Tag Archives: pain

Need to Know: NSAIDs

NSAIDs (nonsteroidal anti-inflammatory drugs) are some of the most commonly used pain relievers and can either be prescribed by your doctor or purchased over the counter (OTC). They’re used to treat a wide range of illnesses, from arthritis to headaches to sprains to postsurgical pain. Like any medication, NSAIDs can cause side effects, some of them serious.

Common Names

Aspirin (Bayer, Bufferin, etc.), ibuprofen (Advil, Motrin, etc.), naproxen sodium (Aleve, Anaprox, Naprosyn), celecoxib (Celebrex), fenoprofen (Nalfon), indomethacin (Indocin), oxaprozin (Daypro), piroxicam (Feldene), diclofenac (Voltaren), salsalate (Disalcid)

How They Work (Method of Action)

NSAIDs block proteins called cyclooxygenase enzymes (COX enzymes) that help make prostaglandins, hormone-like chemicals that cause pain by activating the inflammatory response. Blocking COX enzymes decreases the level of prostaglandins, reducing pain. NSAIDs also lessen inflammation like swelling, redness and fever.

Side Effects and What to Do About Them

The most common side effects of taking NSAIDs are stomach issues like irritation, pain, heartburn, gas, bloating, constipation and diarrhea. These side effects can usually be relieved by taking your NSAIDs with food or milk or by also taking antacids such as Mylanta or Tums. Dizziness, mild headaches, problems concentrating, balance issues and lightheadedness are also common.

More serious side effects can include high blood pressure, ulcers, allergic reactions, retaining fluid (which can cause swelling in the face, hands, lower legs, feet or ankles), bloody or cloudy urine, rashes, blurry vision, jaundice, exhaustion, difficulty breathing, ringing in the ears, vomiting blood, weakness in one side of the body, light sensitivity, extremely painful headache or back pain, a change in balance or ability to think clearly, chest pain and faster heartbeat. Let your doctor know right away if you experience any of these.

The FDA strengthened its warning about non-aspirin NSAIDs in 2015, saying they can increase the risk for heart attacks and strokes, even in the first weeks of use. The increased risk of heart attack or stroke still applies if you don’t have heart disease, though the risk is generally higher for those with heart disease or risk factors for heart disease.

User Experiences

Rick Schneider, 52, used aspirin for most of his life, but when ibuprofen became available over the counter, he started taking that instead. “After two wrist surgeries, I found that the relief gained from ibuprofen was the same as that from narcotic pain tabs, or better,” he says. He also notes that even though he has Crohn’s disease, he hasn’t had any bad effects from taking either ibuprofen or aspirin.

When Laura Swanson, 34, has to work, she takes anywhere from 4 to 8 ibuprofen to help reduce the aches and pains she gets from being on her feet all day, as well as to help with her idiopathic pressure urticaria (hives), which doesn’t respond to antihistamines or steroids. She notices that she bruises more easily on the days she takes ibuprofen, and she tries not to take it when she’s home so she doesn’t overwhelm her kidneys and liver.

Pam Nielsen, 55, is a big fan of ibuprofen and says it’s her go-to for pain and inflammation. Years ago, an OB/GYN nurse told her that taking 4 to 5 at a time every 4 to 6 hours would slow down her bleeding and her horrendous monthly cramps, so for years, she took it that way on the days in her cycle when she couldn’t function. “For me, it works miracles,” she says. She has never had any issues with side effects.

Gail Stoltenberg, 42, is on Voltaren (diclofenac), a type of NSAID, and Motrin (ibuprofen), along with a couple of other medications, for her psoriatic arthritis, ankylosing spondylitis and a central nervous disorder. She uses the ibuprofen as needed for inflammation and says sometimes it helps, but not very often. Her doctor put her on diclofenac, which gives her some relief, but not 100%. However, when she has tried to go off of the diclofenac, her psoriatic arthritis flare-ups have gotten worse.

Drug Interactions

NSAIDs may interact with other medications, which can make them less effective. Talk to your doctor before taking any NSAIDs, whether prescription or OTC, if you’re on any medications that treat high blood pressure, diabetes, heart disease or arthritis; or that thin blood or are immunosuppressants, such as (but not limited to) warfarin (Coumadin), clopidogrel (Plavix), cyclosporine (Neoral or Sandimmune), phenytoin (Dilantin), corticosteroids, lithium and probenecid. Also let your doctor know about any other prescription or over-the-counter medications, vitamins, supplements or herbs you’re taking.

Effectiveness and Considerations

NSAIDs are relatively safe for healthy individuals who use them occasionally, and they are often very effective at preventing pain and inflammation. Long-term use and taking higher doses of NSAIDs can increase the likelihood of side effects.

Be sure to use only the lowest dose you need for effectiveness, and only increase it if that doesn’t work. Once your pain is manageable, try other pain relief methods such as cold or warm compresses or a hot bath to give your system a break from the NSAIDs.

Studies consistently show that NSAIDs are just as effective as, and in some studies, more effective than, opioids for relieving pain. The fact that they have far fewer side effects without the risk of dependency that opioids do makes them a good choice for postoperative and chronic pain.

Alternatives to NSAIDs

If you have chronic pain, there aren’t many alternatives to NSAIDs since they are so effective. However, to reduce risks, try taking the lowest dose you can while still maintaining some relief, especially if you have heart disease. You can also incorporate exercise, weight loss, physical therapy and hot or cold therapy for natural pain relief.

If you have arthritis, you can try acetaminophen (Tylenol) for pain relief, though it won’t help much with inflammation. Antidepressants and anticonvulsants are another alternative to help pain relief, though they come with their own set of risks. As with chronic pain, you can also add physical therapy, massage, acupuncture, joint-supporting splints, exercise and weight loss to help manage your pain. Topical agents such as Bengay, lidocaine patches and Icy Hot can also relieve pain due to arthritis.

Transcutaneous electrical nerve stimulation (TENS) units electrically stimulate nerve and muscle fibers to relieve pain and have been shown to be effective for some people, though they are better for chronic pain than for acute pain.

Is Kratom Really As Dangerous As the FDA Makes It Out to Be?

America is in the midst of one of the worst epidemics in its history over opioids, which may be one of the reasons the FDA recently issued a warning that kratom, a plant-based supplement often used for pain, is potentially addictive since it has opioid-like qualities.

Kratom has also been used by some people to treat withdrawal from opioids. However, the agency stated that there is “no reliable evidence” to support this and “significant safety issues exist.” The FDA also said it has received reports of 44 deaths related to kratom use. However, as a recent Reason.com blog pointed out, in many of these cases, other substances were found along with kratom in the systems of the deceased, making it difficult to prove kratom was the cause of death.

In one of those deaths, a 22-year-old man had a cocktail of drugs in his system that included the antidepressant Prozac (fluoxetine), antipsychotics Seroquel (quetiapine) and Zyprexa (olanzapine), Lyrica (pregabalin), which is used for nerve pain, and several benzodiazepines (tranquilizers) – in addition to kratom. Also, as Jacob Sullum argued in another Reason.com blog, more people have died from prescription and over-the-counter pain relievers than kratom.

So is kratom really as dangerous as the FDA makes it out to be?

It’s hard to say. But it may be harder to get your hands on kratom. The FDA has already blocked importation of the substance. And in 2016, the Drug Enforcement Agency (DEA) ruled to classify kratom as a Schedule 1 drug, putting it in the same class as marijuana, LSD and heroin as substances with no currently accepted medical use and a high potential for abuse. The DEA backpedaled a bit later in the year following outcry from the public. However, the FDA’s warning could make it more likely for kratom’s Schedule 1 designation to go through.

To me, it seems the FDA is making a bit of a rash decision. Although the FDA says it conducted its own medical analysis of kratom, there is a lot of existing research supporting kratom as effective for conditions such as PTSD and depression. Did they consider this before issuing a warning?

Much like the FDA’s and DEA’s position on marijuana, it seems that decisions are being made based on incomplete examinations of the positives and negatives of herbal substances. The FDA and DEA owe it to patients who use kratom and find benefit from it to conduct a more thorough investigation before deeming it unsafe for public consumption.

The Dangers of Taking Too Much Pain Reliever

About 15% of people taking ibuprofen (Advil) or other NSAIDs (nonsteroidal anti-inflammatory drugs) exceed the recommended daily maximum dosage.

Researchers asked around 1,300 ibuprofen users to write down their NSAID use daily in a diary for 1 week. After reviewing the journal recordings, researchers were able to calculate the users’ daily dosage intake and compare it with the maximum recommended dose.

The results, which are published in the journal Pharmacoepidemiology and Drug Safety, indicated that 11% of ibuprofen users and 4% of other NSAID users exceeded the daily dosing limit in just a 1-week time period. Those who exceeded the recommended dosage typically experienced chronic pain, had a poor physical state and smoked daily.

Also, people who exceeded the recommended dosage had the tendency to ignore the recommendation on the label and take matters into their own hands by choosing their own dose. Others weren’t knowledgeable about how to properly comply with the label instructions.

The study was sponsored by Johnson & Johnson Consumer Inc. One of the company’s key products is Tylenol (acetaminophen), which is not an NSAID.

FDA Issues Warning on Herbal Pain Reliever Kratom

Kratom, a plant-based herbal supplement that is being used as a pain reliever, has opioid-like qualities and can potentially be addictive, according to a new warning by the FDA.

Consumers are also using this popular supplement for anxiety and depression.

After analyzing the most common compounds in kratom, the FDA discovered that all of them share structural similarities with opioid painkillers such as morphine derivatives.

The FDA identified 44 deaths that are linked to the use of kratom, up from 36 reported in November 2017.

In a statement, Commissioner Scott Gottlieb, MD, said, “Kratom should not be used to treat medical conditions, nor should it be used as an alternative to prescription opioids. There is no evidence to indicate that kratom is safe or effective for any medical use.”

Book Review: Listening to Your Body to Achieve Healing

This book had me rethinking how I think, or even not think. To this day, it has me reconsidering how my mind, body and soul work together for harmony. The Intelligent Body: Reversing Chronic Fatigue From the Inside Out reminded me of a combination of readings I’ve come to know and love: the Conversations with God books, The Law of One: Ra Material and also The Law of Attraction.

Book Review: Listening to Your Body to Achieve Healing

The Intelligent Body covers several ideas: the combined theory that we are all connected; that everything runs on energy; and the body is responsive to how we direct that energy; and even more so, how humans need to take responsibility for their thoughts and actions. I appreciated the times that the author, Kyle Davies, admitted when he was challenged himself during his process. (Davies is a psychologist and therapist who has worked with clients suffering from chronic fatigue syndrome and pain.) The walk-through he encounters in his own mind when facing direct conflict with what he thought was truth to what could possibly be resonated with me.

With decades of experience in learning to communicate with my inner self and health, I found this book challenged me in very profound ways. Additionally, as a disabled person, it was a direct reminder of how I have identified as a victim, an “ill person” or someone who just is unhealthy, as opposed to being open to who I truly am as a human being.

I spent a month deciding how to review this book, primarily because it was hard to put into words the impact it has had on my life. I read it twice, then I forwarded it to a few close family members and friends, and asked them to read and review as well. I truly feel that Kyle Davies has hit the nail on the head with the connection between body, mind and spirit. I wish to thank him for helping me to heal in a way I have not yet been able to grasp. More so, I thank him for reminding me that I am in charge and I am responsible for who I am.

Although the title seems to put an emphasis on chronic fatigue syndrome and pain, the book can be enjoyed by anyone who wants to learn more about the roles emotion and stress management play in self-healing.

Quick Hits: Americans Open to Non-Drug Pain Treatments, Psychiatric Drugs’ Impact on Cognition & More

More than three-quarters of Americans — 78% — say they are willing to try non-drug alternatives for pain before turning to prescription painkillers. Results from the Gallup-Palmer College of Chiropractic Annual Study of Americans show that 40% of Americans consider prescription painkillers such as opioids a “crisis” or “very serious problem.” And 55% of those who know about the nation’s opioid epidemic place some of blame on the drug industry’s encouraging physicians to prescribe opioids. Another 53% place a lot of blame on doctors overprescribing painkillers to patients. About 23% of those polled said prescription pain meds such as opioids are not very safe, and 8% said opioids are not safe at all. In 2015, more than two-thirds of the opioid deaths reported involved prescription opioids such as oxycodone, hydrocodone, morphine and fentanyl. Posted Sept. 13, 2017. Via Gallup.

Taking high doses of antipsychotic drugs over an extended period may be associated with poorer cognition in schizophrenia. However, taking low doses of antipsychotics such as benzodiazepines and antidepressants over a long time doesn’t affect cognition, according to a new study published in the journal European Psychiatry. The research also found that schizophrenia patients who took a long break from using antipsychotic drugs tended to see their cognitive function improve. Posted Sept. 5, 2017. Via EurekAlert/European Psychiatry.

Women who take antiepileptic drugs (AEDs) during pregnancy have a higher risk of having premature babies or babies that have a low birth weight for their age in the womb. Women with epilepsy who took AEDs while pregnant had a 9.3% increased risk of having a premature baby, while women without epilepsy who took an AED had a 10.5% increased risk, according to results published in the Annals of Neurology. Women who did not take a medication and didn’t have epilepsy had only a 6.2% increased risk of a premature baby. Compared to women who didn’t take an AED and didn’t have epilepsy, women with epilepsy who took one of the drugs gave birth to a child with a mean lower birth weight of 3.9 ounces. For women who took an AED and didn’t have epilepsy, the figure was 4.8 ounces. Common AEDs include Lamictal (lamotrigine), Topamax (topiramate), Tegretol (carbamazepine), Keppra (levetiracetam) and Neurontin (gabapentin). Posted Sept. 11, 2017. Via Medical Express/Annals of Neurology.

Half of Americans Misusing Prescription Drugs, Opioids

Over half of Americans are misusing their prescription drugs — such as taking too much of a drug they are prescribed or taking medications that they are not prescribed — including powerful opioid painkillers, according to a new study examining patient lab tests.

Quest Diagnostics examined more than 3.4 million lab tests taken between 2011 and 2016 involving prescription medications and found that 52% of Americans are misusing them, such as not taking a drug according to their doctor’s orders. Essentially, “every other American tested for inappropriate use of opioids and other prescription drugs,” F. Leland McClure, PhD, a director at Quest, said in a statement.

Last year, more than 33,000 specimens were tested by Quest for opioid, benzodiazepine (a type of tranquilizer medication) and alcohol use last year. Results showed that more than 20% of those tested were positive for both opioids and benzodiazepines, 10% were positive for taking opioids and alcohol, and 3% were positive for taking all 3. Because opioids and benzodiazepines can slow down the body’s central nervous system, when taken together, trouble breathing, heart problems and even a risk of fatal overdose are possible.

Research showed that drug misuse was prominent in all age groups and among both genders. On the bright side, adolescent drug misuse dropped from 79% to 29% from 2011 to 2016. Also, in 2011, drug misuse in samples was 63%. That figure dropped to 52% in 2016.

About 20% of the lab specimens that tested positive for heroin also tested positive for the presence of fentanyl, a power opioid painkiller, that wasn’t prescribed to the patient. Taking heroin and fentanyl together greatly increases the risk for drug overdose and death.

These results are concerning because, according to the study, “treatment of pain, especially chronic pain, is a major challenge for medical professionals, and opioids can provide significant relief for some patients.”

“It appears from our analysis that many patients may be at risk of overdose or other adverse health effects caused by concurrent use of opioids including fentanyl and other drugs such as benzodiazepines,” Jeffrey Gudin, MD, medical advisor for Quest, said in a statement.