Potential risk of pain killers

How Safe are Pain killers


Quite often, it is the pain that brings the patient to the doctor. In the patient’s mind,  it is pain relief, amongst all other therapeutic measures, that enhances the value of the treatment received.

Pain killers have been used since several decades for minor ailments such as aches and sprains.  They are also used to reduce the effects of fever and inflammation on the body.  People with chronic painful conditions such as arthritis use pain killers almost every day to alleviate pain. Sometimes pain killers are used indiscriminately and even abused by some patients.  They are also easily available from the local pharmacy, often without a doctor’s prescription.

In a new study published in the European Heart Journal in March 2016, researcher Morten Schmidt and associates from Denmark’s Aarhus University, studied data from 14 European universities and hospitals. They looked at the use of non-steroidal and anti-inflammatory drugs (NSAID) in patients with heart diseases, and found that NSAID are probably over-prescribed in those with cardiac problems.  This may lead to further cardiac complications for those already having a heart disease; or gastric ulcers and liver and/or renal impairment in other users.

What are the commonly used pain killers?

These are aspirin, paracetamol, celecoxib, rofecoxib, diclofenac, naproxen and ibuprofen.  In addition, there are other opiate derived drugs such as codeine that are used to treat severe pain.

What are pain killers used for?

Aspirin is also an NSAID, although it works differently from the usually used NSAID such as celecoxib and rofecoxib, which belong to the COX-2 inhibitor group.  Aspirin is very useful in acute heart attacks, and may even improve the chances of survival by reducing the blood clot in the artery of the heart.  It is also used for common headaches and toothaches.

Diclofenac is used for a variety of conditions such as menstrual cramps, pain due to arthritis and headaches.  Naproxen is used in treating painful orthopedic conditions.  Ibuprofen, along with paracetamol is one of the commonest used pain killers.  It is often used in combination with paracetamol to reduce fever, inflammation and pain relating to any condition.

Rofecoxib and celecoxib are some of the newer NSAID with relatively less gastric side-effects and are used to alleviate pain related to all conditions.

Because of its cough suppressant properties, codeine is commonly added to cough syrups.  It is also used under controlled conditions – such as during inpatient admissions – to reduce severe pain and induce sleep.

What side-effects can they cause?

Aspirin is associated with worsening of pre-existing asthma and bleeding gastric ulcers.  In general, all pain killers cause a worsening of cardiac conditions, high blood pressure, gastritis, and liver and renal impairments. Paracetamol is probably the most commonly available over-the-counter pain killer.  It is probably the safest drug among all the pain killers, but when taken in excess, it can lead to liver failure.  Codeine is associated with constipation, mood swings and addiction.

What can be done to prevent these side-effects and risks?

  • Do not use pain killers indiscriminately just because they are so easily available
  • Remember that pain killers are not antibiotics, and do not remove the source of infection; therefore they do not have to be used for a long time
  • They also do not remove the root cause of the problem and are only used symptomatically to reduce the pain; therefore they should be used as judicious adjuncts to definitive therapy
  • If you have any of the following conditions, exercise caution while using these drugs:
  1. History of heart attack or stroke
  2. History of stomach ulcers
  3. High blood pressure
  4. High cholesterol level
  5. Bleeding tendencies
  6. Asthma
  7. Liver disorders
  8. Renal disorders
  9. Systemic lupus erythematosus (SLE)
  • For those with chronic conditions such as arthritis, it is always better to discuss the pain management strategy with the treating doctor
  • If you do have to use pain killers on a long-term basis, have your heart, liver, renal and general health checked up regularly
  • If you belong to the extremes of age-groups – child and elderly – use only a small dose of pain killers to begin with, and further doses after seeking professional advice
  • Paracetamol is probably the safest drug that can be used during pregnancy; for all other pain killers, seek expert opinion