Pain Man­age­ment

Don’t over­dose on painkillers

Health & Nutrition - - CONTENTS -

Tak­ing over-the-counter or pre­scrip­tion painkillers may seem like a sim­ple so­lu­tion for chronic pain. It’s ac­tu­ally a bit more com­pli­cated, yet many adults aren’t aware of po­ten­tial prob­lems. They think that if it doesn’t re­quire a pre­scrip­tion, it’s safe. But there are some long-term health risks. Here’s what you should know about some com­monly used pain re­liev­ers.


Ac­etaminophen (Tylenol) helps re­duce fever and pain. It’s avail­able over the counter, and it’s in many types of med­i­ca­tions, in­clud­ing some pre­scrip­tion drugs. But large doses can dam­age the liver. Drink­ing al­co­hol while tak­ing ac­etaminophen can also cause

liver dam­age. Ac­etaminophen may in­crease the risk of bleed­ing if you take war­farin (Coumadin). The FDA sets the max­i­mum daily dose for the av­er­age healthy adult at no more than 4,000 mil­ligrams (mg) per day for short-term use, al­though even lower doses can be toxic to the liver in some peo­ple. It’s in so many dif­fer­ent kinds of med­i­ca­tions that you may in­ad­ver­tently take too much. Such med­i­ca­tions in­clude over- the-counter reme­dies for pain, sleep, or cold symp­toms.


Non­s­teroidal anti-in­flam­ma­tory drugs (NSAIDs), such as ibupro­fen (Advil), naproxen (Aleve) or as­pirin, are avail­able over the counter, and in stronger doses by pre­scrip­tion. Like ac­etaminophen, NSAIDs re­duce fever and pain, and they go fur­ther by re­duc­ing in­flam­ma­tion. But reg­u­lar, long-term use of NSAIDs has been linked to ul­cers, stom­ach bleed­ing, kid­ney prob­lems, high blood pres­sure, and in­creased risk of heart at­tack or stroke. The FDA warned that NSAIDs raise the risk for heart at­tack and stroke even with short-term use, and even among peo­ple who don’t have heart dis­ease.


Opioid med­i­ca­tions, such as oxy­codone (Oxycon­tin) and hy­drocodone (Vi­codin), are among the most com­monly pre­scribed pre­scrip­tion painkillers. They block mes­sages of pain to the brain and re­duce the body’s per­cep­tion of dis­com­fort. But long-term use of opi­oids comes with the

risk of de­pen­dence, ad­dic­tion, con­sti­pa­tion, falls, con­fu­sion, slowed re­ac­tion time, slowed breath­ing, and death. For older adults, the most com­mon cause of pain is os­teoarthri­tis. And the best pre­scrip­tion med­i­ca­tions for that are opi­ates. About two mil­lion peo­ple in the United States strug­gle with opioid ad­dic­tion. Neu­ron­tin (gabapentin) is an an­ti­con­vul­sant med­i­ca­tion of­ten pre­scribed for nerve pain. It’s less risky than NSAIDs and opi­oids, but it has its own risks, such as se­da­tion, cog­ni­tive im­pair­ment, dizzi­ness, and falls.


When tak­ing painkillers on a reg­u­lar ba­sis, weigh the risks and ben­e­fits with your doc­tor. For gen­er­ally healthy older adults with chronic pain, ac­etaminophen is rec­om­mended. It’s the first-line choice for os­teoarthri­tis, but for long-term use, limit the daily dose to 2,000 mg or less. NSAIDs should be avoided if hav­ing high blood pres­sure, heart dis­ease, or kid­ney prob­lems, or if you’re tak­ing blood thin­ners. Oth­er­wise, use the low­est dose pos­si­ble for the short­est amount of time, and avoid NSAIDs once you reach the age of 60. Above 60, the data shows sig­nif­i­cant risks, and they in­crease by decade. Ac­etaminophen should be com­bined with pill-free treat­ments (see box) be­fore try­ing pre­scrip­tion painkillers. If you take pre­scrip­tion painkillers, ask a fam­ily mem­ber to hold and su­per­vise your med­i­ca­tions, and give you only what’s pre­scribed and needed.

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