Hepatitis C: Headache? Joint Pain? Choose the Right Over-the-Counter Painkiller

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Hepatitis C: Headache? Joint Pain? Choose the Right Over-the-Counter Painkiller

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Friday, March 4, 2011

Posted by New HCV Drugs

FILE UNDER LIVER HEALTH, NSAID, WELLNESS

Headache? Joint Pain? How to Choose the Right Over-the-Counter Painkiller

Choosing a painkiller off the drug store shelf can be, well, painful. To offer

some relief, Consumer Reports Health released its " Best Buy Drugs " -- a 22-page

report that compares the effectiveness, safety and price of some of the top

brands (and generics) for pain killing.

The report focuses on non-steroidal anti-inflammatories (NSAIDs), which commonly

are used to treat pain associated with arthritis.

But NSAIDs are only one type of painkiller. Depending on the ache, another type

might be better. And depending on the sufferer, some drugs can be dangerous.

ABC News asked pain experts to weigh in on what drugs to take for various aches

and pains, and when to avoid the drugs.

Acetylsalicylic Acid

The drug commonly referred to as aspirin has been around since 400 B.C., when

people used salicin-containing willow tree bark to treat pain and inflammation.

It was the discovery of salicin as the bark's pain relieving ingredient that led

the development of stomach-friendlier acetylsalicylic acid (ASA) in 1838.

" Aspirin was the 'original' headache medication, " said Dr. ,

assistant professor of medicine and neurology at Duke University Medical

Center's Pain and Palliative Care Clinic.

But ASA's anti-inflammatory properties make it good for other types of pain,

too, including muscle pain, joint pain from arthritis and toothaches. It's also

relatively cheap.

The drug is an NSAID that works by suppressing the production of prostaglandins

-- hormone-like molecules that play an important role in inflammation.

Unfortunately, the same molecules help to protect the stomach lining.

Acetylsalicylic acid also interferes with blood-clotting thromboxanes. Some

people take a daily dose to reduce the risk of heart attack and stroke.

Because of its effects on the stomach and the blood, acetylsalicylic acid isn't

right for everyone. People with ulcers, bleeding disorders or kidney or liver

problems should avoid it, as should anyone who might be allergic to it.

" There are a lot of other non-steroidal anti-inflammatory drugs (NSAIDs) that

have fewer side effects than aspirin so, in many cases, aspirin is not a first

choice, " said Dr. Mike Schmitz, director of pediatric pain medicine at Arkansas

Children's Hospital in Little Rock.

Acetylsalicylic acid use in kids with fevers has been linked to Reye's syndrome

-- a potentially fatal disease that attacks the brain and liver. It should only

been used in people under 19 under specific orders from a doctor.

Ibuprofen

Another NSAID, ibuprofen, has pain relieving effects similar to those of

acetylsalicylic acid. But it tends to work better even at a lower dose and have

milder side effects.

" It is a very good anti-inflammatory medication, originally developed to treat

arthritis, " said Duke's . " It also lowers fever, and helps with symptoms

from the common cold. "

The brand name version of ibuprofen is Advil. But only the generic form of

ibuprofen was named a " best buy " NSAID by Consumer Reports Health today.

Like acetylsalicylic acid, ibuprofen inhibits prostaglandin synthesis. So it can

irritate the stomach and increase the risk for ulcers. It also can cause

bruising and bleeding in people who use blood thinners. Ibuprofen should be

avoided in people with ulcers, bleeding disorders or kidney disease. But it is

not associated with Reye's syndrome and, therefore, can be used in children.

Naproxen

A relative newcomer to the pharmacy shelves, naproxen (Aleve) only was approved

by the Food and Drug Administration for over-the-counter use in 1994.

Naproxen is an NSAID with a pain-killing mechanism similar to that of ibuprofen.

The drugs have comparable effects and side effects, so the choice comes down to

personal preference.

" The anti-inflammatory medications like ibuprofen and naproxen are very good for

the common muscle aches from 'overdoing it' (like at the gym or working in the

yard) and also help with common arthritis pain, " said .

Naproxen -- both Aleve and the generic form -- also was named a " best buy " NSAID

by Consumer Reports Health.

When taking NSAIDs, hydration is important because the drugs may reduce blood

flow to the filtering mechanism of the kidneys. According to the National

Institutes of Health, NSAIDs other than acetylsalicylic acid also can increase

the risk of stroke and heart attack.

Talk to a doctor about cardiovascular risk factors before taking NSAIDs

regularly.

Acetaminophen

The drug known by most people as Tylenol is another mild pain reliever. It is

not an NSAID, so it won't quell inflammation. However, it won't irritate the

stomach, either

" Acetaminophen is better for people who have stomach troubles, " Schmitz said.

" It has been a good drug for children as well. "

The drug is good for treating aches and pains not related to injury or

inflammation. But because it's metabolized in the liver, it can have serious

side effects if taken at high doses or with alcohol.

" The most significant danger of high doses acetaminophen is liver damage and

even liver failure, " said Dr. Doris Cope, professor and vice chairman of pain at

the University of Pittsburgh School of Medicine.

Acetaminophen use should be avoided in people who have consumed alcohol or are

dehydrated, or who have kidney or liver problems.

Because of its potential to cause serious harm at high doses, people should be

careful when taking combination drugs that contain acetaminophen, according to

Dr. Carol Warfield, chair of anesthesia, critical care and pain medicine at Beth

Israel Deaconess Medical Center in Boston.

Certain prescription painkillers also contain acetaminophen, opening the door

for unintentional overdoses.

" In a recent study, fewer than 15 percent of patients knew that commonly

prescribed pain medications [such as Percocet and Vicodin] contained

acetaminophen, " said the University of Pittsburgh's Cope.

Combination Drugs

Over-the-counter medications designed to treat multiple symptoms often contain

painkillers in combination with other drugs. Cold and flu medications often

contain painkillers as well as decongestants. And menstrual pain relievers often

provide diuretics, too.

" I am not a big fan of combination drugs, " Schmitz said. " I recommend that

people know what they are taking, take specific medicines for specific problems

or symptoms, and read the package before they purchase it so that they know what

is in it. "

Talk to a Doc

When in doubt, ask a doctor or pharmacist for a recommendation or an explanation

of a particular drug's ingredients. And during pregnancy, it's important to talk

to a doctor before taking any over-the-counter medication.

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