What do you do if you have a headache, fever, or muscle pain? Chances are you go to the local drug store to pick up an over–the–counter (nonprescription) pain medicine. These drugs are the medicines most often used by Americans. Pain medicines, also called analgesics, help relieve pain, fever, and even inflammation. These medicines may help with arthritis, colds, headache (including migraine), muscle aches, menstrual cramps, sinusitis and toothache.
These drugs are effective and usually safe. However, it is important to realize that no medicine is completely without risk. They should be used carefully. When used improperly, pain medicines can cause problems in the body, including the s. According to the National Foundation, as many as 3 percent to 5 percent of new cases of chronic failure each year may be caused by the overuse of these painkillers. Once disease occurs, continued use of the problem drug makes it worse.
Nonprescription pain medicines should not be used without your doctor’s permission if you know you have low function. Also, even if your function is good, long–term use with high doses of these pain drugs may harm the s. damage happens because high doses of the drugs have a harmful effect on tissue and structures. These drugs can also reduce the blood flow to the . If you are older, your s may have a stronger reaction to these medicines and you may need a smaller dose.
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Disease from pain medicines is often preventable. You can change your risk by how you take medicines. To avoid problems, it is important to follow the instructions on the label. You should tell your health care team how often you use these drugs and how many of pills you take. You should drink plenty of fluids and avoid becoming dehydrated when you use these medicines. If you have special risks, your doctor may be able to recommend a safer alternative and can order regular tests to monitor function.
Analgesics are medicines that help to control pain and reduce fever, and some types also decrease inflammation. These are commonly used analgesics:
Although aspirin was most common analgesic for decades, today, the most commonly used over–the–counter pain medicine is acetaminophen. This drug is available under the brand name Tylenol® and as a generic (no brand name) with the word “acetaminophen” on the package. It is often effective for mild to moderate pain. Its safety depends on how it is used. People who take too much or take it too often risk side effects or worse. Acetaminophen is also found in combination with other ingredients in many cold, sinus, and cough medications. If you take these drugs together, the dose can add up.
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Aspirin. This is one of the drugs grouped together under the name “nonsteroidal anti–inflammatory drugs” or NSAIDs. Nonsteroidal anti–inflammatory drugs (NSAIDs) are a specific group of pain relievers. Some NSAIDs are available over the counter. This includes different brands of aspirin, ibuprofen, naproxen sodium and ketoprofen. Prescription strength NSAIDs are also available.
Acetaminophen is the drug often recommended for occasional use in patients with disease. But everyone with disease should rely on their doctor or other health care professional for a personal recommendation. It is important to know that any drug can be harmful if used at high doses or very frequently. People with disease should also be sure to avoid drinking alcohol while taking pain medicines.
NSAIDs are usually safe for occasional use when taken as directed. However, if your doctor has told you that you have low function, NSAIDs might not be right for you. These medications should only be used under a doctor's care by patients with disease. Also, they might not be the best choice for people with heart disease, high blood pressure or liver disease. Some of these drugs affect blood pressure control. High doses over a long period of time can also lead to chronic disease and even progress to failure.
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For people without disease, the recommended dose of aspirin can be safe if you read the label and follow the directions. When taken as directed, regular use of aspirin does not seem to increase the risk of disease in people who have normal function. However, taking doses that are too large (usually more than six or eight tablets a day) may temporarily and possibly permanently reduce function. In people with disease, aspirin may increase the tendency to bleed.
My doctor recommended that I take an aspirin in low doses every day to prevent heart attacks. Will this hurt my s?
It’s not likely. There is no evidence of risk regarding the regular use of aspirin in the small doses recommended for prevention of heart attacks. Use of a “baby aspirin” is fine, even with reduced function.
Pain Reliever Safety
You should speak to your doctor about the best choice for you. In addition, if you have a medical condition, you should only use NSAIDs under your doctor's supervision.
Your doctor can check your s by doing a simple blood test called a serum creatinine test. The results of the serum creatinine test can be used to estimate your glomerular filtration rate (GFR). Your GFR number tells your doctor how much function you have.
A urine test for the presence of protein may also be done. Persistent protein in the urine may be an early indication of damage.
Safer Nsaid Alternatives
Disease caused by pain relievers is often preventable. Here are some things you can do to help keep your s healthy.Barry Davis has only about 25 percent of his kidney function left. The cause? Over the counter pain meds like Advil and Aleve. They belong to a class known as non-steroidal anti-inflammatory drugs, or NSAIDS. Davis, once an avid runner, says he took up to nine pills a day for three decades. He says he told his doctors.
Doctors may not have warned Davis, but the National Kidney Foundation advises that while NSAIDS are “usually safe for occasional use” they can lead to chronic kidney disease.
“These kinds of anti-inflammatories are meant to be taken in the short term to help with an acute pain or inflammation, ” said Charles Srour, DC, Pro Health Care.
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Davis now sees chiropractor, Charles Srour, who says there are safer alternatives for treating pain long term. He recommends the herb turmeric, specifically curcumin, fish oil and complexes like infladox, which combine supplements.
Davis says he assumed buying medicine over the counter meant it was safe. He urges others not to make the same mistake.
Doctor Srour also says aspirin is an NSAID, but there is far less documentation that it causes kidney failure in comparison to ibuprofen.
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BACKGROUND: Nonsteroidal anti-inflammatory drugs, or NSAIDs, can be prescribed by your doctor or purchased over-the-counter, or OTC. They are the most common medications prescribed for arthritis, but most people are familiar with the OTC NSAIDs, such as aspirin and ibuprofen. These drugs help relieve pain, reduce inflammation and lower fevers. They also prevent blood clots. Some NSAIDs, most commonly aspirin, could protect against heart disease, but it can also cause you to bruise more easily. Side effects include nausea, upset stomach, higher risk for developing an ulcer, and interference with kidney function. You are at a higher risk from NSAIDs if you are pregnant, over the age of 65 or are taking other medications. You are also at higher risk if you have high blood pressure, asthma, a history of kidney or liver disease, or have had ulcers in the past. The side effects and risks also increase the longer you take the NSAID. (Source: http://orthoinfo.aaos.org/topic.cfm?topic=a00284)
HOW NSAIDS WORK: NSAIDs prevent the enzyme known as cyclooxygenase, or COX, from doing its job. COX has two forms, COX-1 and COX-2. COX-1 guards the stomach lining from harsh acids and digestive chemicals and helps preserve kidney function, while COX-2 is produced when joints are injured or swollen. Traditional NSAIDs, such as aspirin, ibuprofen, naproxen and nabumetone, block the actions of both forms of COX. This is why upset stomachs and bleeding can occur, but also why pain and inflammation will subside. One special category of NSAIDs is COX-2 inhibitors. These block only the actions of COX-2 enzymes, which stimulate inflammation. They generally don’t cause upset stomachs or bleeding because they don’t block COX-1. COX-2 inhibitors include celecoxib, rofecoxib and valdecoxib. (Source: http://orthoinfo.aaos.org/topic.cfm?topic=a00284)
ALTERNATIVES TO PILLS: The National Center for Biotechnology Information says, “Although nonsteroidal medications can be effective, herbs and dietary supplements may offer a safer, and often an effective, alternative treatment for pain relief, especially for long-term use.” They recommend the following list:
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