How to use OTC painkillers

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When you open the medicine cabinet to seek pain relief, you have an array of options. Will you choose wisely?

Years ago, over-the-counter choices were limited to aspirin or Anacin, which is simply aspirin plus caffeine. In 1955, acetaminophen (Tylenol) was approved. Whereas aspirin works at the site of pain, inhibiting the swelling and inflammation that sensitize nerve endings, acetaminophen works in the brain by shutting down the pain signals.

Now the best-selling OTC painkiller, Tylenol has two major advantages. It does not cause gastrointestinal bleeding, as aspirin can, and it's safer for children under age 18 who are at increased risk of Reye's Syndrome if they take aspirin.

"Tylenol is a very effective pain reliever for mild to moderate pain, but there is a maximum recommended daily dose of 4 grams," said Brian Siegel, M.D., medical director of the Pain Management program at Yampa Valley Medical Center. "Increasing the dose beyond this can lead to severe liver toxicity."

Three newer painkillers are ibuprofen (Advil, Motrin), naproxen sodium (Aleve) and ketoprofen (Orudis KT). All are non-steroidal, anti-inflammatory drugs (NSAIDs). They are effective against swelling, inflammation, pain and fever, whereas acetaminophen works only against pain and fever. NSAIDs are gentler on the stomach than aspirin, but they can irritate the stomach lining and cause gastrointestinal bleeding.

"Most NSAIDS have equal potency with respect to their anti-inflammatory and analgesic effects," Siegel said. "It is a common misconception that the newer COX-2 inhibitors (Celebrex, Vioxx) are more potent for treating pain when in fact they are not."

The anti-inflammatory action of these \drugs is generally quicker and stronger than that of aspirin, and they are often prescribed by doctors to treat minor sports injuries. Prescription doses are, however, much larger than those recommended on the OTC label. A relatively hefty dose is needed to get a true anti-inflammatory effect.

People who pop pills to self-treat a swollen knee or sprained ankle should think again. First-line treatment for swelling is rest, ice and elevation, along with a modest dose of painkilling medication. If that doesn't work, you should have a physician diagnose the injury and prescribe a safe dose of the right anti-inflammatory medication.

An even riskier practice is to use NSAIDs as a preventive measure against aches and pains. Pain is part of the body's warning system to prevent overuse. Additionally, NSAIDs can cause severe kidney problems if you're dehydrated by extended physical activity.

"All NSAIDs can increase blood pressure, affect the way the kidneys work and cause gastrointestinal bleeding," Siegel said. "They can be toxic in individuals with ongoing liver disease."

Aspirin is often recommended to heart disease patients because it inhibits the clotting action of blood. This quality makes aspirin unsafe for anyone at risk of bleeding because of surgery, open injuries or even significant bruising, which represents bleeding under the skin surface.

Acetaminophen is not without its risks. The drug leaves toxic residues in the liver that can be cleared away with food and fluids but are made worse by alcohol. A risk of overdose occurs if acetaminophen is used for more than 10 days or by anyone drinking alcoholic beverages on a regular basis.

"Liver toxicity from acetaminophen overuse is by far the most common cause of acute liver failure in the United States," Siegel warned. "Patients at increased risk are likely those with depression, chronic pain, alcohol/narcotic use, and those using several products containing Tylenol. As little as 7.5 grams per day can cause severe liver damage."

Persons taking Tylenol are advised to check the labels of all other OTC drugs they are taking. More than 300 products contain significant amounts of acetaminophen.

Each pain medication product has its own benefits and risks. All OTC pain medications have excellent safety records when used as intended. All have side effects that may become dangerous with heavy or long-term use.

Christine McKelvie is public relations director of Yampa Valley Medical Center.

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