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Pain Management/pain medication and duration post car accident

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Question
Hello,

I was in a serious car accident last Thursday (12/11). I was taken to the trauma unit and an assortment of tests revealed that nothing was broken, fortunately. I was warned in advance that the pain would get worse before it got better, and it definitely did that. I'm currently prescribed 5 mg percoset and/or OTC painkillers as needed. Right now, the sore areas are still my legs, chest, and back, particularly in the morning when I'm waking up/getting out of bed.

I have two main questions - 1) approximately how long should I expect that pain will last to the degree that I need pain meds? These days, I'm mostly getting by on OTC pain meds (I'll take the percoset when I wake up, since that's when the pain is the worst, but I've taken ibuprofen thereafter), but it's still pretty chronic. 2) what OTC pain medication is the most appropriate to use? I've been taking ibuprofen b/c it's what I had, but I wasn't sure if tylenol would be better for any reason and I'm about to buy a new OTC bottle.

Thanks!

Answer
Hi Amy,
First let me apologize for the long delay in answering. I usually am much more professional than that. I had a situation with my 15 year old where he took an overdose of a cold medicine (nothing dangerous), but we had to call Poison Control and seek emergency help. These things happen. Pray for me that we'll get through these teen years!!!!! Anyway, I am so sorry that you were waiting on my reply.

I am so happy that there was nothing fractured. Unfortunately, you could expect moderate lingering pain for perhaps up to two weeks, because the soft tissues including the muscles respond by swelling up and producing pain; that's normal. Just don't try to lie around a lot after the first week. Try to move around and STRETCH as much as possible. This will send the message to your muscles that nothing is fractured and you will be OK. Remember, the body works as a unit, and the muscles and soft tissues are trying to "protect" your skeletal system, (bones). Tell them whose in charge! The moderate to severe pain shouldn't last more than 2 weeks, but you will still have stiffness for up to a month.

As far as the pain meds, I have found through experience that ibuprofen and the NSAIDS work much better on this type of pain since they are primarily anti-inflammatories. They seek out the inflamed areas in your body, whether in the mouth or the limbs, and they really do relieve the CAUSE of the pain. I have found that ibuprofen works better than Vicodin when I have had tooth problems, even though the dentist or doctor always gives me a few narcotics to use at night. I have had a broken arm in the last two years, and the pain was unbelievable, (probably because I'm in my 50s)! But, once I started taking ibuprofen or Naproxen I found the pain was actually better than when I took the narcotics!

Yes, narotics such as Percocet have their place. With an accident like yours you certainly needed them. I think you should continue them. And, yes- most of the pain you feel is in your torso- the back, rib cage and chest, because these are the areas that "flare up" the most when someone is injured, because, as I said above, your body is trying to protect itself by showing you that something is wrong by sending pain signals.

I can imagine that morning are especially hard.

Now that I've answered the question as to "how long", I'll answer the type of meds you should take. I would suggest, as most MDs will, that ibuprofen is the drug of choice. Be sure to take at least 600 mg of it. That is much more than the BOX says; in fact, an MD will often prescribe up to 800 mg of ibuprofen. So, if you are an adult that is not too much...take it from me. I always give my husband and adult family members at least 600, and usually 800 mg (usually 4 of the over-the-counter pills). As a nurse I probably shouldn't tell you that, but your doctor should have. It is a prescription-strength dose, but perfectly safe as long as you don't do it FOR LONG PERIODS. In fact, ibuprofen, naproxen and the other NSAIDS are not to be taken for longer than a few weeks due to the fact that they're hard on the stomach. You can even check with the doctor to be sure, or if not available, check with a good trusted Registered Pharmacist. They know more about medicines than MDs anyway, in my opinion.

I don't know how much Percocet the doctor gave you. They have to be careful since Federal laws have cracked down upon them. It is reasonable for you to ask your dr for a refill. He/she may even put you on Vicodin or Lortabs which is slightly weaker, but still a narcotic. Both of these must be written Rx's because they are Schedule II drugs. Can't be called in. Just tell them about the continued soreness and pain; add the fact that you are stretching and trying to get your muscle pain under control, (that will impress them), plus be sure to tell them you are taking ibuprofen or one of the anti-inflammatories regularly during the day. IF by chance they choose not to refill or renew the narcotic prescription, there's not much you can do. It happens all the time. If you were seen in the ER then your regular primary care doctor would be the one to renew the narcotic- ER doctors do not refill anything. Your xrays can always be transferred from the ER to your doctor's office by computer, so they'll have documentation that you were actually injured. Just be honest- tell them the pain is much worse in the a.m., and in order to start your day and get out of bed the Percocet helps with that. Have your returned to work? Then tell them you can't work if you are in so much pain.

To answer the question about which OTC meds you can take, I think I covered the anti-inflammatories pretty well. It is perfectly alright to take Tylenol (acetaminophen) with ibuprofen, or you could alternate it, since they are both entirely different types of drugs and they do not interact. The usual schedule for anti-inflammatories is every SIX (6) hours, while the dose for acetaminophen is every 3-4, so you could take Tylenol in between- UNLESS you get a refill on the Percocet or even Vicodin, because they both contain acetaminophen, and in recent years we've learned that acetaminophen (Tylenol) is toxic to the liver in excessive amounts. Your dr should have told you that, too.

If you do not get a renewal on the narcotics then you can try (in addition to ibuprofen or acetaminophen) a topical cream such as Aspercreme. Believe it or not, they really work. I never believed in them until I learned the hard way when I continued having arm pain and the orthopedist finally stopped refilling my Vicodin. Contrary to the name, Aspercreme does NOT contain aspirin, and can be used in conjunction with the other OTCs I've mentioned. However, if you are terribly allergic to aspirin, Aspercreme does contain salicylate, which is PART of what is in aspirin. What I like about it is that is is greaseless and has NO ODOR!!!! Yes, it really does work, believe me. In fact, if you go online to certain sites you can download a coupon for it.

So, keep in mind that ER physicians are not usually allowed to renew any kind of prescription; you have to get that from your primary MD. It is easy to get them to transfer xrays and records, though, electronically. You can tell the nurse when you call them what I've outlined above. And, please don't allow yourself to continue getting stiff and sore by just lying around. Even though you do not feel up to it please try moving around more, stretching will help tremendously.

I do hope I've helped you, even though I realize it has been almost a week since you sent me your note. I simply did not have the time or presence of mind to help any of my AllExpert patients due to the occurrences with my son. I should have put myself on vacation, but I have several patients who are in bad situations right now, and if they wrote in their emails wouldn't even reach me. That includes you, with your recent accident. I always read my emails; it is just that I had an emergency here at home I had to attend to. I am hoping you understand.

Please write back, even briefly, and let me know what happens. And, let's be grateful and thankful that you had no fractures, because that would have meant months and months of pain and recovery, even possible surgery.

Again, my sincerest apologies for not answering you in a timely manner. I thank you in advance for understanding the extenuating circumstances; these things don't happen every day...THANK GOD!

Below is a site to visit for info on Aspercreme; just apply it to the areas that hurt the most. I am hoping your doctor will give you a small amount of a narcotic that will help you start your day. If you feel any gastric or stomach burning or upset from ibuprofen or the other NSAIDS make sure you tell them. And, please let me know how things work out for you. Below is the website.

CLICK OR GO HERE: http://www.drugs.com/sfx/aspercreme-cream-side-effects.html

Pain Management

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Patricia M

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I welcome questions from people who may want a "nurse's perspective" on the subject of chronic pain and pain management. I am a nurse, NOT a physician (MD).I can answer questions on medications, alternative approaches, and the various organs and body systems. There are many avenues to explore with chronic pain. I am against seeing patients suffer simply because healthcare professionals might suspect they are "drug seekers". There are methods of identifying true pain, and this makes patients feel as if they are taken seriously, which they should be.

Experience

Over 25 years working experience in Internal Medicine, Adult Cardiology, Post-Surgery care, Cancer, psychiatry and some experience as a lay-counselor in addictive medicine (dependence to alcohol and/or drugs, both legal and illegal drugs).

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I am an Expert with AllExperts in several areas: Pharmacy, Internal Medicine, Medical Errors. Feel free to check my Q&A history as well as my ratings, which are very high.

Education/Credentials
Diploma from hospital-based nursing school. Additional courses in pharmacology. I keep current in continuing education. Am currently working as lay-counselor which can lead to my certification as Substance Abuse Counselor.

Awards and Honors
Dean's List while in college.

Past/Present Clients
Internal medicine patients, cardiology patients recovering from heart disease and/or open-heart surgery, cancer, as well as recently working as a lay-counselor to individuals dealing with addiction to drugs and/or alcohol. NOTE: Just because I attempt to help patients with addictive diseases, I have over 25 years in Internal Medicine, have nursed patients with great deal of pain, and I am compassionate. I never label anyone as a "drug seeker". I have seen that done for years, and am against it. All patients should be evaluated for pain in a fair and comprehensive manner. Am an Expert with AllExperts in three other medical categories; feel free to check my ratings, which are high.

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