A Prepper’s Guide to Pain Medication

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In a survival situation, pain has the devilish ability to stop you in your tracks. A prepper’s pain medication stockpile is one of their most valuable assets.  You might hear “toughen up” or “walk it off” on the football field, but this is a completely different ballgame, with no shoulder pads and no second downs. Effective medication is as good as gold in a post-apocalyptic landscape, so make sure you are ready to pile it into your bug-out vehicle if and when the time calls for it.

Sever injury on woman's arm, example of someone who needs a prepper's pain medication stockpi;e

The Problem with Pain

Pain can act as both a reinforcer and an inhibitor of our actions, protecting our bodies from further damage and urging us to find relief. Disregarding a distress signal – for example, walking on a swollen knee or fist-fighting with a broken arm – can lead to long-term morbidity. Not only that, but it is a liability to your health and a risk to your livelihood. The name of the game here is survival, not egotistical chauvinism, so tuck those feelings away for the next frat party and approach your well-being in the humblest of ways.

If you’ve ever experienced excruciating pain, you know that it’s hard to think about anything else. Not only does pain provide an unpleasant sensory experience; it also hinders mental functions such as problem-solving, information processing, and judgment. Decision-making skills are diminished, resulting in poor choices that can have detrimental effects. Being a hero won’t earn you any merit badges, but approaching pain as a medical condition will certainly improve your chances of clinical success.
Bandaging a knee

What are Your Options?

The range of pain relievers covers everything from everyday aches and pains to pain of the magnitude depicted in 80s horror movies, and a prepper’s pain medication stockpile should attempt to include a wide variety of them.  You could consider aspirin a gateway drug of sorts, since it’s one of the earliest and more placid pain relievers. Acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) are fairly tame as well.

Barbiturates, opiates, and other narcotics are painkillers lying at the opposite end of the spectrum. Opiates are among the oldest drugs in human use and have become the gold standard for pain management. A category that started with morphine, the model opiate, has now blossomed into numerous drugs with varying potencies.

Fentanyl, for example, is a synthetic opiate nearly 100 times the strength of morphine. This potency makes it an effective painkiller, but lethal if used incautiously. Thus, care must be taken whenever pain medication is administered, because the line between managed pain and an overdose can be quite subtle.


Tylenol, an essential to every prepper's pain medication collection
Acetaminophen

A synthetic pain reliever (Tylenol)
What does it do? Relieves pain, reduced fevers
Why is it important? Easy on the stomach, generally safe for children
When should you take it? When the headache from your predicament becomes unbearable

Acetaminophen (or paracetamol as it is called across the Pond) is the most widely used drug in the world. In the 1880s German scientists used it to treat worm infestations in humans, only to find it was capable of so much more. The early twentieth century was dominated by paracetamol and aspirin, which were both regarded as safe and effective pain relievers. In the 1950s, though, we came to understand the toxicity of acetaminophen at high doses and its association with acute liver failure. In fact, acetaminophen is involved in 97% of cases where the need for a liver transplant can be attributed to drug use. When it comes to survivalist, an effective prepper’s pain medication knowledge should be as well-rounded as their stockpile, and you should be aware of potential side effects they may cause.

Make no mistake: acetaminophen is very safe when taken as directed. Its use in babies and children is well established, and it is even safe for pregnant or nursing mothers. It’s long been used as a standard treatment for fever, working quickly and effectively to quell cold and flu symptoms. And unlike similar drugs such as ibuprofen and aspirin, it’s easy on your stomach and doesn’t necessarily have to be taken with food. It also does not affect platelet function or increase blood clotting time either, which can be critical during major trauma. And this is the dichotomy of acetaminophen: safe and effective for everyday use yet toxic and potentially deadly at high doses.


Ibuprofen bottle, also an essential prepper's pain medication

Ibuprofen
What is it? A non-steroidal anti-inflammatory drug (NSAID) (Advil)
What does it do? Great for soothing muscle and joint pain
Why is it important? As a pain-relieving workhorse, it has broad applications
When should you take it? When your body has had a demanding day

In the world of backpacking, “Vitamin I” is a staple in everyone’s gear. And it’s no wonder, because ibuprofen is one of the safest and most effective drugs available for common aches and pains. In the military it is standard issue for soldiers in the field, to help them cope with the heavy packs and long tours of duty. The battle for existence will also be a grueling affair, with your body being exerted to extremes beyond its normal capacity. And after a long day of navigating the post-apocalyptic landscape, you’ll be in need of an effective pain reliever that won’t hamper your senses like an opiate would. Not only does ibuprofen work great for joint and muscle aches, it even helps with hangovers (which is what the inventor, Dr. Stewart Adams, hoped it would work for).

As a medicine cabinet mainstay, ibuprofen will be easily found in most abandoned supermarkets and ransacked pharmacies, so obtaining it shouldn’t be a problem. It is one of the few drugs that has both OTC and prescription-strength tablets. It may be handy to have the latter, but multiple OTC pills can always be taken to increase the dosage. Just be sure you know what dosage you’re working with and take it with food to alleviate a majority of its side effects.


Aleve bottle
Naproxen
What is it? Another NSAID, different character (Aleve)
What does it do? A longer-lasting anti-inflammatory
Why is it important? Longer lasting to keep you moving
When should you take it? For muscle/joint pain as well as arthritis

Naproxen might be considered a redundant NSAID in a list that already includes ibuprofen. Both are excellent anti-inflammatory drugs with a proven track record of effective and safe use. They’re also both available as a prescription or over the counter, which increases the likelihood of finding either in an abandoned drugstore. The differences are subtle, but deserve note: ibuprofen is commonly referred to as a 4-hour medicine, in reference to its duration of effectiveness, whereas naproxen is effective for around 12 hours. For long-term treatment of inflammatory pain, this means fewer pills to take every day. Studies have also suggested that naproxen may be better suited for arthritic pain, which will be of benefit to older folks.

Sometimes the choice between two similar medications will boil down to how each works for you personally. It’s quite amazing that although the genetic difference between individual humans is less than 0.1%, our bodies respond to drugs in dramatically different ways. Although there are plenty of NSAIDS at your fingertips, it might be that naproxen works better for you than, say, ibuprofen or aspirin. Or maybe it works the same but has fewer side effects. Either way, it’s important to stay tuned into your body and to be aware of comparable treatments.


Hydrocodone
Hydrocodone
What is it? The opiate your parents warned you about (Vicodin, Norco, Lortab)
What does it do? Makes the pain go away, quickly
Why is it important? It’s a mainstay in America; very abundant and very effective
When should you take it? For mild to moderate pain relief

Hydrocodone has become a poster child for the growing opioid epidemic here in the United States, and for good reason; it continues to be one of the most prescribed medications in the world, year after year. Those stats are useless when fighting for survival, but having it on hand can be helpful for unanticipated injuries, relentless pain, or crude surgical procedures (like when there’s no dentist to pull that infected tooth). And if the popularity of hydrocodone isn’t alluring enough, its ample stock in most pharmacies will make it easy for the average scavenger to acquire.

But as the old saying goes, “Too much of a good thing is a bad thing.” Taking hydrocodone recklessly has serious repercussions. Surprisingly, though, the danger of overuse doesn’t come from the drug itself: hydrocodone is fairly safe, aside from the typical side effects of nausea, dizziness, and constipation. The devil is in the amount of acetaminophen (Tylenol) that typically accompanies this medication. See, paired together, Tylenol and hydrocodone have a synergistic effect, making a potent pain-killing combo in medications such as Vicodin, Lortab, and Norco. These tablets contain anywhere from 325 to 750 mg of Tylenol, which can add up quickly to the 3,000 mg daily maximum dose recommended by the FDA.

Long-term use can start to put your liver in jeopardy, not to mention the massive constipation brought on by the overload of opiates in your system. But hey, in an emergency sometimes it’s best to address the need at hand and worry about side effects later. When it comes to coping with serious injuries, most people will be happy to have this medication included in a prepper’s pain medication stockpile. The take-home message is to treat narcotics with the respect that they deserve if you are using them unsupervised.


Oxycodone pills and bottle, a useful addition to a prepper's pain medication stockpile
Oxycodone
What is it? Another opiate Hall-of-Famer (OxyContin, Percocet)
What does it do? Treats serious pain that isn’t resolving with other treatments
Why is it important? A heavy-hitting painkiller for when you need grand-slam relief
When should you take it? Serious pain, elective surgery, loss of limb

If hydrocodone is the big kid in the playground, then oxycodone is the bigger and stronger kid of the schoolyard. About 50% more potent than hydrocodone, oxycodone packs the punch you need to overcome significant pain. In the Wild West, you were lucky to have a belt to bite on or a bottle of whiskey to guzzle before they pulled a bullet out of you. Now, all the pain relief from the bottom of a Jack Daniels bottle is right in the palm of your hand. And though it’s not typically the first choice for surgical procedures (that is usually IV drugs), oxycodone is very effective at treating acute or “breakthrough” pain. The key to using this prepper’s pain medication in a survival situation is dosage timing, and not allowing the pain to become intolerable and unmanageable.

Oxycodone has several attributes that are worth mentioning. First, it is available in an extended-release form (OxyContin) so that you don’t have to pause your hunting and gathering activities to take multiple pills. And unlike hydrocodone, you can get oxycodone alone without Tylenol, which mitigates the potential for acetaminophen toxicity. It’s also less likely to make you constipated than hydrocodone, which doesn’t mean much now but certainly will after a few days without a bowel movement.


Tramadol pills and bottle
Tramadol
What is it? A synthetic opiate (Ultram)
What does it do? Tames pain in a tame manner
Why is it important? Treating serious pain doesn’t have to make you a zombie
When should you take it? When it hurts but you still have to be on your toes

Pain is totally subjective, which makes it difficult to convey the intensity and duration. Pain will always be just as severe as the patient says it is, which is why most physicians will refer you to a pain rating scale (you’ve seen one hanging in the doctor’s office, with 1 having a happy face and 10 the crying face). The rule of thumb is to use the lowest effective dose that will control pain to minimize side effects. There are also factors unique to the patient and to each drug that make choosing the appropriate treatment challenging. The goal is not necessarily zero pain, but a tolerable level that allows suitable function, and in this case, suitable survival capability.

Tramadol and the two other opiates described above provide a total of three options for suitable pain management. They were all included in this list of prepper’s pain medication so that you have a choice when making pain management decisions-  it’s handy to have options in troubling times. Think of tramadol as a “functional” painkiller: strong enough to calm most pain, but light on the side effects common with most heavy-duty opioids. It has this effect not only because it is an opiate, but from its unique inhibition of norepinephrine and serotonin uptake, meaning that it also acts as a mild antidepressant.

So if you’re in pain but need to stay spry, then tramadol should be considered. And while most opiates, including morphine, hydrocodone, and oxycodone, are Schedule II controlled substances, tramadol is a Schedule III drug. That may be insignificant now, but in survival-land, that means it’s less likely to be secured in a pharmacy under lock and key, and as we mentioned earlier, an effective prepper’s pain medication collection should include pills that will be difficult to find later.

 
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