Scaphoid Injury Medication

Updated: Sep 11, 2019
  • Author: Scott R Laker, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
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Medication

Medication Summary

Drugs used for pain management include analgesics. The agents used for mild to moderate pain, such as aspirin, acetaminophen, and nonsteroidal anti-inflammatory drugs (NSAIDs), are nonopioids. These agents usually suffice; if they do not, however, the clinician can prescribe opiate agonists, such as codeine or propoxyphene.

Related Medscape resources:

CME/CE Acute Pain Management: Overcoming Barriers and Enhancing Treatment

Resource CenterPharmacologic Management of Pain

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Analgesics

Class Summary

Effective management of pain is essential to quality patient care. Pain management improves the patient's quality of life, as well as his/her ability to work productively and to participate in self-care and physical therapy activities.

Acetaminophen (Tylenol, Panadol, Tempra)

Effective in relieving mild to moderate acute pain; however, acetaminophen has no peripheral anti-inflammatory effects. It may be preferred in elderly patients because of fewer GI and renal side effects.

Tramadol (Ultram)

Synthetic analog of codeine; however, tramadol has a lower affinity for opioid receptors than does codeine. It has less potential for abuse or respiratory depression than do other opiate agonists, but both may occur. Tramadol is equivalent in analgesic relief to codeine, but it is less potent than are acetaminophen-codeine and acetaminophen-hydrocodone combinations. A lack of significant cardiac effects and no association with peptic ulcer disease make tramadol an alternative in patients who may not tolerate NSAIDs.

Acetaminophen and codeine (Tylenol #3)

Used to treat moderate to severe pain. Tylenol #3 produces additive analgesia compared with the same doses of either agent alone. Dosage escalation of this combination is limited by the ceiling effect of acetaminophen.

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Nonsteroidal anti-inflammatory drugs (NSAIDs)

Class Summary

Have analgesic, anti-inflammatory, and antipyretic activities. Their mechanism of action is not known, but they may inhibit COX activity and prostaglandin synthesis. Other mechanisms may exist as well, such as the inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell-membrane functions.

Ketoprofen (Orudis, Actron, Oruvail)

For relief of mild to moderate pain and inflammation.

Small dosages initially are indicated in small and elderly patients and in those with renal or liver disease.

Doses over 75 mg do not increase the therapeutic effects. Administer high doses with caution and closely observe the patient for a response.

Naproxen (Naprelan, Anaprox, Naprosyn)

For relief of mild to moderate pain; naproxen inhibits inflammatory reactions and pain by decreasing the activity of COX, which results in a decrease in prostaglandin synthesis.

Ibuprofen (Motrin, Advil, Nuprin, Rufin)

Oral NSAID with analgesic and antipyretic properties. Ibuprofen is useful for the alleviation of mild to moderate pain.

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Cyclooxygenase-2 (COX-2) inhibitors

Class Summary

Although increased cost can be a negative factor, the incidence of costly and potentially fatal GI bleeds is clearly less with COX-2 inhibitors than with traditional NSAIDs. Ongoing analysis of cost avoidance of GI bleeds will further define the populations that will find COX-2 inhibitors the most beneficial.

Celecoxib (Celebrex)

Inhibits primarily COX-2. COX-2 is considered an inducible isoenzyme, being induced during pain and inflammatory stimuli. Inhibition of COX-1 may contribute to NSAID GI toxicity. At therapeutic concentrations, COX-1 isoenzyme is not inhibited; thus, GI toxicity may be decreased. Seek the lowest dose of celecoxib for the shortest duration in each patient.

COX-2 inhibitors have been associated with an increased risk of serious cardiovascular thrombotic events, including myocardial infarction and stroke, though the incidence of costly and potentially fatal GI bleeds is lower with COX-2 inhibitors than with traditional NSAIDs.

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