If Over-the-Counter Meds Are Prolonging Pain, What Does This Mean for Workers’ Comp?

Is it time to change our relationship to NSAIDs, like Advil? What are the alternatives?
By: | January 10, 2023

After an ankle sprain or back injury, most people riffle through their desk drawers or purses in search of a bottle of ibuprofen or aspirin.

The common family of pain relievers known as NSAIDs (nonsteroidal anti-inflammatory drugs) is used to treat everything from headaches and muscle pain to fevers and elevation sickness.

They’re as common in everyday life as they are in workers’ compensation, where they’re often used as first-line pain management. Prescription-strength NSAIDs like celecoxib and diclofenac are often used when a stronger pain reliever is needed, and some doctors consider them a crucial alternative to opioids.

But a new study published in Science Translational Medicine may give people pause before they reach for these over-the-counter medications.

Researchers found that patients with acute low backaches who used NSAIDs as an early pain treatment were at elevated risk of developing persistent and even chronic pain.

Don’t Throw Away That Advil Just Yet

The study examined 98 participants with acute low back pain over a three-month period. It found that early use of NSAIDs could prolong pain for up to 10 times longer than initially expected.

“On the surface, it makes sense that if you’re masking the inflammatory response, you’re going to blunt the recovery process,” said Dr. Gerry Stanley, senior vice president and chief medical officer, Harvard MedTech.

The research is still new, however. More studies are needed to confirm these results and to determine the extent to which NSAID use could affect the development of chronic pain. Nikki Wilson, senior director, clinical pharmacy services, Enlyte, agreed with Stanley that it’s okay for patients to continue using NSAIDs to treat pain, especially when it’s recommended by doctors and pharmacists.

“Sound evidence points to those medications as safe and effective for first-line options for the treatment of pain,” Wilson said. “For the majority of patients, we would not recommend they avoid the use of NSAIDs just based on the study’s findings, but it’s something for the patients to be aware of and consider.”

“For some patients, I think NSAIDs absolutely make sense as the initial therapy,” Stanley added. “We need to do further studies to really dive deeper into this.”

It’s important to recognize that NSAIDs were never the benign, side-effect-free treatment many people see them as. Stomach ulcers, kidney and liver problems and heart and circulation issues can all be side effects of NSAID use.

Drug-Free Pain Solutions

Though it doesn’t yet make sense for patients to avoid NSAIDs, many in workers’ comp are already turning to drug-free solutions to manage pain.

“I think it’s always important to consider nonpharmacologic treatments first,” Wilson said. “Things like hot-cold therapy, stretching, massage, mindfulness, cognitive behavioral therapy, distraction therapy, exercise, acupuncture, spinal manipulation, chiropractic care, physical therapy, and even things like diet, nutrition and sleep can impact pain response.”

The effects of the opioid epidemic are one reason why the industry has shifted toward drug-free pain management alternatives. Opioid use in workers’ comp declined 10.2% between 2020 and 2021, per Enlyte’s Pharmacy Solutions Drug Trends Report.

“We don’t need to think of [opioids] as a forever drug,” Stanley said. “I think we’re on the right path.”

Stanley has seen firsthand how effective drug-free pain management solutions can be. His company, Harvard MedTech, uses virtual reality treatments to help patients manage pain, trauma and other conditions.

“The human body has a natural tendency to want to heal itself,” Stanley said. “A lot of what we do is very much focused on engaging the brain to allow the body and the brain to align in order to heal themselves.”

One former restaurant industry worker has found success using these treatments to manage his chronic back pain after several surgeries. The worker was getting ready to undergo a third spinal surgery, and he was struggling with the emotional toll his pain was causing him. He began to feel depressed and disconnected from his family and his community. He was in so much pain that his young son would kiss the scar on his back every day in the hopes of helping his father heal.

When he started to undergo the virtual reality treatments offered by Harvard MedTech, he learned to refocus his attention. Rather than fixating on his pain, he learned to reengage with his family and friends.

“He said, ‘My pain went from something that I fixated on all day, every day, to something that became a white noise in my background, because suddenly I was going back out with my friends, I was reconnecting with my wife, I was becoming the father to my two young children that I always wanted to be,’ ” Stanley said.

When drugs are needed, doctors and pharmacists are now relying more on safer alternatives for treating pain. Enlyte’s drug trend report found that NSAIDs, muscle relaxants, topicals, steroids and anti-infectives are all being used more frequently during the first two years of a claim.

Wilson finds the shift toward topicals in particular encouraging: “One of the big things that we’ve seen is a shift towards the use of topical medications,” she said. “They have less chance for side effects, in theory, because they’re really acting locally at the site of application.” &

Courtney DuChene is a freelance journalist based in Philadelphia. She can be reached at [email protected].

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