Prepper’s Pain Protocol- Part 1, by ShepherdFarmerGeek

We are talking about a pain protocol for preppers. However, the editor’s have an important message before we get started.

Editor’s Introductory Proviso: I’m not a doctor, and I don’t give medical advice. Mentions of any medicine or medical treatment is for informational purposes only and are in no way endorsed or accredited by, or its principals. is not responsible for the use or misuse of any product advertised or mentioned on the SurvivalBlog site. – JWR

What Do We Do?

What do we do when someone has been shot, survived a grizzly mauling, has been significantly burned, or has been crushed by a falling tree or rock or vehicle accident? We do our best to get them to advanced medical care, calling for help on our cellphone or using our satellite messaging service to send rescuers our exact location. But what if none of that is available, or what if there’s going to be a long delay getting the victim to help? Is there something more we can do?

“Pain Pack” With or Without Prescription

If you’re like most preppers, you don’t have a prescription bottle of Morphine on hand. And you don’t think dosing your friend or child with a big swig of whiskey (or two) is all that good of an idea. Well, one option is the non-narcotic, over-the-counter “Pain Pack™” concept and promoted by Next Generation Combat Medic as “just as good for moderate pain as oxycodone, hydrocodone and even codeine.”

Please read all their original information. What follows is but a small tweak of the “Pain Pack™” plan that I’d like to call the “Prepper’s Pain Protocol.” I’m not a “medical” anything, much less an “expert” in anything. But I know a good thing when I see it. The days/months/years ahead, whenever our national crisis finally kicks off, are going to have an abundance of pain, ours and others. And we need a better strategy for pain control.

Pain Pack Initial Insight

The basic insight of the “Pain Pack™” is that a normal person in good health can safely take a full dose of Tylenol (acetaminophen, 1,000 mg) and a full therapeutic dose of ibuprofen (800 mg) simultaneously, because their mode of action is different. This combination should suffice for all moderate pain. The Tylenol is taken first, and then one hour later the ibuprofen. These meds should take full effect then in about an hour and 20 minutes or so.

After that, if the victim is still experiencing severe pain, the “Pain Pack™” website provides for a small amount of oxycodone that acts in addition to the Tylenol and ibuprofen to provide maximum analgesia with a minimum amount of opioid painkiller.

Don’t Have Pain Pack with Oxy?

But what if you have not been prescribed the “Pain Pack™” with oxy? What then? Well, for starters the Tylenol and ibuprofen combination is quite effective. (Just don’t expect it to take away all of the pain. Most narcotic analgesics don’t even do that!) But, there is more that you can do. Let’s look at several startegies.

Strategy #1

Strategy #1 is to add a bit of caffeine, once it’s clear that the Tylenol and ibuprofen aren’t quite enough. This would be the “Preppers Pain Protocol” (PPP). Why caffeine? Well, medications like Excedrin Extra Strength and Tylenol Ultra Relief include caffeine, because it’s a synergist

Caffeine Amplifies

It amplifies the effect of the Acetaminophen. And it amplifies the effect of the ibuprofen. For example, the maximum dose– two tablets– of Excedrin Extra Strength contains 130 mg of caffeine (along with Tylenol and Aspirin). Another example is Tylenol Ultra Relief. Two tablets (the maximum dose) contain 130 mg of caffeine.

Caffeine in Coffee

One 8 oz cup of coffee typically contains up to 150 mg of caffeine. I don’t know anyone who only drinks one cup! And no one would blink an eye at having a couple of cups of coffee with their Tylenol and nasty headache. We’re not talking about a lot of caffeine here.

(Yes, there is a study that says that taking megadoses of Tylenol and caffeine, as in energy drinks, is a bad idea. More is not always better! Clearly the combination seems safe as long as you don’t go crazy with the caffeine, the Tylenol, or the ibuprofen.

How to Add Caffeine

So, how do you add caffeine to your Tylenol + ibuprofen dose? You could sip one or two cups of coffee, but if you’re in that much pain maybe that’s not such a good idea. A better idea is probably just to take one 100 mg tablet of caffeine.

Why tablets? You can then cut an additional tablet and add a quarter tablet of caffeine every 20 minutes, only if needed, until your victim doesn’t experience any additional analgesia. The commercial formulations contain only 130 mg of caffeine so you’re not going to go much beyond that, because it’s not going to help, and you’re only going to give your victim the jitters and jack up their heart rate, right? (A note to the caffeine junkies: too much daily caffeine might just create a tolerance for it to the point that it might not give you the benefits it could when you really need it. This is something to consider.)

The Tylenol + ibuprofen + caffeine combination obviously isn’t going to be as effective as the official prescription “Pain Pack™” that includes oxycodone, but it will be better than just straight Tylenol and ibuprofen.

Start High and Work Low

My unscientific recommendation, if you’ve got a family member or friend in excruciating pain, is to “Start high and work low.” In other words, start them at the maximum amount of analgesia with the 1,000 mg Tylenol + 100 mg of caffeine and then add the ibuprofen an hour later. If it was me in agony, I’d want to start at the max!

Then, when it comes time for the second combination dose, 6–8 hours later, cut back the caffeine or omit it entirely (again, Tylenol, then ibuprofen an hour later). If their pain level jumps, then add the caffeine back in. It’s simple enough. At each re-dosing, try to cut back the caffeine first, and then start cutting back on the Tylenol and ibuprofen too. Your goal is to quickly determine the lowest effective dose and give that.

Dose For Only Five Days

The official “Pain Pack™” website envisions giving this dosage combination for only five days. Why? Because it’s hard on your heart, your liver, your kidneys, and it can mess with blood coagulation. (And that’s why the combination does not include Aspirin, because a lot of these severe pain scenarios involves bleeding.) Hopefully by five days your victim has begun to heal from his/her injuries.

Strategy #2

There’s a second strategy I’d like to briefly mention for preppers who happen to live near the Canadian border or who travel to Canada. Strategy #2 follows:

Commercial Med Combinations Available OTC in Canada

For decades commercial combinations of Aspirin + Caffeine + Codeine and Acetaminophen + Caffeine + Codeine have been readily available over the counter in Canada. Many Americans, especially those living along the Canadian border, are aware of these products and have legally brought small quantities back to the States after visiting. There was recently a move by the Canadian government to make all medications containing even small quantities of Codeine available by prescription only. However, I don’t know if it’s been finalized.

Federal Regulations

At the end of this article you’ll find the section from Title 21 Code of Federal Regulations that appears to cover this situation. That said, I’m not a lawyer and this is not legal advice, I’m simply referring readers to this section. Read it.

If you’re one of those Americans who legally brought a small quantity back home with you in the past, or these Canadian over-the-counter products are still available, you can substitute two tablets of the Acetaminophen + Caffeine + Codeine formulation for most of the Tylenol and additional caffeine. And that would be the maximum analgesia you can legally reach without a doctor’s prescription.

Canadian Pills

Each maximum dose (two tablets) of these Canadian pills contains 600 mg of Acetaminophen + 30 mg of Caffeine + 16 mg of Codeine (that slowly metabolizes in your body to become an even tinier dose of Morphine).

So, you could add a tablet of plain Regular Strength Tylenol (325 mg) to these two tablets to bring the Acetaminophen total up to 925 mg (or shave off 1/5 of a 500 mg tablet to bring the total to 1,000 mg). And you could add a half tablet of Caffeine to bring the caffeine dose up to 80 mg. And add the 800 mg of ibuprofen one hour later. Voila! I’ve attached two compact summary sheets that you can print, cut down and laminate, one for the basic “Prepper’s Pain Protocol” and one for the PPP + Codeine.

Never Add Alcohol!

NOTE: Never add alcohol to these combinations of over-the-counter medications. It’s going to create more problems than it solves. Don’t do it.

Tomorrow, we will continue with what to do if the above plan is still not enough pain relief.

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  1. While severe pain is a problem and must be handled, I personally feel that pain is over rated by the medical world and society. We as a society have decided that there should never be any pain. I find it more acceptable to regard pain as a normal body function and understand that it is the natural way to handle healing. I damaged my rotator cuff a few years back and they wanted to prescribe pain killers and schedule surgery for it. I did not use the pain killers nor did I have the surgery. It healed and while I still have some pain, if I had covered up the pain, I would have continued to damage the shoulder and it would not have healed. I also find the using a combination of over the counter pain killers more effective than a single one, ibuprofen followed a few hours later by aspirin seems to be more effective than only taking one of them. The Bible only condoned the use of the extreme pain killers of that time for the terminally ill. Proverbs 31:6 still is a good guide to the proper use of medication and a way to keep from becoming an addict, legal or illegal.

    1. Taking too much Ibuprofen will ruin your kidneys too…possibly due to the high blood pressure. I took a lot of ibuprofen over the years and have high blood pressure and bad kidneys…Take that into consideration if you have any kidney issues.

    2. The research articles I’ve seen only document a SMALL blood pressure increase, insignificant in my opinion. – “We conclude that ibuprofen at doses as high as 2400 mg/d for up to seven days has no effect on blood pressure in normotensive women.” – “NSAID users had a 2 mmHg increase in systolic blood pressure (95% CI, 0.7 to 3.3). Ibuprofen was associated with a 3 mmHg increase in systolic blood pressure compared to naproxen (95% CI, 0.5 to 4.6), and a 5 mmHg increase compared to celecoxib (95% CI, 0.4 to 10).”

      Read the research, not the medical column rehash that is often not up to date with the best data. That said, everyone reacts slightly differently to medications – this is why you need to monitor the vitals of EVERYONE taking this Protocol.

  2. 1) My understanding is that the Army uses meloxicam (Mobic) with Tylenol in its IFAK kit because they don’t promote bleeding the way other NSAIDs do: (scroll down to para 10 )

    Unfortunately, Mobic requires a prescription, although a doctor might be willing to give one since it is unlikely to be scanned by government regulators the way opoids are.

    2) For medical problems other than wounds, bleeding might be less of a concern.

    1. Caution: If you are prone to fluid retention, Mobic (Meloxicam) can cause and/or exacerbate fluid retention (Pitting Edema) in the lower extremities.

      Be sure to elevate the feet if this happens and weigh the pros and cons before continuing the dosage.

  3. Thanks for the article. The NOLS Wilderness Medicine folks include the 1,000mg acetaminophen/800mg ibuprofen dosage in their wilderness first aid training, so I got a bunch of those small pill dosage plastic ziplock baggies at my local drug store and put 2 x 500mg acetaminophen and 4 x 200 mg ibuprofen pills in each one, and put a couple of baggies in each of my first aid kits. I’ll go back and add a 100mg caffeine to each baggie. Just a suggestion – I also include a package of adult-dose aspirin in every kit for potential heart attack scenarios.

  4. Good article. Puts somethings in context and offers some good advice.

    I would warn people about two things. Pain medications like oxycodone are under attack because 60,000 or so people die each year by abusing drugs. First of all most of those deaths are the result of either fentanyl use OR gross misuse of prescription drugs like oxycodone and it’s variations. For many the goal is to reduce and perhaps eliminate your access to effective pain drugs and they are misrepresenting these drug deaths to do just that. If you undergo a serious operation you will be so happy that they have effective pain killing drugs available to help you. Do let them take these away from doctors by restricting the doctors ability to prescribe them.

    Oxycodone does not jump out of the bottle and “hook” you one opioids. This is scare talk. You MUST abuse them to get hooked on them. ALL the people who took opioids and died were NOT following a prescription to “take one every 6 hours as needed for pain”. In fact in most cases they were crushing multiple pills and consuming them in every imaginable way. I have a bottle of oxycodone on my bureau, it has sat there for almost three years now, and not once has it begged me to take some.

    One last point; for years the most dangerous drugs sold in drugstores were aspirin and tylenol. These drugs killed a lot of people. Most of those deaths were not the result of intentional misuse of the drug but more the result of innocent overuse. (I say “innocent overuse” because there is no high from taking 6 aspirin or tylenol and usually when people over use these drugs they do so to relieve pain and are unaware that these drugs can be harmful if used to excess.)

    I can guarantee you that if you consume 50 tylenol that you will be dead in a week or two from liver failure. Similar results from aspirin overdose. The bottom line is be careful with all drugs; prescribed and over the counter. But also be careful about those who would like to remove/restrict opioids from the doctors control.

    1. As a former prescription pain user I agree with everything you said. I have been on high doses of rx pain medications for many years. Now, I am on a tiny dose. All of the pain management doctors are now refusing to treat me. Everyone is running scared of the government. I went from 100MCG of Fentanyl patch to 12 MCG. I used to live a pretty normal life, now, I spend a lot of time in bed because the pain is overwhelming. I hope for all of us that truly need our pain medications that the government will make some changes to their restrictions. As a side note, my insurance company has raised all of my co-pays for narcotic pain relievers. It just seems fair that I pay more to get less???

    2. Bravo OneGuy. The “opioid crisis” is being blown all out of proportion and is far more related to illegally obtained drugs than to prescribed medications. Sure, pain is a natural process (so is death) and it’s very useful to identify where there is a problem. But excruciating chronic pain serves no good end. We have a moral obligation to try to assist people who are suffering in this way.

  5. For someone who is a self professed “not a medical anything”, ShepherdFarmerGeek is giving inaccurate medical advice!! I concur with Nurse Kim’s statement. One NEVER gives ibuprofen to anyone initially with a traumatic injury. It will amplify bleeding. Furthermore, as a physician with over 34 years of real world experience that has treated many individuals with “moderate” pain and as one who personally has had moderate to severe pain, I can attest to the lack of efficacy of the combination of acetaminophen and ibuprofen for “moderate pain”. Or perhaps it is all in how “moderate pain” is defined. Pain is a very subjective issue, despite the attempts to define it on a scale. It is not as “cut and dry” as the scales would lead one to believe. One person’s “moderate” is not another’s “moderate” despite attempts to standardize it. As to the “Pain Pack” reference, the web site promoted has several flaws when generalized to the entire scope of pain. If one looks at the “Next Generation Combat Medic” reference, the drugs that are promoted do not include Acetaminophen but rather uses IV Hydrocortisone, Ibuprofen, possibly Paracetamol and IV or IM Ketamine. These are hardly available in the bush and beyond the average individual’s ability to self administer them. Furthermore, if one does take the aforementioned “Pain Pack” combination, there is no rational reason to delay the Ibuprofen for one hour. I am not arguing for the use of opioids where other drugs will suffice and also not arguing for merely biting on a stick; however, the “Pain Pack” idea for the purposes this article promotes are not entirely rational and potentially harmful. Note, even the article’s author endorses use of Canadian opioids in “Strategy # 2”.

    1. 1) ShepherdFarmerGeek is not giving medical advice — he is passing on info that might be helpful in circumstances where a doctor is not available. That is what this blog is about.

      2) The utility of acetaminophen and ibuprofen with coffee for moderate to even severe pain has been noted in several medical sources:

      An extract:
      “Opioids have been used for thousands of years in the treatment of pain and mental illness. Essentially everyone believes that opioids are powerful pain relievers. However, recent studies have shown that taking acetaminophen and ibuprofen together is actually more effective in treating pain. ”

      See also

      (Note: Lower rating -> more effective.
      Note: Paracetamol is another name for acetaminophen )

      3) As I noted in a prior post, the military’s TCCC guidelines use the NSAID Mobic with acetaminophen for mild to moderate pain in soldiers’ first aid pack, although they use the opioid fentanyl for more severe pain PROVIDED the soldier is not at significant risk of shock or respiratory distress. In the source I cited, the TCCC guidelines indicated that katamine would be used for severe pain if shock or respiratory distress was a threat.

      Obviously you don’t want to promote bleeding if the medical problem is a wound. But a dentist prescribed a strong dose of ibuprofen for me after dental surgery whereas in the past I had gotten tylenol with codeine. The ibuprofen worked — although my understanding is that prolonged use of stronger doses can damage the liver.

    2. Medical Onocologist,

      I was wondering what level of training is needed to start making educated decisions when it comes to medical issues like this and no MD/RN is available. I’ve been through basic “keep them alive” first aid training in the military (tourniquets, cpr, shock, evaluation, stopping blood loss) and I’m not in a position to become a nurse or MD (I’d be at retirement age by the time I finished).

      What I can do is invest money and time into maybe one serious class/certification, but probably not more than one. The options I see are: nonstandard civilian versions of the Army Combat Medic class, EMT , Wildernesses EMT and Paramedic courses.

      Can you recommend a baseline level of training?


    3. Bro, it’s not my advice. This is a pain treatment protocol that is widely used. If the victim is bleeding heavily and you haven’t been able to stop it or if they’re already hypovolemic you have bigger issues than pain control. Treating the pain is lower on the food chain than the lifesaving priorities.

      There are trade-offs with every single thing you do to/for a trauma victim. The PPP is just one tool in the toolbox. And having personally experienced excruciating pain I’ve gotta tell you I’m glad to have something helpful that I can use for myself and others when its appropriate.

    4. Acetaminophen is the same as paracetamol.

      I get migraines. Sometimes very bad migraines. Taking either acetaminophen (paracetamol) or ibuprofen alone doesn’t touch them. Taking the two together, sometimes with added caffeine, usually does the trick. Brand-name Excedrin is aspirin, acetaminophen, and caffeine together. I can’t take aspirin, so my doctor suggested I take the acetaminophen/ibuprofen/caffeine combination, instead.

      If that doesn’t work, then I have to resort to codeine or hydrocodone. I can’t take triptans. I hate taking codeine or hydrocodone because they make me itch.

  6. There is a otc product out there called Goody’s extra strength headache powders. It comes in folded paper packets. It contains 260 mg acetaminophen, 520 mg aspirin, 32.5 mg caffeine and 60 mg potassium. Not the dosages recommended in the article but pretty effective on more moderate pain

  7. Dr. Kathy had something similar in her book and taught in her classes.

    After a surgery that I was told I would be in “significant” pain I was given some pain meds. I decided to try the other route and used them for pain without any issues. I guess everyone’s definition of “pain” is different but it worked for me.

  8. I have tried the acetaminophen and ibuprofen combination and found 500 mg acetaminophen and 400 mg ibuprofen to provide much more effective pain relief than either alone. Higher dosages are more likely to cause nausea or gastrointestinal discomfort without much increase in pain relief. Diclofenac is a non-opiod/non-controlled nsaid pain reliever that is also a useful option. But, keep in mind that any nsaid may promote bleeding.

    But, if maximum mental alertness does not need to be maintained, vicodin (hydrocodone/acetaminophone) or percocet (oxycodone/acetaminophen) is more effective.

  9. Keep in mind that some prescription generic opioid painkillers are inexpensive. The cost of the office visit to get the prescription far exceeds the cost of the drug in most cases. For example, I recently filled a prescription for norco 10/325 (10 mg hydrocodone, 325 mg acetaminophen) at costco using the gold discount. Cost for 60 tablets was $12.55 Using the free non-gold discount, it would have been $16.74 at costco or safeway. This is not a copay, but rather the discounted self-pay price. Costco also has their own free prescription med discount program which provides even lower prices in some cases.

  10. I am two weeks into recovery from back surgery. L3-L4 fusion. The only pain meds used are Tylenol and a prescription nsaid. I did not want to use any opioids after surgery and God has been faithful to provide the relief.

  11. Thank you for an excellent article. Please allow me to add one caution. The combination drugs, Opioids: vicodin and percocet both contains tylenol or Acetaminophen. When you look at the directions and precautions for this drug Acetaminophen, there is a warning for the maximum daily safe dosage. Don’t forget to add in the amount of Acetaminophen contained in the combination opioid drugs to the total safe daily dosage. Also, keep in mind, that daily safe dosage reduces with advancing individuals age. It is generally recommended that persons of advancing years not exceed 1,000 mg Acetaminophen in 24 hours to prevent liver damage. In addition to increased bleeding with ibuprofen, again one must use caution and follow directions carefully as kidney failure is possible with too high a dosage and or long periods of use. Key word is caution. Again, thank you for a good article.

  12. You can also get OTC opioids in Mexico. In England, you can go to Boots Pharmacy and get Nurophen Plus, a combo of ibuprofen and codeine. (You have to get it directly from the pharmacist at the window.) Works like a charm, for short-term pain management.

  13. Respectfully, ShepherdFarmerGeek IS giving MEDICAL ADVICE despite being “not a medical anything”. The references given by Don Williams clearly have an agenda and are biased. Placebos have a documented efficacy for pain, but if they work then fantastic. So does acupuncture. Let’s not get into that issue. Sure, we are looking for blog information when a Physician is not available. Let’s not over react when incorrect information is presented.

    1. 1) A week or so ago, in a discussion of vaccines I noted my respect for peer-reviewed science over voodoo alternative medicine lacking any discipline. Although I noted that SOME folk medicine has a long history of effective treatments even when the scientific basis was not understood–e.g, foxglove for heart ailments, well before the effective ingredient –digitalis –was identified. The proof is in the FACTS.

      But that cuts both way. Last time I checked, the Journal of the American Medical Association carried some weight with doctors. From

      “Question Do any of 4 oral combination analgesics (3 with different opioids and 1 opioid-free) provide more effective reduction of moderate to severe acute extremity pain in the emergency department (ED)?

      Findings In this randomized clinical trial of 411 ED patients with acute extremity pain (mean score, 8.7 on the 11-point numerical rating scale), there was no significant difference in pain reduction at 2 hours. Mean pain scores decreased by 4.3 with ibuprofen and acetaminophen (paracetamol); 4.4 with oxycodone and acetaminophen; 3.5 with hydrocodone and acetaminophen; and 3.9 with codeine and acetaminophen.

      Meaning For adult ED patients with acute extremity pain, there were no clinically important differences in pain reduction at 2 hours with ibuprofen and acetaminophen or 3 different opioid and acetaminophen combination analgesics.”

  14. Since the efficacy of any pain relief medication is “subjective” relative to the patients pain threshold and the most effective among them are either illegal or strictly controlled (Big Money-Big Brother). The information given, taken with lots of water (and a grain of salt) along with a healthy dose of discretion, is likely to provide the patient as much relief possible. As much as one could expect without medical intervention (Paging Dr. FRN….) or a late night no knock from your friendly neighborhood constabulary…
    I would offer the same advice as I suffer from severe joint pain and swelling. I find that alternating / combining OTC’s provide the best results.

  15. Cannabis was listed in the US Pharmacopeia 1850-1941. Main indication was pain. The Squibb catalog of 1906 lists describes as anodyne (pain reliever), narcotic, sedative, hypnotic (induces sleep), and antispasmodic. Antidote: caffeine. The National Academy of Medicine in 2017 stated effective for chronic pain. The Randomized Clinical Trials used in the meta-analysis showed a 30% pain reduction compared to placebo. Fascinating articles on older medical use for pain in Dr Todd Mikuriya’s Medical Marijuana Papers (1839-1972) and recent book Cannabis Pharmacy. Approved in 29 states for severe pain; Schedule 1 N (non-narcotic) under current federal law with no currently accepted medical use. All above in public domain. Its in Sir Wm Osler’s textbooks of medicine 1992 to at least 1913 editions. See also My Medicine, a book by a federal marijuana cigarette patient since 11/82. He told the FDA in 1978, Cannabis enabled him to get off Dilaudid and other opioids.

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