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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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Treating Pain With Antioxidants

Antioxidants have made the news a gazillion times in the last few years. After listening to the same information over and over again, I tuned it out. Today I’m paying attention.

Synthetic antioxidants nearly eliminated pain-like behavior in almost three-quarters of mice with inflamed paws. Mice aren’t humans, of course, but it’s an interesting start. Antioxidants are an emerging research interest; with findings such as these, the interest can only grow.

Right now pain treatments options are at extreme ends. OTC painkillers are on one side and opioids are at the other end, with little in between. Finding an effective middle-ground has been tough, but the antioxidant research appears promising (to my untrained eye).

Antioxidants neutralize free radicals, substances that damage cells. While our bodies constantly produce free radicals, healthy tissues inactivate these damaging substances and keep their levels in check. It’s when free-radical production somehow exceeds the body’s natural defenses that problems occur. Researchers have linked this excessive production to diseases like cancer and Alzheimer’s.

A handful of studies published in the last 10 years suggest that free radicals may also contribute to chronic pain. Left unchecked, free radicals build up in the body and can further damage already-injured tissue.

An equally small number of studies, including those by Stephens, suggest that antioxidants may fight chronic pain by helping the body to break down free radicals.

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Responsibility & Narcotics

Posting on the article Victim of Pain is Also Victim of Uncaring Doctor, Kevin, MD points out that “for every responsible narcotic user, you have another hundred who play the drug games.”

As a pain patient I want to kick and scream (and have), yet I know he’s right. (I’m not convinced it’s one to 100, but do believe that more patients come in seeking drugs than pain relief.)

The problem is impossible to solve. It’s great if the DEA gets off doctors’ backs, but drug-seekers remain. Doctors still have to decide which faction each patient represents. That’s no easy feat. And pain patients will continue to be undertreated.

In any case, the comments on Kevin’s post are of interest to any pain patient.

Related posts

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A Win for Pain Docs & Chronic Pain Patients?

Following two years of tight controls that kept doctors from writing multiple prescriptions for morphine-based painkillers in one visit, the DEA has loosened up. They have proposed a formal rule to allow doctors to write three 30-day prescriptions, two of which are future-dated, during a single appointment for patients who need constant supplies of morphine-based painkillers.

A “formal rule” is government speak for a policy that it thinks people should obey, but isn’t legally binding. In this case, it gives doctors more freedom while leaving the door open for DEA prosecution.

It definitely looks like a nod toward progress. The question is whether it is merely symbolic — or, much worse, a diversionary tactic. Any opinions on whether this is step in the right direction or just a smokescreen?