Prescriptions are given to the patient while in the office. Occasionally refills are necessary, and these can sometimes be phoned to a local pharmacy. Strong pain medicines, including narcotics, are only given for short periods of time around around the time of surgery or during the initial stages of an acute injury. They are inappropriate and ineffective for chronic use. The reason for this is that the body habituates itself to narcotics through an enzyme system. The more narcotics one takes, the less effective they become. This is particularly true for chronic use. For this reason non-narcotic pain medicines are much better for chronic-type pain. Some narcotics are more habituating and dangerous than others, and therefore, these are avoided except in special circumstances.
Commonly used in an orthopaedic practice are the nonsteroidal anti-inflammatories (NSAIDS). Aspirin, ibuprofen, Naprosyn, and many others in this class of medications help in not only decreasing pain but also in decreasing inflammation and swelling which is often the cause of pain. As with all medications, they present certain risks. The most common side effect is stomach upset or irritation. In the extreme they can cause ulcers and even bleeding ulcers. One of the warning signs is stomach pain or "heartburn". Taking the anti-inflammatory with meals or a snack will often help prevent this. The medicine should be stopped at the first sign of stomach or gastrointestinal upset. Another side effect is that of increasing the time it takes to stop bleeding when cut. This is usually only a minor increase, but 5 days before surgery, the patient should stop all anti-inflammatory type medicine to avoid any increased blood loss during the procedure.
There are many other possible, though rare, side effects of NSAIDS. Kidney (renal) injury, interaction with other medications such as high blood pressure medicines or diuretics, and other so-called idiosyncratic reactions have been reported in isolated cases. If you are pregnant or breast-feeding, you must consult your obstetrician or pediatrician prior to taking NSAIDS. If you are presently on prescription medicines from another physician, you should consult him/her concerning possible drug interactions prior to taking NSAIDS. Aspirin or ibuprofen (Motrin or Advil) should not be taken while taking other NSAIDS.
Finally, if you are taking NSAIDS for longer than 3 months, you should consult your doctor about possible blood tests to assure that there has been no renal (kidney) impairment.
