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OTC Pain Meds & High Blood Pressure

Over-the-counter pain meds raise the risk of high blood pressure — for men as well as women. A recent study indicates that all painkillers are potential culprits, they include:

This is yet more proof that over-the-counter does not mean safe. Some other problems with OTC painkillers are increased heart attack risk, stomach bleeding and liver damage.

The American Heart Association advised yesterday that doctors be cautious in prescribing painkillers, particularly Celebrex, because of the risks. Today’s New York Times warns that few patients know the appropriate dose of acetaminophen or the havoc it can wreak on one’s liver.

No wonder I try so hard to tough it out.

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Warnings Proposed for OTC Painkillers

A painkiller shouldn’t be considered harmless just because it’s sold over-the-counter. A painkiller shouldn’t be considered harmless just because it’s sold over-the-counter. A painkiller shouldn’t be considered harmless just because it’s sold over-the-counter. Get my drift?

Now the FDA wants to spread the message by adding “prominently highlighted” warning labels to all OTC painkillers. Consumers will be warned that drugs containing acetaminophen can cause liver failure and those with aspirin or nonsteroidal anti-inflammatories (NSAIDs) can cause gastrointestinal bleeding.

The NY Times article points out an issue of particular interest to folks with chronic pain — and one that won’t make it to OTC drug labels:

“A recent study of liver failure in which Dr. Lee participated found that the percentage of cases related to acetaminophen overdoses had grown. Many were caused when patients with chronic pain took prescription narcotics bundled with acetaminophen. The new proposal does not address that combination.”

The brand names of the different types of OTC painkillers are many, but here are some of the most well-known. Other brand names can be found by clicking on the drug type.

For more about the proposed changes, see the FDA’s press release.

You can learn about the risks of OTC meds in the NY Times article, Medline’s pain relief section and in these previous posts:

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News to Noodle

I’m tired of complaining, so here’s some news and information.

Children May Outgrow Migraines

A majority of adolescents with migraines either stop having headaches or develop less-severe ones as they reach adulthood, new research shows.

Of the 55 children studied, 40% had remission by their early 20s, while 20% shifted to less troubling tension-type headaches, according to the report, published in the Oct. 24 issue of Neurology.

Migraine Study Brings Men New Headaches

. . . [M]en who experience migraine attacks have a 24 percent increased risk of suffering from major cardiovascular problems and a 42 percent increased risk of suffering a heart attack.

Web Health Info Seekers Tend Not to Check Sources

Only one-fourth of Americans who search the Internet for health advice regularly check the source and date of the information they find to assess its quality. . . .

Just 15 percent of those surveyed said they always checked the source and date of the health information found online, while another 10 percent said they did so most of the time. Three-quarters of those surveyed said they checked the source and date sometimes, hardly ever or never, Pew said.

I’m appalled by these numbers. There’s too much bad information online to accept it at face value. I never use a source that I’m even slightly skeptical of.

[via Kevin, MD]

Oh, the pain of it all! Oh, the pain!

An ER doc’s take on distinguishing real pain patients from drug seekers:

I occasionally wish my job demanded something more than a valid DEA license, and decision-making skills beyond “yes narcs” and “no narcs.” It just drains the carpe right out of your diem to start the day off in a series of ugly little dogfights over drugs with people whom, to put it charitably, you have concerns about the validity of their reported pain.

Now please don’t jump to conclusions here. Pain sucks, and in the common event that I know to a reasonable certainty that someone is suffering, I am quite free with the narcotics. That’s a big part of my raison d’etre. The problem is that increasingly, it seems that the chronic pain complaints far outnumber the acute pain complaints, and treating chronic (or recurrent) pain in the ED is fraught with difficulty to say the least. You don’t know the patient, they come to the ED over and over for the same thing, they are demanding (both in terms of time expended and emotional energy), some are dishonest, there always seems to be some barrier to treatment which requires ED therapy (“Doctor out of town,” “Lost prescription,” “Only a shot works,” “Threw up my pills,” etc), and there is never objective evidence of physical disease.

[via Kevin, MD]

Sensitivity to Pain Explained

Stabbing back pain or the aches of arthritis send some people to bed in misery while the same distress seems easily tolerated by others. Why does pain hurt some people more than others? Scientists finally have an answer.

It involves a single molecule under control of a gene that acts like a dimmer switch. A “bright” or high setting excites sensory nerves to produce more of a chemical called BH4. For scientists, BH4 has one meaning, but for sufferers, it might as well mean “Big Hurt.” Lower settings block BH4, protecting people from the wrench and bite of chronic pain.

New Report Finds Pain Affects Millions of Americans

One in four U.S. adults say they suffered a day-long bout of pain in the past month, and one in 10 say the pain lasted a year or more, according to the government’s annual, comprehensive report of Americans’ health. . . .

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NSAIDs and Heart Attack Risk

In a study of 5,000 people who’d had heart attacks and 20,000 who hadn’t, the was no evident increase of heart attack risk for people who took moderate amounts of Advil (ibuprofen), Aleve (naproxen), or Cataflam or Voltaren (diclofenac) for a year or more.

This article looked like good news at first glance, but so many people with headache who use OTC NSAIDs like Advil and Aleve exceed the limits of “moderate amounts” that I’m not sure the results apply.

The morals of the story? Just because a drug is sold OTC, it isn’t harmless. If you take lots of OTC painkillers, you likely either have undiagnosed migraine or tension-type headache or rebound headaches from taking too many meds.

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OTC Painkillers and Heart Attack Risk

Vioxx and Bextra made big news this spring when they were pulled off the market for increasing a patient’s risk for heart attacks. A recent study indicates that OTC painkillers containing ibuprofen and naproxen also raise heart attack risks.