Opioids aren’t the only pain drugs to fear

Last month, a White House panel declared the nation’s epidemic of opioid abuse and deaths “a national public health emergency,” a designation usually assigned to natural disasters.

But while opioids are now prominent in the national cross hairs, they are only one of many drug-related problems associated with pain management. Opioids aside, the vast majority of medical difficulties pain patients encounter result from the use and abuse of pain-reducing medications that are sold over the counter.

Some people assume that if one pill is good, two must be better. And it’s not uncommon for older people, who may have an acute pain problem on top of chronic pain, say, from arthritis, to be taking more than one pain medication at a time.

Many people think pain medications like NSAIDs (nonsteroidal anti-inflammatory drugs like ibuprofen and naproxen) they can buy without prescriptions are safe. As George Gershwin wrote, “It ain’t necessarily so.”

A 2013 analysis of data from the National Ambulatory Medical Care Survey revealed that NSAIDs were used by 95 percent of the nearly 7 million patients in the study who took at least one chronic pain medication. Athletes, from recreational to elite, also often take these drugs to counter muscle aches and joint pain.

“For people with a history of coronary artery disease, even when taken short term, NSAIDs can precipitate clogging of the vessels,” said Dr. James Campbell, a neurosurgeon who specializes in pain management.

In addition to cardiovascular risks, NSAIDs can cause gastrointestinal problems, damaging the lining of the digestive tract, especially when they are not taken with food. Their most serious side effects include ulcers, bleeding, kidney failure and, in rare cases, liverfailure.

Nor is acetaminophen (Tylenol and its generic imitators) always safe. It can damage the kidneys when used in large doses, as might happen when taken for chronic arthritic pain.

Last year the Food and Drug Administration required manufacturers to warn consumers that severe liver damage can occur at daily acetaminophen dosages above 4,000 milligrams in a 24-hour period.

But problems of an acetaminophen excess can arise when patients take both prescribed and over-the-counter drugs containing acetaminophen, not realizing that the total dosage is dangerously high. That means patients should read the label on any drug they buy, and always tell their doctors truthfully what and how much of a drug they aretaking.