Male: If you have pain and swelling, Tylenol does not bring swelling down, is that true?
Dr.: It is not an anti-inflammatory.
Male: So, if you have swelling, that is where you mention non-steroidals like Motrin and Aleve…
Dr.: I am a believer in non-steroidals for different types of joint syndromes, even early herniations. It has been helpful for that but Tylenol is still not a bad pain medication.
Male: For pure pain?
Dr.: For pure pain.
Male: But if you have swelling, in initial phases, aspirin, which has been used for many years, Aleve, Motrin, Advil, it is the same thing.
Dr.: Exactly.
Male: Of course, you always mentioned that there is no quantification because every drug has a good point and has a bad point.
Dr.: I mean, all medications have good and bad points. We explain to anyone who is on long-term non-steroidals, they need to bring a Hemoccult sample either to us or their primary care physician. We know that certain people that have heart ache problems are more susceptible especially to Naproxen, the Celebrex’s, certain things like liver function studies have to be tested on a yearly basis. So they are not without risk but I think the risks are very well managed.
Male: A doctor should not just write a prescription and tell you to take something. There should be a plan to follow anything you use in a launch or in basis.
Dr.: Yes, I think the problem that we make in this country is, we have this knee-jerk response to put people on pain and medications before we actually have a diagnosis and we cannot help it. We are physicians. People come in, we hate to see them in pain. We don’t want them to see them hurting but I think sometimes we have to think a little. What type of medications we are putting on before we make that diagnosis? We have to be careful because then you will get in trouble with these patients on long-term narcotics or even long-term non steroidals that could cause problems because we have not made the accurate diagnosis, because the pain was not considered a real problem. Now, fellowships in pain management and the millions of people that are in pain is actually its own specialty with its own board.
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