WHICH PAINKILLER SHOULD YOU BE POPPING?
As worrying research reveals the dangers of long-term aspirin use...
ALMOST ten million people in the UK suffer pain nearly every day and many of them resort to popping pills to dull the ache. Millions more take painkillers for a whole range of conditions. Daily low doses of aspirin, for example, are taken by around 40 per cent of pensioners to ward off heart attack and stroke because of the drug’s blood-thinning properties.
But could these medicines be doing more harm than good?
Last week, researchers warned that healthy older people who choose to take low-dose aspirin daily could be putting themselves at risk of potentially fatal internal bleeding. The study, published in the New England Journal of Medicine, looked at 19,000 people in the US and Australia and found that healthy people over 70 gained no benefit from taking aspirin daily, and were more at risk from major stomach bleeds.
The study adds to mounting evidence that over-the-counter painkillers are having an unintended impact on our health, with rising cases of liver damage, addiction, and heart and kidney problems linked to commonly available tablets. So which pills should you be taking and what are the side effects to watch out for? We spoke to the experts to find out…
ASPIRIN WHAT SHOULD YOU TAKE IT FOR?
ACCORDING to NHS Direct, aspirin is not now usually recommended to treat simple pain because it’s not as effective as ibuprofen. However, adults wanting to reduce fever or target mild toothache, headache and a common cold should take 300mg once daily. A 75mg oncedaily dose may be recommended by a doctor to reduce risk of blood clotting and help prevent heart attack and strokes if you are at increased risk of these problems. You can gargle with 300mg of aspirin in water for a sore throat. Some studies suggest that taking aspirin regularly may help to reduce the risk of developing colorectal cancer.
WHY YOU NEED TO BE CAREFUL
SIDE effects include stomach pain, because acetylsalicylic acid can thin the protective mucous barrier of the stomach. This can lead to damage and bleeding of the stomach wall. ‘You can reduce this risk by taking aspirin with a meal or choosing a coated or soluble version which passes through the stomach without causing damage,’ says Sid Dajani, spokesman for the Royal Pharmaceutical Society.
Professor Peter Rothwell, a clinical neurologist at Oxford University, who has carried out major studies into the risks and benefits of taking aspirin, says healthy people over 70 who take low-dose aspirin to minimise their risk of heart attack or stroke should wean themselves off the drug. ‘If you haven’t had a previous heart attack or stroke, it really is of little benefit,’ he says. Aspirin should never be given to children under 16 because it can cause the rare, though potentially fatal, Reye’s syndrome.
PARACETAMOL WHAT SHOULD YOU TAKE IT FOR?
PARACETAMOL is used to treat mild to moderate pain or sprains, as well as colds and fevers. The safe dose for adults is two 500mg tablets up to four times a day. Paracetamol is good for controlling ‘non-nervy pain’, according to Dr Ganesan Baranidharan, consultant in anaesthesia and pain medicine at Leeds University. ‘Nervy pain, originating from problems with the nerves, often feels like a burning or stabbing pain,’ he says. ‘Non-nervy pain is more like a dull ache due to inflammation, arthritis, or an injury such as a sprain.’
WHY YOU NEED TO BE CAREFUL
SIDE effects are rare and the drug can be taken daily almost indefinitely. However, taking more than the prescribed dose can lead to potentially fatal liver poisoning. ‘The problem is that paracetamol is in so many over-the-counter products, including Sudafed, Night Nurse and flu remedies,’ says Sid Dajani. ‘Health chiefs have repeatedly warned about rising numbers of people unwittingly taking too much, just by combining medications.’ In 2016, there were 219 paracetamol deaths in Britain.
IBUPROFEN WHAT SHOULD YOU TAKE IT FOR?
IBUPROFEN is a non- steroidal anti-inflammatory drug (NSAID) useful for mild to moderate ‘nonnervy pain’, such as period pain and toothache. Because it works to reduce inflammation, it can also help with the pain of rheumatoid arthritis, osteoarthritis or sprains and strains. Take tablets with food to reduce the chance of an upset stomach. The usual adult dose is two 200mg tablets three times a day. It’s also available as a gel applied directly to the skin.
WHY YOU NEED TO BE CAREFUL
TAKING ibuprofen can sometimes cause drowsiness, according to the National Institute for Health and Care Excellence. And NSAIDs should not be used for long periods due to an increased risk of stomach upset and bleeding, plus heart and kidney problems. ‘Anyone who has a stomach ulcer or those taking low-dose aspirin for the prevention of cardiovascular disease should also avoid ibuprofen due to the stomach risks,’ says Dajani. Pregnant women are also advised not to take it.
A recent study found that antiinflammatory drugs such as ibuprofen have little more benefit than a placebo for low back pain.
Professor Roger Knaggs, of Nottingham University, believes ibuprofen does have a role in joint and back pain but gels are better.
CODEINE WHAT SHOULD YOU TAKE IT FOR?
ALTHOUGH you can’t get it as a standalone tablet over-the-counter, paracetamol or ibuprofen combined with a low dose of codeine can be bought in chemists. Adults can typically take these every four hours up to four times a day.
‘It might be appropriate for someone who has a frozen shoulder, severe toothache or sciatica,’ says Dajani. ‘I do ask lots of questions before I decide to sell such painkillers to a patient. However, it’s about the risk-to-benefit ratio.’
WHY YOU NEED TO BE CAREFUL
YOU can become addicted to codeine even at low and medium strength if you take these pills too often and for too long.
UK Addiction Treatment Centres says that the number of people admitted to its six facilities for help for codeine addiction nearly doubled between 2015 and 2017. ‘Generally, you are better off taking them for just a short period,’ says Dr Baranidharan.
‘ Some people might find that taking them makes them a bit slow and reduces their reaction time, so they shouldn’t drive or operate heavy machinery.’