Pain Management in the Outdoors

Pain is a common symptom that accompanies numerous problems. It is typically rated on a subjective 1-10 scale scale with 1 being "barely noticeable" and 10 "the worst pain imaginable."

Some orthapedic pain can be significantly reduced by aligning angulated limbs, reducing  dislocations, and splinting the injured area.

Mild pain usually managed with Over-the-Counter (OTC) pain medications like acetaminophen, ibuprofen, or neproxin. Surprising to some, a number of studies have shown than more severe pain can also be effectively managed by ibuprofen with less side-effects than narcotics. Rx dose of ibuprofen is 600-800 mg every 6-8 hours not to exceed 2400 mg per day. Start with the OTC dose and increase an necessary to the maximum dose.

Rx opioids (narcotics) should be reserved for pain that cannot be managed by other means and administered by those familiar with their use (physicians, physician assistants, nurses, paramedics, etc.). They work by binding primarily to opioid receptors in the brain and spinal cord. They reduce the sending of pain messages to the brain and the feeling of pain. Opioids are best used for short periods of time to manage pain during an evacuation and following surgery (most people develop a drug tolerance within two weeks). In a wilderness environment IV opoids and injections are impractical; Vicodin (hydrocodone and acetaminophen) and Percocet (oxycodone and acetaminophen) tablets are commonly carried first aid kits. The military uses fentanyl lollipops with great success. Avoid taking narcotics with alcohol, some antidepressants, antihistamines, and sleeping pills.

Want more information on this and other wilderness medicine topics? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.

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