Chapter 4 : A quick overview of analgesic pain solutions

Over the counter painkillers

Aspirin is still one of the most widely used analgesic painkillers and as you can buy aspirin in almost any convenience store, it is a medicine that thousands of people all over the world use whenever they have a minor pain such as a headache or some other similar condition.

Technically speaking, aspirin is a non-steroidal anti-inflammatory drug (an NSAID) and was the first drug of its type to be discovered and isolated. For the vast majority of people, aspirin is a relatively safe medicine to take, although as previously suggested, it is a medicine to be avoided for people who are already taking other medicines with which it might interact.

In addition however, it is estimated that approximately 1% of people suffer from an aspirin allergy which is most commonly seen on the skin in the form of hives, rashes, and swellings. An aspirin allergy can bring on asthma attacks in people who already have a susceptibility to asthma, with an estimated 10% of asthma sufferers likely to suffer this form of allergic reaction to aspirin. This can extend as far as developing into anaphylaxis (a severe life-threatening allergic reaction) in a worst-case scenario.

Aspirin can also cause upset stomachs and diarrhea, as well as bleeding (both internal and external) and bruising as a result of its anticoagulant capabilities.

In a very small number of cases, aspirin can lead to Reye’s Syndrome which is a potentially fatal condition characterized by damage to many internal organs, especially the liver and the brain. Given the seriousness of this particular condition, early diagnosis of Reye’s Syndrome is absolutely essential because otherwise brain damage or death could be the result.

Reye’s syndrome passes through five distinct stages with the first being characterized by heavy vomiting that is not reversed by eating, general lethargy, nightmares and all-round confusion. If anyone who is taking aspirin exhibits any of these symptoms, it is absolutely critical to get them to a doctor or emergency hospital as quickly as possible.

Paracetomol (and Tylenol) (acetaminophen) is another widely used and generally available analgesic as well as being effective for reducing fever as well. For this reason, it is widely used as a treatment for headaches, fever and other minor aches and pains.

Paracetamol is technically known as an aniline analgesic and is the only one still widely used for the treatment of pain, because all other similar analgesics were withdrawn as they were believed to exhibit carcinogenic qualities (which so far, paracetamol does not). However, the fact that it is made from coal tar may give you a reason to question this as carbon is often believed to have carcinogenic qualities as well.

In normal doses, one of the advantages of paracetamol is that it does not irritate the stomach lining or affect blood coagulation in the same way that NSAID’s like aspirin do.

However, higher than recommended usage has been seen to have a potential connection with gastrointestinal bleeding and very high dosages have the capacity to cause liver damage, which in the most severe cases can be fatal. Indeed, paracetamol or tylenol poisoning is the number one cause of acute liver failure in most Western countries and the way that most people choose to commit suicide in these countries as well.

Furthermore, a massive study conducted in 31 countries and involving over 200,000 children in 2008 and reported in the leading medical journal ‘The Lancet’ found that the use of paracetamol in the first year of life made children far more likely to develop asthmatic symptoms at around age six or seven. In addition, children who took paracetamol during the first year of life and also children who took the drug at ages 6-7 demonstrated a far higher likelihood of developing eczema and rhinoconjunctivitis later too.

Ibuprofen (Advil, Nuprin etc) and Naproxen (Aleve) are both NSAID’s like aspirin. They therefore share many of the potential side effects that have already been highlighted as been endemic to aspirin. For instance, aspirin allergy, upset stomach and a higher risk of asthma attacks can be equally ascribed to both of these medicines as they can to aspirin.

Ibuprofen however carries additional risks as it is believed to increase the risk of myocardial infarction (heart attack) if taken in high dosages and you can also cause or exacerbate irritable bowel syndrome, Crohn’s disease and ulcerative colitis due to its capability of starting gastrointestinal bleeding.

With Naproxen, some of the most widely reported side-effects include constipation or diarrhea, drowsiness, upset stomach, stuffy nose and heartburn.

However, whilst the NSAID’s already detailed are likely to carry a slight increase in risk levels for heart attacks and strokes, the risk associated with Naproxen might be considerably more serious. Indeed, the National Institute of Health terminated a trial into the effects of Naproxen as a drug for reducing the severity of Alzheimer’s disease (in 2006) because of the suspicion that the drug significantly increased the risk of heart attack or stroke.

Since that time, further analysis suggests that at normal dosages, the increased risk of suffering a heart attack or stroke is fairly low although as you will see in the next section, this is certainly not true of all NSAID’s.

Prescription drugs

As a general observation, most of the pharmaceutical painkillers that are prescribed by doctors fall into one of two categories.

The first group is made up of stronger non-steroidal anti-inflammatory drugs than those that are available across the counter such as aspirin and ibuprofen. The second group of drugs that your doctor may prescribe to deal with your pain is the opiate or synthetic opiate-based drugs.

Let’s take each in turn starting with a small selection of the more common NSAID’s that your doctor might prescribe.

Celecoxib (Celebrex), Diclofenac (Volteran, Naklofen, Arbitren etc) and Tramadol (Ultram) are all NSAID’s that bring with them the usual potential adverse side-effects of taking drugs of this nature such as an increased risk of internal and external bleeding, bruising, upset stomachs, constipation and nausea etc.

However, unlike Naproxen with which it now appears that the increased risk of suffering a heart attack or stroke at normal dosage is small, the risk is significantly higher with both Celecoxib and Diclofenac. Furthermore, the risk seems to be increased irrespective of the dosage although of course the risk is going to become larger as your dosage is increased.

Research indicates that the increased heart attack and stroke risk factor is 1.63 compared to non-users. Nevertheless, this represents an increased risk that it is suggested many chronic pain sufferers will tolerate in return for the greater pain management capabilities of these drugs in comparison to weaker drugs such as aspirin. In effect, it seems that many pain sufferers know the increased risks and are willing to live with them to get rid of their pain.

In addition, the risk of suffering liver or kidney damage appears to be increased with all three drugs included in this category and should such damage occur, it appears that in most cases, it is likely to be irreversible.

Demerol, Vicodin and Lorcet are all drugs that are based on natural or synthetic opiate based drugs that are used to treat various different medical conditions and pain caused by these conditions.

Demerol is a drug that contains pethidine which for the majority of the 20th century was the most commonly favored opiate based drug, with 60% of doctors being reported as prescribing it for acute pain and 23% prescribing it for chronic pain in 1983. The popularity of the drug stemmed from the fact that it was supposed to be safer whilst also being stronger than morphine-based drugs which were the major alternative available at the time.

Since that time however, this has been proved incorrect. Indeed, because of the short duration of its effectiveness and low potency, it is debatable whether Demerol was ever really effective at all.

On the other hand, it carries a far more significant risk of causing neuropathological problems such as delirium and seizures than many other competing medicines, hence it is only prescribed very rarely nowadays. In fact, several countries such as Australia have either placed severe limits on the use of Demerol or banned it altogether.

The side effects of Vicodin are fortunately not as severe as those of Demerol, with the most common being nausea, upset stomach, light-headedness or dizziness. In more rare cases, Vicodin can cause allergic reactions, unconsciousness, jaundice, bleeding, bruising, constipation and altered sex drive, but these are the exceptions, rather than the norm.

One Vicodin problem that is significant is the fact that it is a drug to which it is easy to develop resistance relatively quickly. Consequently, many people are tempted to take progressively larger doses of Vicodin in an effort to combat the effects of increasing bodily familiarity with the drug which will naturally decrease its effectiveness.

Whilst increasing the dosage in this way will fight the pain more quickly and more effectively, all opiate-based drugs are addictive and obviously, the more of them you take, the more quickly it is likely that you become addicted. Vicodin can be highly addictive due to the presence of hydrocodone but whilst increasing the rate at which you take the drug to alleviate your pain will work, the damaging effects in both social and medical terms could be extremely harmful.

Becoming addicted to Vicodin represents a classic case of being addicted to prescription drugs and even though this is a prescribed drug, this does not make the addiction any worse. For example, reports of significant social and legal problems for Vicodin addiction sufferers are common as they visit doctor after doctor after doctor to try to get a prescription to feed their increasingly ravenous appetite

The ‘potential adverse side-effects’ of Vicodin therefore go way beyond the short term physical or medical side-effects highlighted earlier. Rather, they encompass many far more damaging side-effects which can and will adversely affect the quality of your life if you become addicted to this particular drug.

Remember, all opiate based drugs are naturally addictive so you must always apply a great deal of caution with any drug of this type.

As suggested, the ingredient in Vicodin that makes it so addictive is hydrocodone, and if you followed the earlier link, you may have noticed that amongst the brand names that are associated with this particular drug is Lorcet.

Hence, this particular medicine also has significant addictive qualities too. Addicts often demonstrate serious liver problems whilst an overdose of Lorcet or any other hydrocodone-based medicine can lead to respiratory depression, heart failure, heart attack, jaundice, seizures, blackouts, amnesia and ultimately death.

Furthermore, because many opiate-based drugs include acetaminophen (our old friend paracetamol or Tylenol), even relatively minor over-doses have the capability of causing jaundice or even serious, irreversible liver damage in many patients.

To sum up…

All pharmaceutical analgesics have potential side-effects, ranging from relatively mild problems such as upset stomachs or a touch of diarrhea to serious, irreversible problems like liver or heart failure, drug addiction and death.

Of course, for the vast majority of people, most of the worst side-effects of taking chemical-based pharmaceutical analgesics are never likely to be something that affects them. Nevertheless, the fact is, if only one in a hundred people suffers an allergic reaction to aspirin or one in 10 finds that their asthma has been exacerbated by taking the same drug, the odds of suffering an adverse side-effect are probably far higher than you had ever previously imagined.

The case for avoiding these drugs if at all possible is therefore extremely strong which brings us to the point of considering what alternatives there might be. Fortunately, there are many entirely natural alternatives available for anyone who is looking for effective pain management and these alternatives will provide the focus for the rest of this book.

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