Pain relief sometimes backfires
Rebound effect more common among men
Rebounds are great on the basketball court and the hockey rink, but not so much fun when we’re talking about medication. Rebounds occur when you stop taking a drug, or it no longer has the same effect because your body has become habituated. The original symptom that you were trying to alleviate returns with a vengeance. Serious and debilitating rebound effects are well documented in hard-drug users, but now it seems we can get them from something as benign as over-thecounter painkillers.
The U.K.’s National Institute for Health and Clinical Excellence (NICE) stirred up a hornet’s nest recently by estimating that one out of 50 people in that country are causing their own chronic headaches by overusing painkillers.
The drugs in question include aspirin, acetaminophen, ibuprofen and specific anti-migraine drugs like triptans. The risk seems to be higher when the painkiller is combined with caffeine.
Chronic use was defined as taking painkillers more than 15 days per month. A woman who suffers from this type of medicationover use headache was on the BBC news the day after the NICE announcement, explaining how terrifying it is to have to give up the one thing that relieves her headaches — in order to relieve her headaches!
On the surface this might seem to be a women’s health issue. Females do get more headaches overall, and the medication-overuse variety strikes an estimated 3.5 females for every male, according to German headache expert Dr. HansChristoph Diener. Still, the concept is important for all of us to understand. Also, a disturbing new trend has surfaced in the world of prescription painkillers — an explosion of chronic use, especially by guys.
According to Christopher M. Jones of the U.S. Centers for Disease Control, from 2002-03 to 2009-10, there was a 74.6-per-cent overall increase in the number of Americans who took prescription painkillers 200 or more days per year. But for men, the increase was 105.3 per cent. The most affected group was aged 35 to 49 which saw a 134.6-per-cent increase, perhaps as they move into the aches-andpains years. On the bright side, chronic prescription painkiller use by teenagers dropped by 25.7 per cent over this period.
Breaking the cycle of painkillers and headaches is a challenge for many people. Doctors may substitute other drugs like dihydroergotamine or corticosteroids on a short-term basis.
According to a Mayo Clinic report on this subject, hospitalization may sometimes be the best option.
The Mayo Clinic article notes that it’s important to find a long-term strategy that doesn’t involve taking painkillers.
Alternatives include antidepressants, anticonvulsants, beta and calciumchannel blockers and even Botox. Of course, each of these comes with its own risks and side-effects.
Wouldn’t it be great if researchers could find a way to defeat chronic headaches that doesn’t use drugs at all? There are promising results from several alternativemedicine therapies. The Mayo Clinic cites acupuncture, hypnosis, biofeedback, massage therapy, dietary supplements and chiropractic treatment.
Others have suggested exercise, taichi, qigong and yoga.
Acupuncture, consisting of 24 sessions of 30 minutes each over 12 weeks, was tested in headache patients in Taiwan.
It was compared against the anticonvulsant drug topiramate. Dr. Hen-Hong Chang and colleagues found “a significantly larger decrease in the mean monthly number of moderate/severe headache days” by using acupuncture. Headache days per month dropped from 20.2 to 9.8 in the acupuncture group versus 19.8 to 12.0 for those who got the drug. Significantly, the rate of adverse responses was 6.0 per cent for the acupuncture group versus 66 per cent for the topiramate group.
Don’t like needles sticking in your body? You might be able to use your head to defeat your headaches. A 1997 analysis by researchers at the Wilford Hall Medical Center in San Antonio, Texas concluded that “behavioural treatments have become the most widely used non-pharmacological treatments for chronic benign headache and produce outcomes similar to or better than the most widely used pharmacotherapies.”
Drugs may have improved since then, but there’s still wisdom in that statement.
Because so many people get them, headaches have been the focus of most of these studies.
But the principle applies to many kinds of pain.
Avid golfers sometimes suffer from golfer’s elbow (medial epicondylitis) and may take medication for pain and inflammation. Doing that too frequently can set them up for the overuse scenario. The same applies to tennis players, runners and people who pursue any sport so vigorously that pain is a regular occurrence. Of course, workers in construction and the oilpatch may do things on the job that lead to chronic pain.
So, while women may hold the lead in the head- ache pain race, men do plenty of things that hurt, and we need to watch out for those painful rebounds.