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Medication Class — Pain Control

Medication Class Description:

Pain control medications fall into four broad categories.  Two are authorized and two are not approved.   The authorized types include non-steroidal anti-inflammatory medications (NSAIDs) and acetaminophen (Tylenol and other 'non-aspirin' pain relievers) and the newer class of COX-2 inhibitors (Celebrex and Vioxx).  Celebrex can be used after a 48 hour ground test period shows no side effects.  Merck announced a voluntary withdrawal of Vioxx  from the U.S. and worldwide market due to safety concerns of an increased risk of cardiovascular events (including heart attack and stroke) in patients on Vioxx. Vioxx is a prescription COX-2 selective, non-steroidal anti-inflammatory drug (NSAID).  Acceptable alternatives include Celebrex and Bextra.

The prescription medication Ultram is prohibited for use when flying. Though not a narcotic by chemical make-up, Ultram is a potent pain reliever that has warnings of potentially causing physical and psychological dependence.  Its' side effects include malaise, confusion and a lowered seizure threshold.

The non-approved types include narcotics for short-term relief of severe pain and antidepressant medications (even in very low doses) for long-term chronic pain relief.   Both have the potential to impair alertness and judgement.  Narcotic type medications may also give a positive result on DOT drug testing programs.  Another medications, Neurontin (gabapentin), is sometimes used to affect conduction of pain at the nerve level.  Unfortunately, it also has an unacceptable side effect level and is not allowed by the FAA.

Local anesthetics, such as Lidocaine and Novacaine, do not have any minimum period of observation after injection before flying in the current FAA policy. Military pilots generally have an 8-12 hour waiting period before flying.  Pilots should be able speak clearly before flying after receiving an oral injection.  For suturing and other procedures using local anesthetic, the underlying injury should not interfere with pilot duties.  Caution:  some skin wounds, particularly facial wounds, sometimes receive an anesthetic containing cocaine ("TAC").  There is a remote possibility that large doses could result in a positive drug test within 24 hours.   Although the names are similar to cocaine, Lidocaine and Novacaine are not related and will not cause a positive drug test.

Medications Within Class:

Vioxx, Celebrex, Tylenol, Apirin, NSAIDS, Ultram, Lidocaine, Novacaine, TAC, Bextra, Neurontin (gabapentin), Elavil