What are good back pain management options now that propxyphene has been taken off the market? The FDA recently prompted Xanodyne into taking the medication off the market. Darvon and Darvocet were the brand names for propoxyphene. The medication was a very good narcotic in the lower strength category, but eventually became associated with cardiac toxicity.
Without Darvocet there is a need for alternative pain medications in this lower strength category. One very good alternative is good old acetaminophen, which in and of itself can be great for musculoskeletal, arthritis, and postoperative pain. Recommended doses should not be exceeded, especially if the person drinks a lot of alcohol. If this is exceeded, there is risk of injury to the liver. The typical maximum dose each day is 4 grams.
Nonsteroidals include nonselective types like ibuprofen and naproxen, and the more selective COX-2 inhibitors like celecoxib. NSAIDS have shown excellent effectiveness for musculoskeletal pain.
Interestingly, patients are unique with some responding great to ibuprofen, while others may need to be switched to naproxen or another alternative. The FDA recommends that the lowest effective dose should be used for the shortest time frame. They should be avoided in patients with congestive heart failure or ischemic heart disease. In patients with a history of a previous gastrointestinal event that are taking NSAIDs, therapy with a proton pump inhibitor should be included.
Along with acetaminophen and NSAIDs, another analgesic available is tramadol, which is a non-narcotic medication that acts centrally and has been shown in the past to be equal to propoxyphene. There is a newer medication called tapentadol which acts similarly to tramadol with mu-opioid agonist activity and inhibition of norepinephrine reupatake.
Looking at narcotics at the lower end of the strength scale, codeine or hydrocodone are effective for handling short term treatment. Long term use should be avoided due to potential addiction and side effects.
Topical agents may assist with localized painful areas like capsaicin cream or lidocaine patches. These can be very helpful in combination with oral medications.
Without Darvocet there is a need for alternative pain medications in this lower strength category. One very good alternative is good old acetaminophen, which in and of itself can be great for musculoskeletal, arthritis, and postoperative pain. Recommended doses should not be exceeded, especially if the person drinks a lot of alcohol. If this is exceeded, there is risk of injury to the liver. The typical maximum dose each day is 4 grams.
Nonsteroidals include nonselective types like ibuprofen and naproxen, and the more selective COX-2 inhibitors like celecoxib. NSAIDS have shown excellent effectiveness for musculoskeletal pain.
Interestingly, patients are unique with some responding great to ibuprofen, while others may need to be switched to naproxen or another alternative. The FDA recommends that the lowest effective dose should be used for the shortest time frame. They should be avoided in patients with congestive heart failure or ischemic heart disease. In patients with a history of a previous gastrointestinal event that are taking NSAIDs, therapy with a proton pump inhibitor should be included.
Along with acetaminophen and NSAIDs, another analgesic available is tramadol, which is a non-narcotic medication that acts centrally and has been shown in the past to be equal to propoxyphene. There is a newer medication called tapentadol which acts similarly to tramadol with mu-opioid agonist activity and inhibition of norepinephrine reupatake.
Looking at narcotics at the lower end of the strength scale, codeine or hydrocodone are effective for handling short term treatment. Long term use should be avoided due to potential addiction and side effects.
Topical agents may assist with localized painful areas like capsaicin cream or lidocaine patches. These can be very helpful in combination with oral medications.
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