USC School of Pharmacy's Co-Directors of Pain Management recently presented an interactive, one-hour lecture on the management of headaches, back and neck pain, and osteoarthritis. Attached is the material that was handed out which discusses how to identify, prevent, and treat tension/stress headaches, migraines, sinus headaches, osteoarthritis, and neck/back pain. It includes over-the-counter (OTC) pain medications and lifestyle remedies, addressing who should use them and for what type of pain.

1. Pain Management
USC School of Pharmacy
Maya Shehayeb & Angela Shen
January 8, 2015

2. Background
100 million in the U.S. have Chronic Pain.
The pain lasts for weeks, months, or years.
It can be severe enough to cause difficulty
sleeping or depression.
12 million peopleCancer
23 million peopleHeart Attack & Stroke
25 million peopleDiabetes
100 million peoplePain

3. How much pain are you feeling?

4. Over-the-Counter Pain Medications
• Tylenol
• Advil/Motrin
• Aleve
• Aspirin

5. Tylenol (acetaminophen)
325 mg 500 mg 650 mg
Take 2 tablets
every 4-6 hours
Take 2 tablets
every 6 hours
Take 2 tablets
every 8 hours
Relieves pain and headache, lowers fever.
Do not take Tylenol if you have liver damage.

6. Tylenol (acetaminophen)
Acetaminophen can cause liver damage
if taken inappropriately.
Do not take more than 2000-3000 mg/day
Avoid other products containing acetaminophen
when taking Tylenol:

7. Advil or Motrin (ibuprofen)
• To relieve pain and inflammation such as
headache, backache, and arthritis.
• Stop taking 1 or 2 days before surgery.
200 mg
Take 1 tablet every 4-6 hours

8. • Very similar to Ibuprofen but lasts longer
(relieves pain up to 12 hours)
• Can be too strong for 65 years and older
Ibuprofen may be a better choice
Aleve (naproxen)
220 mg
Take 1 tablet every 8-12 hours

9. • Always take these medications with food.
• They may bother the stomach (or cause
stomach bleeding if you already have an
ulcer).
• Be careful if you have asthma, kidney
problems, or high blood pressure.
Advil, Motrin, or Aleve
(ibuprofen or naproxen)

10. Bayer (aspirin)
325 mg, pain81 mg, heart protection
only if Dr. recommends it
• Relieves headache or muscle pain.
• Can cause stomach bleeding. Avoid if you have
an ulcer. Stop taking a week before surgery.
•Avoid if you have asthma, kidney problems, or
gout. For adults only.

11. Common Pain Conditions
1. Headache
2. Back/Neck Pain
3. Arthritis
4. Nerve Pain

12. Types of Headache
• Tension
• Migraine
• Sinus
• Medication Overuse
*Do not use headache medications
for more than 3 times a week or
longer than 3 months.

13. Tension Headache
• Squeezing of forehead and back of head
• Caused by stress or emotional anxiety

14. Migraine
• Throbbing pain on one side of face
• Can see flashing lights, hallucinations and have
difficulty speaking
• See your doctor, if undiagnosed

15. Sinus Headache
• Pressure behind the forehead and cheeks.
• Congested sinuses.
• Pain is worse when awaken, lean forward, or
blow nose.
Humidifier Elevate Head

16. Types of Arthritis
• Rheumatoid Arthritis
• Osteoarthritis

17. Rheumatoid Arthritis
• Stiff hands and feet in the morning for
more than 45 minutes
• Swollen joints (can be on one side of the
body only)
• Fever and fatigue
 See your Doctor

18. Osteoarthritis
• Bones rub against each other and wear
down the cartilage between them.
• Knees, hips, and lower back are stiff in
morning for < 30 minutes. Pain gets better
with movement.
Protruding Bones Stiff Joints

19. Osteoarthritis Treatment
Low-impact exercises: walk, bike, swim
Cushioned shoes Tylenol

20. Glucosamine Chondroitin
Use with caution if you have a shellfish allergy or diabetes.
1500 mg daily 1200 mg daily
• Can prevent loss of and rebuild cartilage
• Start with Glucosamine alone
(add Chondroitin after 3-5 months, if working)
Osteoarthritis Treatment

21. • Capsaicin
• Menthol: causes cooling
• Methyl Salicylate: causes warmth, do
not use right after a bath or with a
heating pad. For adults only.
Topical Products: for local pain relief

22. Lower Back Pain

23. Prevent Back Pain
Do not lift with your back. Lift with your knees.
Hold the load close to your body.

24. Prevent Back Pain
Good Posture
Sleep on a Firm Surface

25. Treat Back Pain
Ibuprofen
Ibuprofen
Naproxen
For pain and
inflammation

26. Right after an injury…
At the start, Cold pack
20 minutes, 2-3 times a day
After 2-3 days, Heat pack
20 minutes, 3-4 times a day
Rest for 2-3 days

27. Nerve Pain
Tingling, shooting pain and numbness
Can try Capsaicin, but should go see your doctor

28. Capsaicin
• For nerve and muscle pain
• Apply a thin layer 3-4 times a day. Causes a
warmth and burning that will go away 3 days
later, if regularly applied.
• Maximum relief after 14 days of regular use.

29. See your doctor if you have:
fever > 104˚F or >1 day
sore throat
swelling
loss of movement
severe pain
abdominal pain, nausea, or vomiting
Use over-the-counter medications for
LESS than 7 days

30. If you need more help or have questions,
call the American Chronic Pain Association
(800) 533-3231