Medication Summary
The goal of therapy is to reduce inflammation and to minimize severe pain. To achieve this goal, anti-inflammatory agents and analgesics are the drugs of choice (DOCs).
Analgesics
Class Summary
These agents commonly are used for the relief of mild to moderate pain. Pain control is essential to quality patient care. Analgesics ensure patient comfort, promote pulmonary toilet, and enable physical therapy regimens. Most analgesics have sedating properties that are beneficial for patients with injuries. Although the effects of NSAIDs in the treatment of pain tend to be patient specific, ibuprofen is usually the DOC for the initial therapy. Other NSAIDs may be considered.
Propoxyphene products were withdrawn from the United States market on November 19th, 2010. The withdrawal was based on new data showing QT prolongation at therapeutic doses. For more information, see the FDA MedWatch safety information.
Ibuprofen (Motrin, Advil, NeoProfen, Provil, Dyspel)
In the absence of contraindications, this is usually the DOC for treating mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.
Naproxen (Aleve, Anaprox DS, Naprelan, Naprosyn)
For relief of mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing the activity of the enzyme cyclooxygenase, which results in a decrease of prostaglandin synthesis.
Ketoprofen
For relief of mild to moderate pain and inflammation. Administer small dosages initially to patients with a small body size, elderly persons, and those with renal or liver disease. When administering this medication, doses >75 mg do not increase therapeutic effects. Administer high doses with caution, and closely observe patients for response.
Acetaminophen (Tylenol, Aspirin Free Anacin, Feverall, Mapap, Cetafen)
DOC for pain in patients with documented hypersensitivity to aspirin or NSAIDs, in those with upper GI disease, or in those who are taking oral anticoagulants.
Acetaminophen with codeine (Tylenol with codeine, Capital/codeine)
The combination of acetaminophen and codeine is indicated for the treatment of mild to moderate pain.
Hydrocodone and acetaminophen (Lorcet Plus, Vicodin, Norco, Verdrocet, Zamicet)
This agent is indicated for the relief of moderately severe to severe pain.
Oxycodone and acetaminophen (Percocet, Endocet, Primlev, Xartemis XR)
The combination of oxycodone and acetaminophen is used for the relief of moderate to severe pain. It is the DOC for aspirin-hypersensitive patients.
Oxycodone/aspirin
This drug combination of oxycodone and aspirin is indicated for the relief of moderately severe to severe pain.
Indomethacin (Indocin,Tivorbex)
Indomethacin is thought to be the most effective NSAID for the treatment of AS, although no scientific evidence supports this claim. It is used for relief of mild to moderate pain; it inhibits inflammatory reactions and pain by decreasing the activity of COX, which results in a decrease of prostaglandin synthesis.
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This 80-year-old woman presented 1 week after a fall because of persistent pain and discoloration in the anterior part of her chest. Certain movements of her right arm were especially painful though not incapacitating. Note the extensive ecchymosis of the anterior part of her thorax and the swelling of the right upper parasternal/lower anterior neck area. The right sternoclavicular joint area was tender and edematous to palpation.
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Superior mediastinal contents may be threatened in posterior dislocations of the sternoclavicular joint.
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CT scan of a left sternoclavicular dislocation demonstrates anterior and superior displacement of the clavicle from its normal articulation with the manubrium. The right sternoclavicular joint is normal.
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CT scan of a left sternoclavicular dislocation demonstrates anterior and superior displacement of the clavicle from its normal articulation with the manubrium. The right sternoclavicular joint is normal.
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CT scan of a left sternoclavicular dislocation demonstrates anterior and superior displacement of the clavicle from its normal articulation with the manubrium. The right sternoclavicular joint is normal.
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The right sternoclavicular joint appears edematous on lateral inspection. Palpation confirms the apparent anterior dislocation.
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Comparison of the normal left sternoclavicular joint emphasizes the abnormalities.
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The patient refused further workup and treatment beyond a temporary sling, stating that the injury had not significantly affected her lifestyle. She was discharged home in the company of her daughter with over-the-counter analgesics.
