"How much (said medication) are you taking per day?"
"Has the medication you've taken given you any relief?"
These were a few questions I had asked a new patient of mine earlier this week. This patient had been taking acetaminophen (Tylenol) for his pain, and lots of it. When I inquired as to how much he was taking, I found out that he was consuming double the recommended dose for several weeks. Further inquiry led me to find out that the medication he was taking had very little impact on his overall pain, hence his decision to come into the clinic. Although he decided to have his complaint checked out, he continued to take the medication despite reporting that it had provided him little-to-no relief.
There are a few things troubling about this scenario which prompted me to comment on the use of over the counter (OTC) medications for pain symptoms.
I'd like to preface this by saying that I'm by no means anti-medical nor do I radically condone the use of medication. Hell, I'll admit to taking the odd Advil so I can get some rest when I get a major headache. I'd just like to bring some things to light that typically fly under the radar so that you all may make more informed decisions regarding the care you provide yourselves.
Acetaminophen (Tylenol) and NSAIDs (Advil, Naproxen, Motrin, Ibuprofen, etc.) are commonly used to treat various symptoms such as mild to moderate pain, minor fever, acute and chronic inflammatory conditions, etc. Although widely used, the use of these medications are not without potential repercussions. For instance, the list of side effects that may be experienced while taking Tylenol is lengthy, notably the effects that Tylenol can have on the liver. Many disease processes can cause acute liver failure (AFL), but overdosing on Acetaminophen is the leading cause of this condition in the US. Approximately 66% of those with AFL will recover with supportive care. Ironically, a fairly recent study (and the largest of its kind) has recently shown that Tylenol was no more effective than a placebo (sugar pill) in reducing the symptoms experienced with acute mechanical back pain - which is what this patient was taking the Tylenol for.
On the other hand, adverse liver effects with NSAIDs is much lower, but they can have profound effects on the kidneys after only a few days of use (Naproxen appears to be the biggest culprit). In fact, it's estimated that approximately 1-5% of all patients using NSAIDs will experience adverse renal (kidney) events. This may not seem like much but prolonged NSAID use results in approximately 120,000 hospitalizations in North America and 20,000 deaths in the US annually. Fortunately, the effects on the kidney are reversible when the medications are used infrequently.
Many complaints I see in the office have to do with some sort of tendon injury. A fairly recent study (albeit, an animal study) has shown that NSAID use had a negative effect on the healing process for the injured tendons. So depending on your diagnosis, you may be doing more harm than good (in more ways than one)!
Unfortunately for some, the application of the medications mentioned above goes beyond masking fever, pain, and mild to moderate inflammation. Athletes have been known to use these medications as a preventative measure to avoid injury, with the hopes that they may train or play injury free longer or with more intensity - although there is no scientific validation of this thought process. What we do know is that exercise on top of medication use such as ibuprofen can cause an increase in inflammatory markers seen with gut leakage (the most common side effect of ibuprofen use is GI upset). Fortunately, the digestive system seems to recover rapidly after one or two episodes of medication consumption. What about those who take it prior to exercise on a regular basis? We don't yet definitively know what the long term consequences are of medication use prior to training and/or sport are, but it's known to not be harmless and it should be strongly discouraged.
All in all, the points I'd like to pass on are:
If you 're experiencing some discomfort/pain but you don't feel the absolute need to take the medications mentioned above, then don't. And if you're going to use any of the medications above, please follow the recommended dosages in addition to the instructions given to you by your physician.
If the over the counter medication you're taking does not seem to "do its job" (i.e. doesn't mask your pain or the pain persists for a number of days), talk to your physician, pharmacist, chiropractor, naturopath, physiotherapist, etc. They will be able to shed some light on what's going on with your complaint, implement or advise you on various therapies available or send you in the right direction if it is something outside their scope of practice.