have guessed these results,” says the study’s lead author, Dr. Steven Nissen, chair of cardiovascular medicine at the Cleveland Clinic. “The whole world has been saying for a decade now that if you must take an NSAID, you probably ought take naproxen because it’s the safest. We just don’t see that in these results. In almost every measure, ibuprofen looks worse, naproxen is intermediate and celecoxib is the best.”

    The study, which is published in the New England Journal of Medicine and which Nissen will present at the American Heart Association annual meeting in New Orleans, involved more than 24,000 people with heart problems who needed to take an NSAID to treat conditions like arthritis and rheumatoid arthritis. They were randomly assigned to take one of the three drugs for nearly two years and followed for another three years for heart attacks, stroke or death. The people assigned to celecoxib did not show any higher rates of these events than those taking ibuprofen or naproxen. When Nissen and his team looked at kidney problems, they found lower risk among those taking celecoxib than among people taking ibuprofen.

    “These results negate the preconceived notion—the present thinking—that COX-2 inhibitors are associated with increased heart risk,” says Dr. Nitin Damle, president of the American College of Physicians. “I think people may be more willing to start COX-2 inhibitors a little earlier because they see that heart risk is not increased.”

    The previous concerns about COX-2 inhibitors and heart problems led many internists to prescribe NSAIDs like ibuprofen and naproxen as their first-choice therapies for people with osteoarthritis and rheumatoid arthritis, he says. They would only turn to celecoxib if people had stomach issues. Now that may change.

    For people who take NSAIDs only occasionally, however, and for short periods of time, the findings shouldn’t make them worry that they’re putting their heart at risk. The study did not include healthy people who didn’t have a history of heart problems, and short-term use is not likely to have the same effect as longer term use typical of patients in chronic pain.

    Nissen also notes that nearly 70% of the participants in the study stopped taking their assigned medication; that’s typical in a study of chronic pain in which people get frustrated when their symptoms aren’t relieved and switch from treatment to treatment. But the proportion who stopped their treatment in each group was about the same, meaning that the results were unlikely to have been drastically different if they had continued.

    The study also doesn’t address people who take higher doses of any of the drugs; the people were assigned standard doses of 100mg celecoxib twice a day, 600mg ibuprofen three times a day, and naproxen 375mg twice a day.

    Whether the findings will now push celecoxib to the front line of treatment for chronic pain conditions isn’t clear yet. Insurance companies cover ibuprofen and naproxen as first line treatments because studies show they are more effective in treating pain symptoms. The current study doesn’t address celecoxib’s efficacy compared to the other drugs, but does show that it’s as safe as they are for the heart.

    That means that people who need to take anti inflammatory pain relievers for longer periods of time should consider celecoxib as a viable option, since it doesn’t increase risk of heart problems and may even lower risk of kidney issues. “I think this study really does change the impression we have that COX-2 inhibitors have increased heart risk,” says Damle. “Now it looks like they have similar risk than other non steroidals such as ibuprofen or naproxen.” For those who only take NSAIDs occasionally, the results shouldn’t deter them from seeking relief from the medications.

    Most Popular on TIME

    Contact us at [email protected]

    About the author

    Leave a Reply

    Your email address will not be published. Required fields are marked *