Choosing a Pain Remedy Carefully

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July 6, 2004

THE CONSUMER

Choosing a Pain Remedy Carefully

By MARY DUENWALD

.... most people reach for one of three remedies available on the drugstore

shelf: acetaminophen (Tylenol), ibuprofen (Motrin or Advil) and aspirin...

People who take small daily doses of aspirin to prevent heart disease should

be especially careful about piling on more pain relievers, which might in

some cases cause side effects or interfere with aspirin's heart-saving

effects, doctors say...

.... Aspirin's effects last about four hours, as do acetaminophen's, though

the drugs are also formulated as long-acting. Ibuprofen works for about 6

hours; naproxen, 8 to 12.

Acetaminophen differs from the other drugs in that it does not fight

inflammation, only pain. So it is not as effective in treating a swollen

sprained ankle or a cut or bruise.

Aspirin, ibuprofen and naproxen belong to a class of drugs called Nsaids,

non-steroidal anti-inflammatory drugs, which inhibit the enzymes that make

prostaglandins, chemicals that cause inflammation and perform various other

tasks throughout the body.

Prostaglandins produce menstrual cramps, by causing the uterus to contract,

so Nsaids tend to work better than acetaminophen in dampening that pain. But

prostaglandins also help maintain the protective coating of mucus in the

stomach and intestines, and taking Nsaids too frequently or in too-large

doses can cause ulcers...

.... stomach and intestinal problems caused by Nsaids account for more than

100,000 hospitalizations each year and 16,500 deaths. Buffered or coated

Nsaids may cause less stomach upset in the short term, but they offer no

protection against ulcers.

Unfortunately, ulcers from Nsaids can develop without symptoms. " If you're

feeling fine, that's no guarantee that you're not going to have a

complication, " said Dr. M. Wolfe, chief of gastroenterology at

Boston University's medical school.

Nsaids also can cause sodium retention, raising blood pressure. The risk of

these side effects is greatest for people who take daily doses for arthritis

or other chronic problems, and is especially high for people over 65, who

are more susceptible to drug side effects.

The risk of side effects is also greater for heavy drinkers who imbibe three

or more drinks a day because alcohol can irritate the stomach lining.

Acetaminophen is an especially bad choice for chronic drinkers because it

carries the risk of liver damage...

Some studies have suggested that ibuprofen when taken with aspirin might

undermine its protective effects, by acting on a different part of the same

enzyme, blocking aspirin's access. But this question is not settled. ...

Researchers do not yet know whether naproxen might also interfere with

aspirin's antiplatelet effects. Tylenol in moderate doses does not appear

to.

People who take aspirin to prevent heart problems should talk to their

doctor about choosing a painkiller. ...