A Backpacker's Best Analgesic?

[highway]

I have often wondered what is the best pain reliever for the "backpacker's Shuffle"? That is the slow, deliberate, agonizing, hunched over pace some of us are forced to take for the first steps in the morning after having carried a pack over rocky hill and dale for far to many miles the day before. For those with young, limber feet it may only be a few steps. But for the older ones, particularly those with feet that were damaged many years earlier but repaired, the shuffle may last an hour or more, with slightly diminishing pain in every step.

The available choices seem to be:

1. Acetylsalicylic acid or Aspirin
2. Acetaminophen
3. Ibuprofen
4. Naproxen

The pain reliever aisle of the pharmacy or grocery store is full of shelves of countless brands of the above and I would like to know what type or brand would better relieve the pain in my feet in the morning? :-?

And then there is the problem of mixing them, as Ibuprofen seems to cancel out the blood-thinning characteristic of aspirin, if that is a problem for anyone.

And I already know about alcohol but my wife has just about weaned me off that. Besides it tastes bad in the morning and plays havoc with your navigational skills :D

[Moose2001]

In 2001, I hiked just about every day with pain in my feet and especially my heels. For the first hour of the day, I had to walk on just the balls of my feet until the Vitamin I kicked in. This year, I started having the same problem and I tried putting a pair of gel heel cups in my boots. What a difference!! The pain was gone almost immediately. I no longer had to pop Vitamin I first thing in the morning to walk. I thought about tring the gel insoles but as long as the heel cups worked, I decided to stay with just those. You might think about trying a set and see if they help you.


I have often wondered what is the best pain reliever for the "backpacker's Shuffle"? That is the slow, deliberate, agonizing, hunched over pace some of us are forced to take for the first steps in the morning after having carried a pack over rocky hill and dale for far to many miles the day before. For those with young, limber feet it may only be a few steps. But for the older ones, particularly those with feet that were damaged many years earlier but repaired, the shuffle may last an hour or more, with slightly diminishing pain in every step.

The available choices seem to be:

1. Acetylsalicylic acid or Aspirin
2. Acetaminophen
3. Ibuprofen
4. Naproxen

The pain reliever aisle of the pharmacy or grocery store is full of shelves of countless brands of the above and I would like to know what type or brand would better relieve the pain in my feet in the morning? :-?

And then there is the problem of mixing them, as Ibuprofen seems to cancel out the blood-thinning characteristic of aspirin, if that is a problem for anyone.

And I already know about alcohol but my wife has just about weaned me off that. Besides it tastes bad in the morning and plays havoc with your navigational skills :D

[rumbler]

1. Advil
2. Maker's Mark
3. Absolut Mandarin with pinapple and orange tang

Not necessarily in that order. :D

[Alligator]

Over the summer, I herniated a disc in my back. After several different treatments, the one that worked the best for me was Celebrex (this and time). My back is still healing, so occasionally it flares up. On these mornings I take my one Celebrex pill and I'm good for the day. It's not a good idea to take ibuprofen daily for long periods. I was taking the maximum amount to try and combat associated sciatica pain in my leg. It was starting to erode the lining of my stomach. The Celebrex does not have this side effect. Of course, since it is a prescription drug, you should talk it over with your doctor.

I also would not advocate "hiking through the pain" for extended periods. I once tried to "work daily through the pain" by popping ibuprofen. It only aggravated the problem.

I often think that a drunk with a paint gun laid out the AT, the way it meanders in places. A little alcohol might actually make the path seem straight!

[Kerosene]

New padded insoles with nice socks to start, followed by liberal doses of Vitamin I as needed, but not day in and day out.

[MedicineMan]

I would chime in here but it would feel way too much like work :)
On the serious side I would like to mention Toradol. This is a legend (prescription only) NSAID (non-steroidal, like Motrin, Alleve,aspirin, and many others), but it is extremely powerful, so much so that it is limited to a certain number of days use (as is 50mg of Vioxx in our hospital). Toradol is equipotent with morphine in its analgesic capacity. I keep a small number of tablets in my personal survival kit for a broken leg or really bad burn. Unlike morphine and other narcotics, it doesnt cause drowsiness and is not additive. It is not for every day use but is something to consider consulting with your MD about for the truly desparate situation where you need to quell pain without impairing your abilities to think.

[highway]

What about over-the-counter pain relievers?

Is there one that would be more appropriate for burning, aching joints and muscles, as a backpacker would have, rather than one mostly for headaches?

There was once a great thread on this site where someone of some medical consequence went into detail explaining the differences between the different OTC remedies available to us and even made a recommendation as to the preferred one. I vaguely recall it and can't find it so I suspect it was on one of the first Whiteblaze forums which disappeared during the early birth pains of this site.

The answer would be interesting, if, in fact there is one. Or, are they all the same?

[jlb2012]

brand name is Aleve

[Former Easy]

You can have your doctor give you a script for Vicodin, IB 800 or Tylenol 4, I have meet a few hikers that did this. I'm going to go the same route next hike, the over the counter stuff just didn't cut it. I'd atleast ask you doc for IB 800 you have a better chance of your doc fulfilling this script than the other 2 unless you have a doc in the family.

[smokymtnsteve]

easy..see your thread END TRAIL DRUG USE....gesssh...talk about reformed alkys being offensive

[Former Easy]

easy..see your thread END TRAIL DRUG USE....gesssh...talk about reformed alkys being offensive


LOL ...... but a prescription is legal and not a criminal act :D

[Photofanatic]

..........

[Jaybird]

I have often wondered what is the best pain reliever for the "backpacker's Shuffle"? That is the slow, deliberate, agonizing, hunched over pace some of us are forced to take for the first steps in the morning after having carried a pack over rocky hill and dale for far to many miles the day before. For those with young, limber feet it may only be a few steps. But for the older ones, particularly those with feet that were damaged many years earlier but repaired, the shuffle may last an hour or more, with slightly diminishing pain in every step.
The available choices seem to be:
1. Acetylsalicylic acid or Aspirin
2. Acetaminophen
3. Ibuprofen
4. Naproxen
The pain reliever aisle of the pharmacy or grocery store is full of .............. :D



Daily dose of 800mg MOTRIN :D

[Blue Jay]

Pain is there for a very important reason. To drug out the pain and continue to abuse yourself is the prescription for permanent pain. Slow down, rest more, lighten your load. That is the only way to stop pain. Although that is not what our culture wants you to do. Have a problem, take a pill.

[Frosty]

You can have your doctor give you a script for Vicodin, IB 800 or Tylenol 4, I have meet a few hikers that did this. I'm going to go the same route next hike, the over the counter stuff just didn't cut it. I'd atleast ask you doc for IB 800 you have a better chance of your doc fulfilling this script than the other 2 unless you have a doc in the family.

What is the difference between getting a prescription for 800mg IB, and simply taking 4 over-the-counter 200mg pills at a fraction of the cost?

[gravityman]

What is the difference between getting a prescription for 800mg IB, and simply taking 4 over-the-counter 200mg pills at a fraction of the cost?

There isn't. Just the same. Just be careful about the length of time you are taking IB. It's tough on the stomach (ulcers).

I find that IB is better at sharp pain. Aleve (naproxin) is better on dull pains, but it lasts a LOT longer.

Gravity Man

[rpsp1066]

Motrin & Moleskin take care of most of the foot pains.Try spending a few minutes stretching too!I have to stretch out some mornings to get up and going under normal cicumstances,much less before a day of hiking.
rpsp1066

[Jack Lincoln]

Do whatever you need to do. Smoke some reefer if that might help you.

Carry a big bottle of percocets if that will help you.

Do whatever it takes.

ps: don't need any of your sanctimonious horse**** but I am sure that I will get it anyhow.

Have a wonderful day.

[SGT Rock]

For an analgesic you can use Naproxin, it does the same thing as Ibuprofin but lasts longer and takes less time to build to a working level. It also (according to my PA) works well at cutting fever, beter than IB, so you don't need IB and asprin or Tylenol to do the job in your kit.

I also like a little boubon for muscle relaxant. ;)

Seriously, For you TRAINED medical people, is it true what I have been told about IB, that it can actually take about 12 hours for a dose to even build up in your system to do it's job? It was explained to me (again by my PA) that the relief most people claim to feel from IB must be them working through their pain or a placebo effect because the ibuprofin has to build up to a certain level to work and that level must be maintained to continue it. And that the time it takes ibuprofin to get going depends on dose, body weight, etc. which could be 12-18 hours in most people. I wonder if this is true, or if he is full of it.

[Footslogger]

It varies by individual but just about any analgesic/NSAID you take by mouth requires some time to have a noticeable affect. Can't quote the exact time it would take for Motrin (Ibuprofin) or Naproxin to begin showing any real benefit.

I would offer 2 strategies to anyone hoping to get pain relief from an oral medication (regardless of your pill of choice). First ...if you know you're gonna need it ..."front load" the situation a bit. In other words, take the pill(s) before the pain appears. Second ...take the pill(s) with food. It will speed up the absorption and thereby deliver the relief somewhat sooner.

Hope that helps.

'Slogger

[rumbler]

To reiterate, Maker's Mark works almost immediately. Easily regulated, and nothing works better for joint pain.

[Footslogger]

Thanks Rumbler ...how could I ever forget the "medicinal alcohol" that got us through those difficult episodes of pain !!

'Slogger

[Jack Tarlin]

Slogger, I haven't the faintest idea what you're talking about!

[Footslogger]

Slogger, I haven't the faintest idea what you're talking about!
What was it that you didn't understand Jack ...the term "medicinal alcohol" or the idea that we would only use it in case of emergency ??

Either way ...see me in Damascus and I'll "refresh" your memory !!

'Slogger

[MedicineMan]

IBUPROFEN
PHARMACOKINETICS
ONSET AND DURATION
2.1.1 ONSET
A. INITIAL RESPONSE:
1. Analgesia (headache), regular release: 15 minutes (Schachtel & Thoden, 1988).
2. Arthritis, regular release: few days to 1 week (Prod Info Motrin(R), 1999).
3. Postsurgical-dental pain, liquigel form: meaningful relief, within 25 minutes (Olson et al, 2001).
B. PEAK RESPONSE:
1. Analgesia (headache), regular release: 30 minutes (Schachtel & Thoden, 1988).
2. Arthritis, regular release: 2 weeks (Prod Info Motrin(R), 1999).
3. Postsurgical-dental pain: Within 90 minutes (Olson et al, 2001).
2.2 DRUG CONCENTRATION LEVELS
2.2.1 THERAPEUTIC
A. TIME TO PEAK CONCENTRATION:
1. Oral, regular release: 1.4 to 1.9 hours (Tech Info Motrin(R), 1981).
a. Average peak serum concentrations of 34.95 to 36.60 mcg/mL and 51.74 to 56.59 mcg/mL, following single oral doses of 400 mg and 600 mg were noted at average times of 1.41 to 1.64 hours and 1.41 to 1.83 hours, respectively (Tech Info Motrin(R), 1981).
b. Ibuprofen arginine is a new formulation of ibuprofen designed to achieve higher and earlier peak serum concentrations which may improve its efficacy for relieving pain. After a single dose of ibuprofen arginine 200 mg and 400 mg, the maximum concentration was 26.1 mg/L and 56.4 mg/L, respectively, compared to 16.3 mg/L and 43 mg/L, respectively, after ibuprofen 200 mg and 400 mg (Moote, 1996). For ibuprofen arginine 200 mg and 400 mg, the t-max occurred at 16.9 min and 24.4 min, respectively. The t-max for ibuprofen 200 mg and 400 mg was 90 min and 63.8 min, respectively.
c. The time to reach maximum concentrations was similar between healthy children and children with cystic fibrosis (Konstan et al, 1991).

NAPROXEN
PHARMACOKINETICS
2.1 ONSET AND DURATION
2.1.1 ONSET
A. INITIAL RESPONSE:
1. Analgesia, regular release: 2 hours (Mahler et al, 1976).
2. Gout, regular release: 24 to 48 hours (Prod Info Naprosyn(R), 1997; Wilkens et al, 1975).
3. Rheumatoid arthritis, regular release: 2 weeks (Prod Info Naprosyn(R), 1997).
2.1.2 DURATION
A. SINGLE DOSE:
1. Analgesia, regular release: 7 hours (Prod Info Naprosyn(R), 1997; Wilkins et al, 1975).
2.2 DRUG CONCENTRATION LEVELS
2.2.1 THERAPEUTIC
A. TIME TO PEAK CONCENTRATION:
1. Oral, regular release: 2 to 4 hours (Prod Info Naprosyn(R), 1997; Makela, 1977).
a. After single oral doses of 250 and 500 mg, peak concentrations were 37 mcg/mL and 79 mcg/mL, respectively, (Runkel et al, 1974).
b. After administering naproxen 10 mg/kg/day (divided into 2 doses) to 21 children for 14 days, peak concentrations were 39 to 41 mcg/mL, respectively (Makela, 1977).
2. Oral, controlled release: 5 hours (Prod Info Naprelan(TM), 1996).
a. After administering 2-naproxen sodium CR 500 mg tablets, the maximum serum concentration was 94 mcg/mL (Prod Info Naprelan(TM), 1996).
3. Topical, gel: 24 hours (van den Ouweland et al, 1989).
a. Following topical application of NAPROXEN gel (10%) 1 g, mean serum concentrations of NAPROXEN were greater than 1 mcg/L at 4 hours, 40 mcg/L at 24 hours, and 13 mcg/L at 96 hours (van den Ouweland et al, 1989).
2.3 ADME
2.3.1 ABSORPTION
A. BIOAVAILABILITY (F):
1. Oral, regular release: complete (Prod Info Naprosyn(R), 1997).
2. Oral, controlled release: complete (Prod Info Naprelan(TM), 1996).
a. Naproxen sodium CR is formulated so that 30% of a dose is released immediately, and the remaining part of the dose is coated as microspheres which provides sustained release properties (Prod Info Naprelan(TM), 1996).
3. Oral, sustained release: almost complete (Kelly et al, 1989).
4. Rectal, suppository: complete (Gamst et al, 1984).
B. EFFECTS OF FOOD: clinically insignificant (Prod Info Naprelan(TM), 1996; Palazzini et al, 1992; Mroszczak et al, 1988).
1. The rate of absorption of the SR versus CR preparation was less, but the extent of absorption was the same (Kelly et al, 1989).

[Kozmic Zian]

Yea......Pain......The Best Medicine for Pain is continued walking and working out. The better condition your body is in, the less pain you will experience. If you have extra body fat, loose it before you go. Lighten your load, within reason. The more conditioned and hard your feet, ankles, knees and back are, the less stress and muscle tension will occur. The best remedy for pain is to take nothing, as stated above, because continued use of pain killers is just a temporary mask of the problem. On a LDH, everyone experiences some kind of pain related to the walking, but as you progress, you'll notice that the pain receeds and if on a Thru-Hike, towards the end you'll feel light as a feather and painless. The physical benefits of a Thru-Hike are well documented. They say it can automatically add 10 years onto a persons life! Walk On, my brothers and sisters.....KZ@

[MedicineMan]

but there are those of us (i see one in the mirror daily) that due to genetics, past history of bodily abuse (sports, too many years with a heavy pack, whatever) who need to continue on daily NSAIDS-first generation or a newer COX2 inhibitor. For those of us on this trail there are some key things to remember....
With first generation NSAIDS (motrin,nalfon,feldene,aleve,dolobid,aspirin, and many others) almost always we see an atenuation of the non steroidal effect. This is remedied by switching to another NSAID and the process is repeated after the body adapts to those slight molecular differences that set each drug apart.
We haven't seen this yet with the COX2 Inh's (Bextra,Celebrex,etc) but time will tell.
Point is that you can begin to alternate them now...ibuprofen for a couple of days and then naproxen for several days then aspirin for a couple of days (subtitute weeks for days depending on location,availability and personal response).....
and dont forget acetaminophen...while little to no documented antirheumatic effects (read antiinflammatory) it is still a viable analgesic and will give your stomach lining a break from the NSAIDS while still relieving pain.