Q&A: Pain management possible for patients with drug allergies

Key takeaways:

• Sensitivities to acetaminophen and NSAIDs are common but vary.
• Topical pain relief solutions may provide fewer side effects.
• Physiotherapy and osteopathy are nonpharmaceutical options.

Patients who experience musculoskeletal pain have many pharmaceutical options for relief — unless they also suffer from allergies to these medications.

We spoke with Luke Fuller, BSci, BSci (Clin Sci), MHSci (Osteopathy), MPhysio, CSCS, an osteopathic manual practitioner and physiotherapist who specializes in musculoskeletal dysfunction and sports injuries, about alternatives and how allergists can help.

Healio: What are the most common pain management drugs with reported sensitivities or allergies?

Fuller: From my personal experience, some common pain relief drugs that report sensitive and/or allergic reactions include acetaminophen-based medication such as Tylenol (acetaminophen, Johnson & Johnson) and/or Panadol (paracetamol, Haleon) in Australia and the Middle East and North Africa region, as well as nonsteroidal anti-inflammatory drugs (NSAIDs) such as Advil (ibuprofen, Haleon) and Aleve (naproxen sodium, Bayer). Sensitivities to pain management drugs vary widely, so it is really crucial for patients to discuss their medical history with a qualified health care provider.

Healio: What conditions do these drugs typically treat, and why is treatment so important?

Fuller: Pain management drugs are commonly used to manage musculoskeletal pain including back pain, shoulder pain and headaches. These and similar conditions not only impact the individual’s well-being but can also contribute significantly to economic and/or societal burdens, so effective treatment is essential. For example, musculoskeletal pain can reduce a person’s capacity for daily activities, contribute to lost productivity or even force them to take time off work, all of which underline the importance of addressing pain effectively and promptly.

Healio: What pharmacological alternatives do you recommend for these drugs?

Fuller: While I’m not a general practitioner or pharmacist, I often recommend topical pain relief solutions, such as Medistik (Natureteq), as a non-ingestible alternative. I use topical solutions in my practice, as they can provide targeted pain relief with fewer systemic side effects, making them a great option for many patients. However, it is important to note that patients should always consult with their primary care provider or pharmacist to explore the best options for their unique needs.

Healio: Do you recommend any nonpharmacological strategies for pain management for these patients?

Fuller: Absolutely! Nonpharmacological approaches are highly effective and can complement traditional treatments. Some strategies include:

• physiotherapy and osteopathy: Personalized, hands-on manual therapy and manipulations to help release muscle tension and improve range of motion;
• registered massage therapy: Targeted massage to help alleviate tension and improve circulation;
• dry needling: An evidence-based technique that targets trigger points and helps relieve muscle tension, improve circulation and promote faster muscle recovery and is particularly useful for managing musculoskeletal pain and stiffness;
• meditation and mindfulness: Techniques to help manage chronic pain by addressing the mind-body connection; and
• prescribed exercises: Programs developed by trained professionals (eg, physiotherapists or kinesiologists) to help strengthen muscles and support recovery.

These approaches not only address physical symptoms but also promote overall well-being and physical health.

Healio: How can allergists and pain management specialists collaborate to ensure positive outcomes for these patients?
Fuller: Collaboration and open communication are vital. A multidisciplinary, 360-degree approach and mindset allows specialists to treat each patient holistically, considering their physical, mental, emotional and even spiritual health. Sharing information, developing treatment plans together and fostering patient trust can significantly enhance outcomes for individuals with complex or unique needs.

For more information:

Luke Fuller, BSci, BSci (Clin Sci), MHSci (Osteopathy), MPhysio, CSCS, is the founder and CEO of Ace Sports Clinics. He also travels with the ATP Tour of Men’s Professional Tennis and is a member of the Medistik Medical Expert Board.