Monday, May 14, 2018

Do Topical (rub on) Pain Medicines Work?

Your grandma may have told you to put hydrogen peroxide or alcohol on a wound, but that is actually not a good idea. The instinct to kill germs with a strong antiseptic is understandable (how many times have we used alcohol-based, hand sanitizers -like Purell- as an alternative to hand washing?) However, broken skin that is bleeding or otherwise scratched, cut, or burned is very vulnerable to damage caused by these caustic liquids. You may kill the bacteria, but in the process you also kill your healthy cells that are needed to heal the wound. It's kind of like using a sledge hammer to kill a bug - it's going to do more harm than good.

The best thing for simple cuts and scrapes is clean water and gentle soap. Wash your hands first and then rinse the injury for at least 5 minutes to get all the potential particles and debris out of it. After the wound is clean (in the ER we use copious amounts of sterile saline to rinse wounds) it's important to judge whether or not stitches will be required to help it close. Assuming it's a small cut or abrasion, the next step is to apply pressure to reduce bleeding, and then keep it moist, and covered with a clean bandage. Moisture allows repair cells to migrate across the broken skin and lay down new collagen. Without moisture, the wound bed dries out and crusts, creating a scab and a higher chance of scarring.

How do you keep a clean wound moist? Ideally with "occlusive dressings." Maybe you've seen the new kind of Band-Aids that are rubbery or gel-like in appearance? Those are designed to co
ntain the wound in a moist environment and block air from getting in. Some studies suggest that wounds heal up to 10 days faster if they are kept moist, and scar reduction is significantly improved. These dressings (if undisturbed) can be left on for 1-3 days at a time, but should be changed right away if they're broken, soiled, or contaminated (such as dipped in dirty water).

While the wound is healing, there will be a small inflammatory reaction as the repair cells do their job. Sometimes wounds are itchy or have slightly red or pink border. They may also leak a little bit of clear, sticky fluid. Those are all part of the normal healing process. However, if the wound is becoming more (rather than less) painful with time, if it has redness that is expanding, or if there is a foul odor or pus coming from it, it could be becoming infected which may require medical attention.

Antibiotic ointment (such as Neosporin or Bacitracin) reduces infection risk in minor contaminated wounds. Once a wound is fully washed and decontaminated, good old Vaseline (petroleum jelly) is just as effective in helping it heal. If you are injured far away from access to clean water and gentle soap, an antibiotic ointment may reduce your risk of infection (so long as the wound is not too large or dirty).  Butter is not a good substitute for ointment because it is not sterile, by the way.

The bottom line is that minor cuts, scrapes, and burns should be washed thoroughly and then kept moist with petroleum jelly and/or occlusive dressings. Antibiotic ointments are a precaution that isn't needed for otherwise clean wounds, and carry a small risk of allergic reaction. The stinging pain of hydrogen peroxide or alcohol in a wound is not the feeling of germs dying, it's the body crying out as you add a new chemical burn to an already painful situation.

References
https://www.advancedtissue.com/the-best-and-worst-ideas-for-open-wounds/
https://www.mdedge.com/jfponline/article/62565/dermatology/do-topical-antibiotics-improve-wound-healing
https://www.mayoclinic.org/first-aid/first-aid-cuts/basics/art-20056711

If you have any questions about first aid for wounds, please log into your account and send us your question. We are here to help.

Friday, May 4, 2018

Health Tip: First Aid For Small Wounds

Your grandma may have told you to put hydrogen peroxide or alcohol on a wound, but that is actually not a good idea. The instinct to kill germs with a strong antiseptic is understandable (how many times have we used alcohol-based, hand sanitizers -like Purell- as an alternative to hand washing?) However, broken skin that is bleeding or otherwise scratched, cut, or burned is very vulnerable to damage caused by these caustic liquids. You may kill the bacteria, but in the process you also kill your healthy cells that are needed to heal the wound. It's kind of like using a sledge hammer to kill a bug - it's going to do more harm than good.

The best thing for simple cuts and scrapes is clean water and gentle soap. Wash your hands first and then rinse the injury for at least 5 minutes to get all the potential particles and debris out of it. After the wound is clean (in the ER we use copious amounts of sterile saline to rinse wounds) it's important to judge whether or not stitches will be required to help it close. Assuming it's a small cut or abrasion, the next step is to apply pressure to reduce bleeding, and then keep it moist, and covered with a clean bandage. Moisture allows repair cells to migrate across the broken skin and lay down new collagen. Without moisture, the wound bed dries out and crusts, creating a scab and a higher chance of scarring.

How do you keep a clean wound moist? Ideally with "occlusive dressings." Maybe you've seen the new kind of Band-Aids that are rubbery or gel-like in appearance? Those are designed to contain the wound in a moist environment and block air from getting in. Some studies suggest that wounds heal up to 10 days faster if they are kept moist, and scar reduction is significantly improved. These dressings (if undisturbed) can be left on for 1-3 days at a time, but should be changed right away if they're broken, soiled, or contaminated (such as dipped in dirty water).

While the wound is healing, there will be a small inflammatory reaction as the repair cells do their job. Sometimes wounds are itchy or have slightly red or pink border. They may also leak a little bit of clear, sticky fluid. Those are all part of the normal healing process. However, if the wound is becoming more (rather than less) painful with time, if it has redness that is expanding, or if there is a foul odor or pus coming from it, it could be becoming infected which may require medical attention.

Antibiotic ointment (such as Neosporin or Bacitracin) reduces infection risk in minor contaminated wounds. Once a wound is fully washed and decontaminated, good old Vaseline (petroleum jelly) is just as effective in helping it heal. If you are injured far away from access to clean water and gentle soap, an antibiotic ointment may reduce your risk of infection (so long as the wound is not too large or dirty).  Butter is not a good substitute for ointment because it is not sterile, by the way.

The bottom line is that minor cuts, scrapes, and burns should be washed thoroughly and then kept moist with petroleum jelly and/or occlusive dressings. Antibiotic ointments are a precaution that isn't needed for otherwise clean wounds, and carry a small risk of allergic reaction. The stinging pain of hydrogen peroxide or alcohol in a wound is not the feeling of germs dying, it's the body crying out as you add a new chemical burn to an already painful situation.

References
https://www.advancedtissue.com/the-best-and-worst-ideas-for-open-wounds/
https://www.mdedge.com/jfponline/article/62565/dermatology/do-topical-antibiotics-improve-wound-healing
https://www.mayoclinic.org/first-aid/first-aid-cuts/basics/art-20056711
If you have any questions about first aid for wounds, please log into your account and send us your question. We are here to help.

Monday, April 30, 2018

Health Tip: Is Ibuprofen (Motrin) Safe?

On any given day, 30 million Americans use a non-steroidal anti-inflammatory drug (NSAID) to treat their pain. Studies show that NSAIDs can reduce pain by about four points on a ten point scale.

Ibuprofen is part of the NSAID class of drugs, and is the most popular. These common pain meds reduce inflammation by inhibiting a group of "cyclooxengenase" enzymes (abbreviated COX1 and COX2). The COX 2 enzymes are responsible for triggering the immune system to respond to injury. However, it so happens that the COX 1 enzymes protect the stomach lining and enhance blood clotting. So at the same time that most NSAIDs reduce pain and inflammation, they can also increase the risk of ulcers and bleeding. Other potential side effects include increased blood pressure, kidney injury, and ringing in the ears (tinnitus).

This list of side effects may seem worrisome at first, but they are actually not too common if ibuprofen is taken in small amounts for short periods of time. For those without stomach ulcers, kidney or heart disease, or blood clotting issues, NSAIDs have a less than half of one percent chance of causing an unwanted side effect.

For those with a history of gastritis or stomach ulcers, NSAID risk is greatly reduced by taking it in combination with a type of antacid called a "proton pump inhibitor" such as pantoprazole (Protonix) and omeprazole (Prilosec).

When we think about medicine risks, I think it's important to compare the alternatives. Acetaminophen has a different side effect profile and can be effective for arthritis pain.  But consider opioid pain medicines (oxycodone, hydrocodone, codeine, morphine, and tramadol, etc.) - they may be effective for severe, acute pain, but they come with a surprisingly high risk of dependence and addiction. Beyond the risk of severe constipation, nausea, and reduced breathing rate, is the risk of becoming addicted to the medicine. Did you know that 5% of people who are given a prescription for opioid pain medicines become addicted to them long-term, and 10% become addicted if they're given a second prescription? Dependence on opioids (meaning you experience physical withdrawal symptoms if you stop taking them, and/or need higher doses to control the pain) can begin as early as 3 days after starting them, and an estimated 26% of those who take them engage in "problematic behaviors" afterwards. Opioid overdose is a more common cause of death than automobile accidents in the United States these days!

You also may be surprised to know that NSAIDs such as ibuprofen have been shown to be equally effective in reducing arthritis pain as opioid medications. For chronic pain, opioids have shown to be ineffective.
My opinion is that ibuprofen is a reasonable first line drug for the management of inflammatory pain (from arthritis or an acute injury such as muscle strain, bruise, fracture, or surgical procedure) so long as you don't have significant stomach, heart, or kidney problems and are not taking a blood thinner (such as Coumadin, Pradaxa, Eliquis, Xaralto). Acetaminophen may be preferable in these cases, though may be less effective. However, the risks are far lower than an opioid medication, and the benefits are fairly similar.

It's important to know that the risks of bleeding, heart attacks, and kidney injury increase with higher doses or longer term use. Ideally, people should take the lowest effective dose for the shortest amount of time to reap the benefits of pain relief without the unwanted potential side effects. It is estimated that 20% of ibuprofen users exceed the recommended daily dosing, putting themselves at higher risk for side effects. Remember to be realistic about pain control - it is unlikely for pain to be completely removed by any medicine, but a 4 point drop (on the 0-10 scale) is an excellent result.

If you do have health problems, talk to your doctor first before taking NSAIDs. For the average American, ibuprofen's 0.4% risk of bleeding is a lot better odds than a 26% chance of dependency and a 5-10% chance of long-term drug addiction with an opioid pain medicine!

References
https://www.uptodate.com/contents/nonsteroidal-antiinflammatory-drugs-nsaids-beyond-the-basics
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5478398/
https://www.drugabuse.gov/publications/teaching-packets/neurobiology-...
https://www.cbsnews.com/news/opioid-painkiller-addiction-dependence-can-start-in-days/
http://www.latimes.com/science/sciencenow/la-sci-sn-pain-opioids-ibuprofen-20171107-story.html
https://www.nbcnews.com/storyline/americas-heroin-epidemic/americans-are-abusing-over...;

If you have any questions about Ibuprofen, please log into your account and send us your question. We are here to help.