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Ibuprofen & Life-Threatening Potassium Loss

Ibuprofen and prescription NSAIDS (non-steroidal anti-inflammatory) are among my most effective meds, so this article caught my attention: Research finds ibuprofen linked to life-threatening potassium deficiency.

[Patients] were diagnosed with hypokalaemia, a dangerously low level of potassium in the blood that can lead to abnormal heart rhythms, the breakdown of muscle fibres, fatigue, muscle weakness, spasms, and paralysis.

Although hypokalaemia from ibuprofen isn’t a huge risk, I was surprised that one man was taking less than 4,800 mg per day. That’s still way too much to take regularly — 1,200 mg (or six regular-dose Advil or generic ibuprofen) is the maximum recommended daily dose for short-term use — but it is easy to creep to excessively high doses when you’ve got a killer headache or migraine.

An issue of far greater concern to people with migraine or headache is rebound or medication-overuse headaches. According to the National Headache Foundation’s rebound information sheet,

When used on a daily or near daily basis, [over-the-counter painkillers] can perpetuate the headache process. They may decrease the intensity of the pain for a few hours; however, they appear to feed into the pain system in such a way that chronic headaches may result. [emphasis added]

I must repeat: frequent use of over-the-counter painkillers like acetaminophen (Tylenol) and NSAIDs (Advil & Aleve) can turn occasional headaches or migraines into chronic ones.

If you’re having frequent headaches, see your doctor. Of course, few medical professionals know much about headache and migraine, so weaning yourself off may be the better option. Before you do, read Teri Robert’s excellent article, Medication overuse headache — when the remedy backfires and visit some forums to learn about other’s experiences. Migrainepage, My Migraine Connection, and WebMD are my favorites.

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Learn About Meds at DrugBank, a Massive Drug Database

Whatever you want to know about your medications, DrugBank can tell you. Seriously. Each of the nearly 4,100 drugs on the site has 80 data fields covering names and chemical structures to how and why the drug works to patient information and helpful websites.

The information on Topamax, ibuprofen and Imitrex, which are some common headache drugs, is impressive. DrugBank also links to popular drug sites, including Drugs.com and RX List, when readers want more information.

via ChronicBabe

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A Headache Specialist’s Comments

Christina Peterson, a neurologist (and migraineur), is a blog reader who leaves terrific, educational comments. I always learn a lot from her. Some of her comments on recent posts are so informative that I want to be sure you all see them.

Warnings Proposed for OTC Painkillers

This is a really important post–it can’t be overstated.

In fact, the NYT article, if anything, understates the matter. The truth is that at this time, over 50% of all liver transplants are necessary because of the medical use of acetaminophen. It’s such a big problem that even the makers of Tylenol have run a commercial asking people not to exceed the recommended amount.

Gastritis and ulcers are no fun, and most people have been made aware of the cardiac and blood clot risks of anti-inflammatories like Vioxx and Celebrex, but a lot of people tend to think that ibuprofen and acetaminophen are benign.

They aren’t.

It’s also important to know that a lot of prescription analgesics, like Vicodin, Percocet, Fioricet, Amidrin (and all their generic names), also contain acetaminophen–so don’t double up.

If you are an intermittent migraine sufferer, and not a chronic headache sufferer, a double-blind randomized controlled trial has established that acetaminophen has no role in the treatment of acute migraine. There are better options available.

Men & Women Experience Pain Differently

This is vastly oversimplified. (Well, OK, it’s a newspaper…) But I trust this blog readership to be more sophisticated than the sixth grade level general readership a newspaper shoots for. So.

Most of the studies that have recently emerged have indeed shown a difference in pain processing between men and women. The major difference is that pain processing in women fluctuates with estrogen levels. (Estrogen–it’s our theme of the week, isn’t it? 🙂

Some of the studies available are simplistic and misleading–lab animals were injected with estrogen, and pain thresholds decreased, which led researchers to conclude that therefore, women were weak, and couldn’t tolerate pain as well as men. (Can anyone say, “Researcher bias”?)

But if you think this through, it is counter-intuitive. It makes no sense. Pregnant women have very high estrogen levels–estrogen levels climb throughout pregnancy, until they are very high by the time labor begins.

And menstrually-associated headaches occur when estrogen levels are at their lowest–the day before menstruation begins is the most common day for a menstrual migraine, and that is the day for a drop in estrogen.

Dr. Nancy E.J. Berman, who has done very important research on the effects of hormones on trigeminal neurons and the effects on orofacial pain, TMD, migraine and fibromyalgia, and who won the Wolff Award this year from the American Headache Society, also wrote the chapter on “Sex Hormones” in the book, The Headaches. She has noted that migraine improves both during pregnancy, when estrogen is high, and after menopause, when estrogen is low. She feels that this suggests that it is rapid changes in estrogen and progesterone that serve as a trigger for migraine attacks.

Some studies suggest that women tolerate pain better than men when estrogen levels are higher, and less well than men when estrogen levels drop–we are still discovering whether it is the rate of drop that is critical (likely), or whether it is also the estrogen:progesterone ratio that has an effect.

Other studies have shown that postmenopausal women process pain similarly to men.

I will say this, though: when I do Botox injections in the office, it’s generally not the women who get faint on me. 😉

Birth Control Pill News

This is all well and good…if you are young, and if you do not have migraine with aura.

Please refer to the following from the ACHE website: Will Using Oral Contraceptives Increase the Risk of Stroke?

It is the standard of care amongst headache experts to advise that women with migraine with aura either not use oral contraceptives at all, or use them very judiciously and with aspirin cardiac prophylaxis, and only if there are no significant cardiovascular risk factors. It is also recommended that women who have migraine without aura discontinue oral contraceptives after age 35. Smokers who have migraine should not use oral contraceptives at all.

I recall reading a recent article that surveyed migraine sufferers, and found that a significant proportion of primary care physicians were not aware of current recommendations regarding migraine and oral contraceptives. (I cannot, however, find the article in my giant stack-of-articles-to-be-filed. So, no citation for you–sorry. I think the author was Dr. Elizabeth Loder, but Google is not bringing it up.)

There is also newer data regarding the increased risk of heart disease in women with migraine, which was published in JAMA recently.

This study looked at women over 45, but estrogens, contained in the vast majority of contraceptives, are also a cardiac risk factor.

So–if you are going to proceed with this, be certain your physician knows you are a migraine sufferer (if you are), and research your family history and personal cardiovascular risk factors.

To learn more about and from Dr. Peterson, visit her websites, Migraine Survival and Headquarters Migraine Management.

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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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More News Than You Want to Read

I’ve attempted to gather the news I’ve missed, but articles are surely missing. If you know of something, please post a comment with a link to it if you have it.

Under each heading the articles are vaguely ordered by relevance.

Research
Acupuncture May Ease Impact of Headaches
Adding acupuncture to standard medical treatment may improve the quality of life for people who suffer from frequent headaches, according to a new study.

Botox May Ease Facial Pain: Benefits Lasted for 60 Days in Small Study
A shot of Botox may ease a type of facial pain called trigeminal neuralgia, doctors report.

Pain Affects Black Women More Intensely
The far-reaching effects of chronic pain may be worse for black women than they are for white women.
(via Kevin, MD)

Websites Bolster Chronically Ill
Using interactive websites can help people with long-term conditions that include depression, heart disease and HIV/Aids, a study has found.
(via Medical Humanities)

Drugs
Eli Lilly Expands Cymbalta Liver Warning: FDA
Eli Lilly and Co. has expanded its warning about possible liver-related problems with its depression drug, Cymbalta, and cautioned doctors against its use in chronic liver disease patients, U.S. health regulators said on Monday.

EU Body Gives Old Pain Drugs Clean Bill of Health
Europe’s drug watchdog said on Monday it had no new safety concerns over older pain medicines like ibuprofen and naproxen, following an extensive review of side effect issues.

Another Way to Cut Drug Costs: Split Pills
Smart shoppers can’t resist a two-for-one sale. But should you purchase prescription drugs the same way you buy pizza or canned corn? For years, people who take daily medications have saved money by asking their doctors to prescribe pills with double the dose they need, which they then cut in half with a knife.
(via Kaiser Network)

Pain Meds Scarce in Black Neighborhoods: Study Finds Medicines Understocked
Pharmacies in black neighborhoods are much less likely to carry sufficient supplies of popular opioid painkillers than those in white neighborhoods, a new study has found, leading researchers to conclude that minorities are routinely undertreated for chronic pain.
(via Kevin, MD)

PhRMA Lawsuit Challenges D.C. Rx Drug Price Control Law
The Pharmaceutical Research and Manufacturers of America filed suit against the Washington, D.C., government last week alleging that a new price-control law on prescription drugs will cut supplies, hinder development and cause a “limitless parade of lawsuits.”

Drug Panels ‘Have Financial Links’
Doctors around the world are being advised to prescribe specific drugs by experts with close financial links to the pharmaceutical industry, it has been claimed.
(via Kevin, MD)

Healthcare Costs
Is Complementary Medicine Cost Effective? BMJ
The cost-effectiveness of using complementary treatments in the United Kingdom has been the subject of much speculation and controversy.
(via Kevin, MD)

Treated for Illness, Then Lost in Labyrinth of Bills
When Bracha Klausner returned home after an extended hospital stay for a ruptured intestine three years ago, she found stacks of mail from doctors and hospitals waiting for her.
(via Kevin, MD)

Dying to Pay, New Bankruptcy Laws Hurt Seriously Ill
New bankruptcy rules that went into effect on Monday, don’t just affect those who’ve run up their credit cards due to poor spending habits.

They also affect people who have little choice about their cash flow, people who’d give anything ‘not’ to be in the situation they’re in.
(via Kevin, MD)

Insurance
Workers May Be in For Health Plan Sticker Shock
USA Today on Friday examined the shift toward higher employee contributions to health care costs as employers try to curb their health care spending. According to USA Today, employers are utilizing various methods, including coinsurance, restrictions on prescriptions, high-deductible plans and wellness incentives.
(via Kaiser Network; quote from USA Today Examines Rising Health Insurance Premiums, Out-of-Pocket Costs for Employees)

Wall Street Journal Examines UnitedHealth Group’s Move to Consumer-Driven Insurance Plans
The Wall Street Journal on Monday examined Minnesota-based UnitedHealth Group’s move to “so-called consumer-driven health care” in the face of “steadily eroding business” as a traditional health insurer. Consumer-driven plans are based on the idea that people will consider health care spending more carefully if they have to pay a larger proportion of the cost themselves.

High Deductible, High Risk: ‘Consumer-Directed’ Plans a Health Gamble
Elizabeth Fowler can be called an educated health care consumer: An expert on health care policy, she used to be the chief health and entitlements counsel for the Senate Finance Committee. But she was pushed to the limits of her knowledge and patience keeping track of her so-called consumer-directed health plan — a type of insurance designed to protect consumers from catastrophic medical costs while prompting them to shop wisely for routine care.
(via Kaiser Network)

Policy
Canadians Still Waiting: 18-week Delay for Medical Care Reduced by a Day
Large increases in health-related spending have only marginally reduced the waiting times for medical services in this country from record-high levels in 2004, a new report says.
(via Kevin, MD)