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What’s the best medication for acute pain?


There are two types of pain: acute and chronic. The general definition of acute pain is a sharp pain that last a few days. Chronic pain is considered less sharp and lasts a long time. There are many pain medications and some work better than others.


Opioids are in the news a lot these days because they have been promoted a lot for acute and chronic pain but they are very addictive. Generally speaking dentists are trying to reduce the prescribing of opioids. Most dental pain is acute. A toothache can be extremely painful and once treated the pain can be resolved in a couple of days. Dental surgery can be very painful afterwards but again will calm down after a few days.


So what is the best pain medication for this acute pain? Opioids are very effective but they work on the pain centre of the brain so that you are not as aware of the pain. But they are addictive , they can make you drowsy and should not be used if you will be driving or doing something that requires a lot of concentration. But an important part of acute pain is the inflammation that drives the pain. Opioids don’t do anything about the inflammation so they don’t affect the source of the pain.


Nowadays we have many anti-inflammatory pain medications. The most popular ones are acetaminophen (the popular one is Tylenol) and ibuprofen (like Advil and Motrin). Their anti-inflammatory effects make them reasonably good pain pills. There is a significant difference between these two types of pain pills. Acetaminophen is broken down by the body in the liver while ibuprofen is broken down in the kidneys. That’s why people with liver disease should not use acetaminophen. That’s also why you shouldn’t drink any alcohol while taking acetaminophen.


Ibuprofen should not be taken if one has any kidney disease but it should also be avoided by people with asthma as it can make that condition worse and it can also increase bleeding for those on blood thinners or in those that have ulcers. In reality most people in the population can take these medications.


Researchers in England took these medications a step further. They tried combining acetaminophen and ibuprofen. They found that this combination was as effective as opioids in many cases. Now, in England and Australia, you can buy Maxigesic which is simply acetaminophen and ibuprofen combined. Recently a similar medication called Combogesic was approved by Health Canada so that Canadians now have this drug combination available. It has 325 mg. of acetaminophen and 97.5 mg. of ibuprofen. For significant pain I would recommend 3 tablets every 6 hours on the clock for 3 days maximum. That would give you 975 mg. of acetaminophen plus 292.5 mg. of ibuprofen. If pain relief is needed for more than 3 days it should be scaled back to every 8 hours.

It is very important to take the medication “on the clock” because it keeps the anti-inflammatory effect level.


You will see more and more of this pain medication combination recommended as we try to get away from the use of narcotics.