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Frequent use of over-the-counter painkillers carries real risks

It's easy to overdose or to patch over problems that require a doctor's care. Research adds the list of risk factors, but it also sees possible new benefits.

February 14, 2011|By Emily Sohn, Special to the Los Angeles Times
  • Over-the-counter painkillers can be used too much.
Over-the-counter painkillers can be used too much. (Kirk McKoy / Los Angeles…)

When something hurts, most Americans open their medicine cabinets and pop a few capsules, tablets or gel-caps.

Acetaminophen, aspirin, ibuprofen, naproxen: More than 80% of us report using these four main over-the-counter analgesics, according to the market research firm Mintel. Two-thirds of us keep stashes on hand, not just at home but also at work, in our handbags or in the car. And about half of us have multiple bottles available, just in case.

All that pill popping certainly affects our health — and not always for the better. Used correctly, over-the-counter analgesics can help with acute aches and pains. Even more enticing, growing evidence suggests that some of them might also help fight Alzheimer's and Parkinson's disease, as well as heart attacks and some cancers.

But there are real risks. It's easy to overdose, with dangers that include stomach upset, organ failure, strokes, even death. And the safe upper limits may vary from one person to the next, depending on body size, genes and prior health conditions.

Even healthy people can get themselves in trouble by thinking that if a little bit helps a little, a lot will help more. For some groups, including serious athletes and people with migraines, new evidence suggests that taking painkillers the wrong way or at the wrong time can do the opposite of what users took them for in the first place — create pain.

As data roll in about both the benefits and risks of over-the-counter painkillers, experts say the only good advice for everyone is to think twice before taking them.

"They are powerful drugs that are safe when taken as directed," says Janet Engle, a pharmacist at the University of Illinois at Chicago and a member of the Non-prescription Drugs Advisory Committee at the U.S. Food and Drug Administration. "If you don't take them as directed — and something like 50% of patients don't — you can get into all kinds of issues."

Consumers may be glad to know that over-the-counter painkillers work better than sugar pills in trials, though placebos do have some effect. A 2004 study in the Journal of Rheumatology, for example, found a 30% to 45% reduction in pain symptom scores in knee osteoarthritis patients who took either naproxen or ibuprofen, compared with a 20% to 25% improvement for those who received placebos.

Many times, in fact, over-the-counter painkillers work as well as a group of anti-inflammatory medications called Cox-2 inhibitors, which are prescription only.

It's not clear whether any one painkiller works better than the others for all people or for all types of pain: Scientists haven't done many head-to-head comparisons. And since all bodies and metabolisms are different, one drug might work best for one person while a different one works best for another, says Wayne Nicholson, a clinical pharmacologist at the Mayo Clinic in Rochester, Minn.

In one of the most comprehensive comparisons done on an extremely common pain condition, a 1991 study randomly assigned about 150 patients with osteoarthritis of the knee to get 1,200 milligrams of ibuprofen, 2,400 mg of ibuprofen or 4,000 mg of acetaminophen a day. A month later, all three groups reported the same amount of improvement — a reduction of up to 15% in their reported levels of overall pain. The study did not include a placebo.

The higher dose of ibuprofen used in that study is recommended by prescription only. But half as much worked just as well on most measures of pain and range of motion, Nicholson notes — and that kind of result pops up in many studies.

It contradicts what many people do: take larger doses when the pain is particularly bad.

"There's actually a pharmaceutical ceiling effect," Nicholson says. "For the average person, you get a certain effect at a certain level. You could take a ton more medicine, but it's not going to work more for you. It's just going to cause more side effects. That's where people get in trouble."

Uses beyond pain

People most commonly turn to over-the-counter painkillers for headaches and sore muscles. But at low levels, according to growing research, these medicines may also help fight far more serious diseases. Aspirin is the most well-known example. For more than 30 years, doctors have been prescribing a small daily dose to patients at high risk of heart disease.

Unlike the other nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin inhibits enzymes that make platelets in the blood clump and stick together. That, in turn, reduces the risk of clotting. According to the U.S. Health and Human Service's U.S. Preventive Services Task Force, a daily dose of baby aspirin (81 mg) or a dose of regular aspirin (325 mg) taken every other day can reduce the risk of heart attack in men ages 45 to 79 by 32%. For women ages 55 to 79, the risk of stroke from blood clotting drops by 17%.

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