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A New Health Headache: Choosing Pain Medication
National Dragster, Feb 25, 2005 by Torstveit, Jeremy
Running Healthy
The new racing season has begun, and with it come the inevitable bumps, bruises, muscle strains, and aching joints. Tension and tire shake will cause headaches for even the most hardened drivers and crew chiefs. Cold mornings, long drives, and constant loading and unloading will have arthritis sufferers reaching for pain pills frequently. New research data suggests that taking certain pain medications may be hazardous to some. Does the old standby need to be trashed? What alternatives are available? The dilemma faced by 30 to 40 million pain sufferers in the United States who take medications every day and the millions more who need an occasional analgesic is determining how much relief is worth the risk of drug side effects.
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Drug studies in the news
Non-steroidal anti-inflammatory drugs (NSAIDs) have been the mainstay of treatment for arthritis , pain, headache, inflamed muscles, toothache, and other musculoskeletal ailments. They are quick acting and effective but tend to cause stomach irritation and ulcération, especially when taken in large doses and for long periods. The NSAID subgroup COX-2 inhibitors (Vioxx, Celebrex, and Bextra) were created with the hope of avoiding stomach problems while still providing good pain and inflammation relief. These COX-2s are not over-the-counter drugs, like other NSAIDs, but require a prescription, which doctors have written for millions of patients.
Recent studies suggest that patients on the COX-2 drugs, especially Vioxx, had higher incidences of heart attack and stroke. Vioxx was withdrawn from the market voluntarily by its manufacturer, and patients were directed to their doctors to look for an alternate medication. Apparently, the COX-2 drugs prevent the body's ability to produce a natural blood thinner. Without this substance, clots can form more easily in the vessels that carry blood to the heart and brain, increasing the risk of heart attack and stroke. To make this even more confusing, one non-COX-2 NSAID, Naproxen (Aleve), which has been on the market for many years, was also implicated. It is important to note that the higher the dose and the longer the treatment, the higher the complication rate for all of these drugs. Though more details have been promised by researchers, it is important to consult with your doctor now to see what changes in medications may be necessary.
Choosing medications
Celebrex and Bextra, which did not have as high a complication rate as Vioxx, are still on the market. For those who don't have cardiac risk factors, an extremely sensitive stomach, or a high degree of arthritis pain, these still may be the best drugs. The occasional use of Aleve for severe toothache or menstrual cramps also probably carries little additional risk. For many others, though, it's probably time for a change. Remember that even over-thecounter medication still needs to be taken with caution and as directed because all medications, overthe-counter or prescribed, carry potential side effects.
Acetaminophen (Tylenol) is probably the safest pain and fever medication available and is the drug of choice for children. It has minimal side effects on the stomach, but it does not treat the cause of the pain and fever. Heavy users of alcohol can develop liver damage from taking Tylenol, even as directed. Kidney problems also have been reported when large doses have be'en taken many days in a row. Tylenol is included in many combination therapy pills; you might be getting something you don't want or need with these products.
Aspirin is an excellent pain and inflammation reliever and a good fever reducer - especially for those with an iron stomach. I'm sure it relieved drag racing legends Don Garlits, Don Prudhomme, Connie Kalitta, and others of their tire-shake headaches and bruised rib pain, but better products are now available. Coated or buffered aspirin may relieve the mild stomach upsets, but those with a history of gastrointestinal bleeding or ulcers should stay away from aspirin. Those who take low-dose aspirin as a blood thinner should use another medication for pain. Aspirin is not recommended for children because of its association with the rare and potentially fatal Reye's syndrome.
Ibuprofen (Advil and others) is a strong pain reliever and anti-inflammatory drug that is fairly easy on most stomachs, especially if taken with food or antacids. I can vouch for this one on tire-shake headaches, having been subjected to five years of field testing by my "clinical investigator" and crew chief Fred Mandoline. Generic ibuprofen in 200mg doses can be obtained at discount retailers at a much better price than many drugstores. Remember, ibuprofen, like the other drugs discussed, can cause liver damage. The best way to avoid complications is to keep the duration of use at one or two days and to not exceed manufacturer specs on dosage. Keeping the duration low, switching between different medications, and using lower doses also prevents pain rebound, which in the case of headaches is caused by the pain reliever itself!
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