What is good pain medication for post partial nail avulsion (removal) for ingrown toenail (onychocryptosis)?

From the Guidelines

For pain management after a partial nail removal for an ingrown toenail, I recommend starting with over-the-counter acetaminophen (Tylenol) at 650-1000mg every 6 hours or ibuprofen (Advil, Motrin) at 400-600mg every 6 hours as needed, as these are effective for treating mild to moderate pain, according to the most recent and highest quality study available 1.

Key Considerations

• The choice between acetaminophen and ibuprofen depends on the patient's individual needs and medical history, with ibuprofen having the added benefit of reducing inflammation but requiring food to prevent stomach irritation.
• Elevating the foot above heart level for the first 24-48 hours can help reduce throbbing pain and swelling.
• Applying ice wrapped in a towel for 15-20 minutes every 2-3 hours during the first day can also aid in pain management.
• Keeping the surgical site clean and covered as directed by the healthcare provider, changing the dressing daily, is crucial for preventing infection.

Pain Management Strategy

• The basic analgesic regimen should include a combination of paracetamol and a non-steroidal anti-inflammatory drug, as recommended by the most recent study 1.
• Opioids should be reserved as rescue analgesics in the postoperative period, as they are not typically necessary for mild to moderate pain management after a partial nail removal.
• The oral route of administration of analgesic drugs should be advocated as the first choice, as it is the most convenient and effective method for managing pain in this context.

Monitoring and Follow-up

• Patients should be informed about pain and pain management and be encouraged to take an active role in their pain management, as recommended by the study 1.
• The intensity of pain and the treatment outcomes should be regularly assessed using visual analogue scales, verbal rating scales, or numerical rating scales, to ensure that the pain management strategy is effective.
• If pain worsens, is accompanied by increasing redness, warmth, or discharge, the patient should contact their healthcare provider, as these could indicate an infection requiring additional treatment.

From the FDA Drug Label

For patients with moderate to moderately severe chronic pain not requiring rapid onset of analgesic effect, the tolerability of tramadol hydrochloride tablets, USP can be improved by initiating therapy with a titration regimen: Good pain management practice dictates that the dose be individualized according to patient need using the lowest beneficial dose.

Tramadol may be considered for post partial nail removal for ingrown toe nail pain, as it is indicated for moderate to moderately severe chronic pain. However, the dose should be individualized according to patient need using the lowest beneficial dose.

• The recommended initial dose and titration regimen should be followed as outlined in the label.
• It is essential to note that tramadol is a systemic medication, and its use should be weighed against potential risks and benefits, especially in patients with certain medical conditions or taking other medications. 2

From the Research

Post Partial Nail Removal Pain Management

For post partial nail removal due to ingrown toenail, pain management is crucial for a comfortable recovery.

• The studies 3, 4 do not specifically mention pain medication for post partial nail removal.
• However, they discuss various treatment approaches for ingrown toenails, including surgical and conservative methods.
• Partial nail avulsion is a common surgical approach for treating ingrown toenails, and it may involve some postoperative pain.
• While the studies do not provide direct recommendations for pain medication, they suggest that partial nail avulsion followed by phenolization or direct surgical excision of the nail matrix are effective treatments for ingrown toenails 3.
• It is essential to follow the doctor's advice for postoperative care and pain management after partial nail removal.

Treatment Approaches

The treatment approaches for ingrown toenails can be categorized into:

• Conservative approaches, such as soaking the foot in warm water, using topical or oral antibiotics, and proper nail-trimming technique 4.
• Surgical approaches, including partial nail avulsion, complete nail excision, and phenolization 3.
• Other options, such as electrocautery, radiofrequency, and carbon dioxide laser ablation of the nail matrix 3.