APM Blog


Over-the-counter-medications (1)

02 Nov

The first line of treatment for illnesses of all sort isn’t usually found in the doctor’s office – it’s found in the medicine cabinet. The same is just as true, if not more so, for pain. Backache? Leg pain? Headache? Most people turn to the anti-inflammatory and pain-relieving power of over-the-counter medicines. But, just like any other medications, there can be drawbacks to these easily obtainable pills. Learning when to take them – and when to default to the expertise of a physician – may give you the best chance of effectively managing your pain.

Knowing Your Options

At the onset of pain, most people reach for either an acetaminophen (Tylenol) or a nonsteroidal anti-inflammatory drug (Aspirin, Advil, Aleve), also known as NSAIDs, which can be very effective in fighting pain. In fact, these medications are recommended in the CDC’s new guidelines, which say, “In particular, acetaminophen and NSAIDs can be useful for arthritis and low back pain.”[1]

Acetaminophen, which is a component of more than 500 OTC and prescription medications,[2] is both a pain reliever and fever reducer. It can be useful for relieving headaches and common aches and pains. According to the Journal of Pharmacy and Therapeutics, though, the way in which the drug blocks pain is largely unknown.[3]

NSAIDs, found in more than 550 medicines, are able to temporarily relieve both pain and inflammation, according to the FDA, by blocking the body’s production of chemicals that are believed to be associated with pain and inflammation.[4] It can be useful for people experiencing arthritis or muscle strains and sprains.

Medication Misuse

According to a survey released this year by the American Gastroenterological Association (AGA), Americans regularly ignore dosing information on the OTC medicines we ingest. [5] This is especially true for individuals suffering from chronic pain. In fact, 43 percent of chronic pain sufferers reported that they knowingly have taken more than the recommended dosages of OTC medications. And 28 percent of those sufferers have experienced complications due to an overdose of these medicines.

Overdosing on OTC meds isn’t something many people take into consideration when they begin an acetaminophen or NSAID regimen. But the fact that 66 percent of those with chronic pain believe the directions on pain medications are merely guidelines and 27 percent are willing to take more medicine than directed “because they incorrectly believe their symptoms will disappear faster,” according to the AGA, means overdoses are more common than you might think. An average gastroenterologist will see around 90 cases of OTC pain medicine overdose each year.

Problems also arise when individuals utilize both OTC medicines for pain and multi-symptom OTC medicine for allergies, colds or flu symptoms, since it’s likely they may contain the same active ingredient. Taking both can increase your daily dosage of acetaminophen or NSAID, putting you at an increased risk of dangerous side effects.

Common Side Effects

NSAIDs have the potential to cause bleeding in the stomach or digestive track, especially among patients older than 65, those with a history of stomach ulcers or those taking blood thinners or corticosteroids.[6] In addition, NSAIDs can increase the risk of heart attacks and strokes, and the FDA has recently strengthened label warnings regarding these issues.[1]

Acetaminophen is known to be easier on the stomach than NSAIDs, but it still has its side effects. Particularly, large doses or prolonged usage may damage the liver, especially if individuals drink more than three alcoholic drinks a day. 6[7]

And while deaths from OTC overdoses aren’t as common as those from medications like opioids, they do occur. In 2010, 881 died from an overdose of acetaminophen, while 228 died from NSAIDs.1

Treatment Options

According to the AGA, “Americans living with chronic pain can get relief safely, but it is important to work with a healthcare professional to effectively manage chronic pain.” 2 A healthcare provider, especially one well-versed in pain management,  can not only ensure that your dosage of OTC medications is appropriate and that they do not interact or overlap with any of your other medications, but they may also be able to provide treatment options for more prolonged pain relief, including injections, nerve blocks and implants. While OTC pain relievers do provide a degree of relief, oftentimes they don’t treat the true cause of the pain. Thus, when pain persists despite OTC medication usage, it may be time to seek alternative treatment in the form of pain management.

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[1] Dowell, Deborah, Tamara M. Haegerich, and Roger Chou. "CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016." Morbidity and Mortality Weekly Report (MMWR) 65, no. 1 (March 18, 2016): 1-49.

[2] American Gastroenterological Association. "Know Your Medicines." 2016. Accessed April 06, 2016. http://gutcheck.gastro.org/know-your-medicines/.

[3] Toussaint, K., X. C. Yang, M. A. Zielinski, K. L. Reigle, S. D. Sacavage, S. Nagar, and R. B. Raffa. "What Do We (not) Know about How Paracetamol (acetaminophen) Works?" Journal of Clinical Pharmacy and Therapeutics 35, no. 6 (December 2010): 617-38.

[4] Hertz, Sharon. "The Benefits and Risks of Pain Relievers." U.S. Food and Drug Administration. September 24, 2015. Accessed April 06, 2016. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm107856.htm.

[5] American Gastroenterological Association. "Executive Summary: Gut Check: Know Your Medicine Survey." 2016. Accessed April 06, 2016. http://gutcheck.gastro.org/gut-check-know-medicine-survey/.

[6]"11 Things You Should Know about Common Pain Relievers." Harvard Health. October 9, 2015. Accessed April 06, 2016. http://www.health.harvard.edu/pain/12-things-you-should-know-about-pain-relievers.

[7]American Gastroenterological Association. "FAQs." 2016. Accessed April 06, 2016. http://gutcheck.gastro.org/faqs/.

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