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Practically every home medicine cabinet has at least one nonprescription drug for pain, which has been purchased over-the-counter in a drugstore or supermarket. Nonprescription preparations are commonly taken with little regard for their possible side effects, but every medicine has potential side effects that can appear even if you take it only once. Even those that do not cause an immediate reaction can slowly but surely harm the body if taken over a long time or if mixed with the wrong medicines. A description of a few of the most popular pain medicines will follow.
Aspirin is an inexpensive drug that has helped countless people who have routine aches and pains, as well as others who have more serious ailments such as rheumatoid arthritis and osteoarthritis. However, this seemingly harmless pill has potential side effects when taken in high doses, including heartburn, nausea, vomiting, ringing in the ears, hearing loss, hives, and itching. A more serious side effect of taking high doses of aspirin is bleeding. Aspirin should be avoided by persons with ulcers, gout, asthma, liver, or kidney disease; pregnant women and women who are breast-feeding; and anyone who will soon undergo surgery or has a bleeding disorder.
CAUTION Do not take aspirin while taking Coumadin, except under the supervision of your physician
Aspirin can also cause problems when combined with certain substances. For example, taking aspirin and drinking alcohol increases the chances of gastrointestinal tract bleeding. Aspirin can also displace certain drugs from their binding sites on protein, altering their effectiveness. Drugs that should not be taken with aspirin include tolbutamide or chlorpropamide for diabetes; commonly used nonsteroidal anti-inflammatory medicines; methotrexate, which is used to depress the immune systems of rheumatoid arthritis patients; phenytoin, which is used to control epileptic seizures; and heparin, which is used to thin the blood in the treatment of blood clots.
Acetaminophen is an effective treatment for moderate pain and fever, but it is not effective against inflammation, swelling, or redness. Potential side effects include trembling, light-headedness, fatigue, itching, fever, sore throat, unexplained bruises or bleeding, blood in the urine, and pain in the side or lower back. Long-term use may cause anemia as well as liver and kidney damage. Acetaminophen causes massive free-radical damage to the liver.
In addition, do not consume alcohol while taking acetaminophen because the addition of even small amounts of alcohol seriously magnifies the production of free radicals, and liver damage can occur more easily.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) NSAIDs are used for joint pain, stiffness, swelling, and painful menstrual periods. Potential side effects include stomach pain, gastritis, peptic ulcers, gastrointestinal bleeding, headaches, nausea, dizziness, depression, drowsiness, ringing in the ears, vomiting, diarrhea, cramps, convulsions, blood in the urine and stool, chest tightness, rapid heartbeat, fainting, and chills. Ironically, these medicines can actually cause pain: the very thing they are taken to eliminate.
NSAIDs should not be taken by anyone who has asthma, bleeding problems, heart failure, elevated blood pressure, peptic ulcer disease, ulcerative colitis, and a number of other diseases. Long-term use can damage the eyes and ears and cause weight gain. NSAIDs are often used by people with arthritis, but paradoxically NSAIDs can increase arthritic inflammation due to their effect on the thickness of the intestinal lining (see the Arthritis protocol). Indocin (indomethacin) is a particular NSAID used for arthritis and other ailments. This powerful drug quells pain and inflammation but has potential side effects including nausea, vomiting, diarrhea, constipation, abdominal pain, gas, ulcers, rectal bleeding, headaches, dizziness, depression, fatigue, anxiety, insomnia, confusion, fainting, blurred vision, deafness, vaginal bleeding, asthma, weight gain, irregular heartbeat, high blood pressure, chest pain, and even coma.
Medications derived from opium (such as morphine), Demerol, and oxycodone require expert knowledge and careful monitoring but should not be dismissed as a form of treatment because of concerns about addiction. The vast majority of persons who have pain do not show addictive signs even when on high doses of opium derivatives. However, pain patients can be inadvertently labeled as addicts because of their need for repeated doses of these medications. The general bias against opium derivatives has led to considerable under-treatment of pain as described previously. It is not within the scope of this protocol to describe the uses of opium derivatives, but two are described below:
Talwin is a synthetic, modestly addicting narcotic (opioid) that is prescribed for moderate pain. Talwin can cause nausea, vomiting, anorexia, diarrhea, dizziness, hallucinations, headaches, confusion, insomnia, fainting, sweating, chills, rash, lowered blood pressure, irregular heartbeat, and other problems.
Percodan is a synthetic relative of codeine. It is a powerful painkiller available by prescription. Like many of the opiates, it has a potential for addiction and needs to be monitored carefully. Side effects of Percodan include dizziness, nausea, vomiting, constipation, and sedation.
Surgery is a questionable treatment for chronic pain because no one knows what the surgeon should do once the patient's body has been opened up on the operating table. If the patient has back pain, should the disc with a slight bulge be taken out? Maybe or maybe not.
Surgical residents operate on the 3F policy: find it; fix it; forget it. Their motto is "When in doubt, cut it out."
Any time that a patient has surgery, there is a risk of infection, excessive bleeding, shock, and even death. Also general anesthesia presents risks, including allergic reactions to anesthetic drugs, coma, and death. There is no such thing as risk-free surgery.
Neural blockage (a nerve block) is one of the most important tools for diagnosing and treating certain types of chronic pain. Physicians inject a local anesthetic or other drug to block nerve function in a specific area, thus temporarily stopping the pain message from flowing to the brain.
However, after ascertaining that the procedure works, many physicians will make the nerve block permanent by injecting alcohol or another drug that destroys the nerve's ability to function. Almost any nerve or nerve root can be found and blocked, producing at least temporary relief. But nerve blocks are not always the answer because in blocking the pain, the usefulness of the nerve is also blocked. For example, if a nerve that helps move a finger is blocked, that finger cannot be used.