What are the best treatments for body pain caused by excessive coughing?

Treatment of Body Pain from Excessive Coughing

For body pain caused by excessive coughing, use ibuprofen 400 mg as your first-line analgesic, as it provides superior pain relief compared to acetaminophen and has an excellent safety profile at over-the-counter doses. 1, 2

Immediate Pain Management Strategy

First-Line Analgesic Treatment

• Ibuprofen 400 mg should be your primary choice for musculoskeletal pain from coughing, as it demonstrates superior efficacy to acetaminophen 1000 mg in pain relief studies 2
• Dosing can be up to 1200 mg daily (400 mg three times daily) for over-the-counter use, which has a safety profile comparable to acetaminophen 1, 3
• At these OTC doses, ibuprofen carries low risk for gastrointestinal, cardiovascular, or renal adverse events 1
• Ibuprofen's anti-inflammatory properties specifically address the musculoskeletal inflammation caused by repetitive coughing 1

Alternative Analgesic Options

• Acetaminophen up to 3000 mg daily can be used if ibuprofen is contraindicated, though it is less effective for this type of pain 2, 3
• Avoid aspirin as it has significantly more adverse events than ibuprofen at comparable doses 3

Concurrent Cough Suppression

You must simultaneously treat the underlying cough to prevent ongoing muscle strain. The analgesic only addresses symptoms while the cough perpetuates the injury.

For Acute Viral Cough (Most Common Cause)

• Start with honey and lemon as first-line treatment - these are as effective as pharmacological options and have no adverse effects 4, 5
• If pharmacological treatment is needed, use dextromethorphan 60 mg for maximum cough suppression (not the subtherapeutic 30 mg found in most OTC preparations) 4, 5
• For nocturnal cough disrupting sleep and causing nighttime muscle strain, add first-generation sedating antihistamines 4, 5

For Postinfectious Cough (Persisting After Viral Illness)

• Trial inhaled ipratropium first before central antitussives 4, 5
• If ipratropium fails and quality of life is significantly impaired, consider inhaled corticosteroids 4
• For severe paroxysms causing significant body pain, prednisone 30-40 mg daily for a short course may be warranted after ruling out other causes 4, 5

Clinical Algorithm for Combined Management

1. Assess cough duration and characteristics:

   • Acute (<3 weeks): Likely viral, treat symptomatically 4
   • Subacute (3-8 weeks): Consider postinfectious cough 4
   • Chronic (>8 weeks): Requires diagnostic workup for underlying causes 4

2. Initiate dual therapy:

   • Ibuprofen 400 mg three times daily for body pain 1, 2
   • Honey and lemon for cough suppression 4, 5
   • Add dextromethorphan 60 mg if honey alone insufficient 4, 5

3. Escalate if needed:

   • For postinfectious cough: Add ipratropium 4, 5
   • For severe paroxysms: Consider short-course prednisone 4, 5

Important Safety Considerations

Ibuprofen Precautions

• Check for contraindications: active GI bleeding, severe renal impairment, aspirin-sensitive asthma 1
• At OTC doses (≤1200 mg/day), cardiovascular risks are minimal and lower than with some other NSAIDs 1
• Short plasma half-life and lack of toxic metabolites contribute to favorable safety profile 1

Dextromethorphan Precautions

• Verify combination products don't contain additional acetaminophen when using higher 60 mg doses to avoid acetaminophen toxicity 4, 5
• Do not use if pneumonia suspected (tachycardia, tachypnea, fever, abnormal chest exam) 4
• Avoid in productive cough where secretion clearance is beneficial 5

Common Pitfalls to Avoid

• Using subtherapeutic dextromethorphan doses (30 mg) when 60 mg provides maximum suppression 4, 5
• Prescribing codeine-based antitussives, which have no greater efficacy than dextromethorphan but significantly more adverse effects 4, 5
• Treating pain alone without addressing the cough, allowing continued muscle strain 4
• Continuing antitussive therapy beyond 3 weeks without diagnostic workup 5
• Missing underlying causes like GERD, asthma, or medication side effects (ACE inhibitors) that require specific treatment 4