Shocking Over The Counter Pain Reliever Risks

Very Serious Risks Associated with Over The Counter Pain Relievers

You may be unaware of the risks associated with taking NSAIDs (ibuprofen/motrin/advil, naproxen/aleve, aspirin, and many prescription anti-inflammatories) and Acetaminophen (Tylenol).

These pain relieving, anti-inflammatory drugs are one of the most widely used types of medicines in the US.

More than 70 million prescriptions and more than 30 billion over the counter NSAIDs are sold every year in the US. We can clearly see that pain is very, very common.

Why? Well, that’s a story for another time.

NSAIDs are often called non-steroidal because they are not steroids, makes sense to me! 

Steroids work through a different mechanism by suppressing part of the body’s natural healing response to trauma through the immune system. 

NSAIDs are very commonly used over the counter and prescription medications to reduce pain and inflammation.

NSAIDs reduce our the body’s ability to make hormone like chemicals called prostaglandins.  These are often made in response to injury, but many other factors also.

News stories have talked about recent studies finding serious risks with the use of Nonsteroidal Anti-inflammatory Drugs (NSAIDs) and Acetaminophen (Tylenol).

We’ll cover just a few of the concerns here.

You probably remember when Vioxx and Bextra (Rofecoxib) were identified as causing over 100,000 strokes and heart attacks in otherwise seemingly healthy patients who were prescribed these NSAIDs for pain relief.

These medications were commonly prescribed for arthritis, back pain, knee pain, etc. It should be noted that these people thought taking the medications was safe only to later suffer very serious health problems including death.

Other NSAID medications are increasingly come into question about safety, including over the counter pain relievers that we’ll talk about here.

Heart Attacks and Cardiovascular Risks When Taking NSAIDs

A 2017 BMJ study reviewed 82 studies for a meta-analysis of data. They found 8 that met their standards. Over 400,000 subjects were part of this analysis.

There were over 61,000 heart attacks in this group.

Here’s what the researchers found…

“Studying 61,460 myocardial infarction [heart attack] events in real world use of NSAIDs, we found that current use of a NSAID is associated with a significantly increased risk of acute myocardial infarction. This was observed for all traditional NSAIDs, including naproxen.”

The researchers reported that “NSAID (users) exhibited a rapid onset of risk for myocardial infarction in the first week of use.”

The researchers found huge increases in relative risk for people who took different NSAIDs for one week or less:

• Ibuprofen: a 48% increased risk of heart attack
• Diclofenac (Voltaren): a 50% increased risk of heart attack
• Naproxen (Aleve): a 53% increased risk of heart attack
• Celecoxib (Celebrex): 24% increased risk of heart attack

These are relative risk numbers which is how many studies are reported in order to make pharmaceutical effects seem larger to the people reading about the drug’s effect… Because this is relative risk it does mean that the overall risk is still fairly small.

Having said that though…

Considering the fact that heart disease is the number one killer of men and women in the US, this one study alone raises some serious reasons for concern.

About 610,000 people die of heart disease in the United States every year, this is 1 out of every 4 deaths.

If you already have heart or cardiovascular risk factors or wish to avoid increasing your risks, then it’s important to consider alternatives to NSAID pain relievers (often referred to as anti-inflammatories).

Very Concerning Safety Risks Reported…

A 2009 study, “Iatrogenic Effects of COX-2 Inhibitors in US Population Drug Safety” reported very concerning risks with NSAID use.

Over 4 years from 1999-2004, researchers found…

• 46,783 heart attacks,
• 21,832 strokes,
• 100,842 excess Gastrointestinal (stomach/intestines) hemorrhages (bleeding).
• Over the counter NSAIDs were associated with an excess of 87,327 GI hemorrhages.
• Prescription COX-2 inhibitors (like Celebrex) resulted in 26,603 deaths.
• Over the counter NSAIDs use resulted in 9,606 deaths.
• Vioxx which was later pulled from the market caused the 14th most common drug related deaths (from 1998-2005).
• Celebrex was the 10th leading cause of drug related disability or other serious problems during the same years.

The researchers reported,

“Conclusions: Iatrogenic effects of coxibs (NSAIDs) in the US population were substantial, posing an important public health risk.

Drugs that were rapidly accepted for assumed safety advantages proved instead to have caused substantial injury and death.”

More Reasons For Concern With NSAID Use.

NSAIDs can cause and increase the risk of…

• Stomach Problems: Digestive tract upset, stomach pain, nausea, bleeding ulcers
• Cardiovascular Risks: Heart attack, Stroke, Irregular heart rhythms (A-fib), Fluid retention, Heart failure, High blood pressure
• Dizziness
• Unsteadiness
• Kidney problems
• Liver problems
• Asthma, breathing problems
• Allergic reactions (including Anaphylactic shock)
• Skin rash and other skin reactions
• Ringing in the ears and damage to the ears
• Changes in vision

Given how common all of these symptoms already are in people, it again re-enforces the idea that real caution should be used when considering taking these medications, the majority of which are available over the counter.

In other words, if you already have some of the problems listed above, you should be very careful about taking these medications.

The mortality rate from NSAID related gastrointestinal toxicity, is 0.2% per year. NSAID use results in about 107,000 hospitalizations every year for stomach complications and 16,500 yearly deaths for arthritis patients.

OK. NSAID pain relievers have some risk.

Pain really interferes with my life though.

I know you’re thinking, “I have to do something.“

What About Acetaminophen (Tylenol)?

Tylenol/Acetaminophen is not an NSAID. It works through a little different way.

It should be noted that acetaminophen is in a lot of different medications ranging from sleep aids to cough syrup and prescription pain relievers including opiates.

In fact, acetaminophen is in more than 100 over the counter medications.

Unlike NSAIDs, acetaminophen does not reduce inflammation or blood clotting or cause stomach complications… so everything’s cool, right?

Acetaminophen overdose is one the most common causes of over the counter drug overdoses in the US.

More than 30,000 cases per year of acetaminophen overdose occur according to the American Association of Poison Control Centers.

Acetaminophen is a leading cause of liver failure in the US.

People with pre-existing liver problems (and this is a huge number of people given that fatty liver disease effects about 1/3 of US adults and almost as many kids), people who are heavier alcohol drinkers, or those that are taking other liver toxic medications should be extremely cautious about taking any of the products that contain acetaminophen (Tylenol).

Beyond liver toxicity…

People who take acetaminophen regularly double their risk of kidney cancer.

We’ve also seen that Tylenol (acetaminophen) reduces testosterone in men.

What Are Your Safer Alternatives For Pain Relief?

It’s very important that we don’t rely upon these medications if other safer treatment that works very well can take care of the problem without causing us to die or lose our health.

The longer you rely upon these medications, the greater your risks… and this brings up a very serious question,

If your problem continues, how are you going to take care of it?

In other words, we know that even short term use has very serious risks let alone long term use.

The obvious choice for most people taking pain relievers for headaches, arthritis, neck pain, back pain, knee pain, and other musculoskeletal related problems is to see a Chiropractor.

You are far more likely to suffer a very serious injury, including death, from taking even an over the counter pain reliever than from having 1000’s of chiropractic treatments.

Chiropractic is exceptionally safe and what really matters too is that it’s extremely effective at reducing pain from so many different causes including most of the reasons that people are taking NSAIDs or Acetaminophen!

Add to this, we also work with our patients on eliminating the triggers of the pain and inflammation while improving other factors that improve your health and wellness instead of damaging it.

Need To See An Experienced Texarkana Chiropractor?

Contact Us!

We’re here to help you like Dr. Hagebusch has helped thousands of other Texarkana area residents recover from injuries and various other conditions ranging from arthritis pain, chronic pain, whiplash, sports injuries, migraines, headaches, vertigo, and much more!

References:

https://www.cdc.gov/heartdisease/facts.htm

https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-strengthens-warning-non-aspirin-nonsteroidal-anti-inflammatory

https://www.health.harvard.edu/blog/fda-strengthens-warning-that-nsaids-increase-heart-attack-and-stroke-risk-201507138138

Cardiac risk factors and prevention. Use of non-steroidal anti-inflammatory drugs in US adults: changes over time and by demographic. https://openheart.bmj.com/content/4/1/e000550

Risk of acute myocardial infarction with NSAIDs in real world use: bayesian meta-analysis of individual patient data. BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1909 (Published 09 May 2017) https://www.bmj.com/content/357/bmj.j1909

Vasc Health Risk Manag. 2014; 10: 25–32. Published online 2014 Jan 6. doi: 10.2147/VHRM.S54159 PMCID: PMC3888349 PMID: 24421643. Risk of stroke associated with nonsteroidal anti-inflammatory drugs
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3888349/

Drug Safety April 2009, Volume 32, Issue 4, p 335–343. Iatrogenic Effects of COX-2 Inhibitors in the US Population. https://link.springer.com/article/10.2165/00002018-200932040-00007

https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/ibuprofen-drug-facts-label

https://www.who.int/selection_medicines/committees/expert/19/applications/Naproxen_Addendum_1.pdf

https://www.drugs.com/answers/common-side-effects-nsaids-537878.html

https://www.webmd.com/arthritis/anti-inflammatory-drugs#1

https://www.drugs.com/sfx/acetaminophen-side-effects.html

https://www.rxlist.com/tylenol-side-effects-drug-center.htm

https://www.goodrx.com/blog/is-tylenol-acetaminophen-bad-for-your-liver-or-kidneys/