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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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Online Tool to Assess What Kind of Headaches You Have

Migraine, tension-type, sinus, cluster. . . . You know what your headache feels like and the other symptoms you have. Seems like finding a diagnosis would be easy, but it can be quite complicated. Consider these factors:

Headache Central, an educational site sponsored by the Michigan Headache Treatment Network, has a tool to help classify your headaches in medical terms. The online program asks questions about your headaches, determining which questions to ask based on your previous responses. After you’ve answered all the questions, you’re given a page with your responses and possible diagnoses summarized in a doctor-friendly format to print and take to your next appointment.

The program is not intended for you to diagnose yourself but to provide your doctor with a more complete view of what you’re experiencing. Of course, many readers will use the information to guide further online research. Arriving at your doctor’s office well-informed is helpful; so is being open to what they have to say. Think of the headache classification tool a starting point from which your doc can ask you relevant questions (and vice versa) to flesh out your diagnosis and find the appropriate treatment for you.

FYI: The program doesn’t work in Firefox.

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Treating Pain With Opioids

multicolor pillsKUOW, one of Seattle’s public radio stations, had a program yesterday on treating chronic pain with opioids with an expert panel weighing in. I only listened to the first half, but what I heard was informative and interesting.

They discussed a recent rise in overdoses among chronic pain sufferers. These are thought to be accidental, resulting from the need to increase dosages when the the patient develops tolerance.

Something I didn’t realize is that, according to the panel, most of the studies on opioids and pain focused on cancer pain, not chronic pain. There’s a significant distinction between medicating people with progressive, potentially fatal diseases and treating people with lifelong pain. Addiction and dependence are concerns, but tolerance — and the higher doses it requires — is a big risk too (not to mention potentially fatal).

Not covered in the program was that opioids appear to change the brain so that the patient actually becomes more sensitive to pain. Building tolerance is not only your body getting use to the drug (called desensitization), but you actually become more sensitive to pain overall (referred to as sensitization), not just the pain that you are specifically treating. It also increases allodynia, which is already a migraine symptom.

This is a summary of the clinical implications of these findings:

“The diminishing opioid analgesic efficacy during a course of opioid therapy is often considered as a sign of pharmacological opioid tolerance. As such, an opioid dose escalation has been a common approach to restoring opioid analgesic effects, assuming that there are no contraindications and no apparent disease progression. . . . [A]pparent opioid tolerance is not synonymous with pharmacological tolerance, which calls for opioid dose escalation, but may be the first sign of opioid-induced pain sensitivity suggesting a need for opioid dose reduction.”

While I firmly believe that pain sufferers should have access to opioids, the issue is much more complicated than DEA intervention. They’re an easy scapegoat and a problem for sure, but the body’s roadblocks may be a greater obstacle. Perhaps we should listen to our bodies and not rely so heavily on opioid pain relief.

Related stories:

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Rebound Rebound

A 2003 study found that more than a third of patients treated for rebound headaches from analgesics begin overusing that medication again within a year. This is greater than the percentage who return to using triptans or ergots.

Considering that painkillers are pretty effective when people first start taking them, this makes a lot of sense. Over time, they become less helpful and lull you into rebound. Sounds a lot like the trap of caffeine.