Drug therapy, home therapy and more

We tend to think of over-the-counter pain relievers as perfectly safe.

But even these drugs have risks, so it’s important to follow the instructions on how to take them. And if you have an ulcer, you need to be very careful before applying over-the-counter (OTC) pain relievers. Many common ones can irritate the stomach lining, worsening ulcers and potentially causing serious problems.

“People think that if a drug is available over the counter, there is no risk,” says Byron Cryer, MD, a spokesman for the American Gastroenterological Association. “But about a third of all ulcers are caused by aspirin and other pain relievers. More than half of all bleeding ulcers are caused by these drugs.”

The problem is not only with OTC pain relievers. Many remedies for colds, sinus problems, and even heartburn contain the same ingredients.

If you have ulcers, you need to avoid foods or medications that will make your condition worse. So before you grab a bottle of pain reliever to soothe your aches and pains, learn the dos and don’ts.

How do pain relievers work?

In a way, all the pain is in your head. When we feel pain, it is the result of an electrical signal being sent from nerves in a part of the body to the brain.

But the whole process is not electrical. When tissue is injured (for example, from a sprained ankle), the cells release certain substances in response. These chemicals cause inflammation and amplify the electrical signals that come from the nerves. As a result, they increase the pain you feel.

Painkillers block the effects of these painkillers. The problem is that you can’t focus most pain relievers specifically on a headache or a bad back. Instead, the drug travels throughout the body. This can cause some unexpected side effects.

What are the risks for people with ulcers?

Why do pain relievers increase the risk of gastrointestinal (GI) problems? The same chemicals that amplify pain—that some painkillers block—also help maintain the protective lining of the stomach and intestines. When a pain reliever prevents these chemicals from working, the digestive tract becomes more vulnerable to damage from stomach acids.

For people with ulcers, high-risk pain relievers are non-steroidal anti-inflammatory drugs or NSAIDs. They include aspirin, ibuprofen, naproxen sodium, and ketoprofen, the active ingredients in medications like Advil, Aleve, and Bufferin.

Other pain relievers may be less dangerous. Acetaminophen works differently and poses a much lower risk of gastrointestinal problems. But like all drugs, it has its own side effects. You should not take any over-the-counter medication for more than 10 days without your healthcare provider’s approval.

The risks of NSAIDs are quite serious. Research shows that people who use NSAIDs are about three times more likely to have gastrointestinal bleeding. Even in low doses, NSAIDs can make mild ulcers much worse.

Aspirin has additional risks. “Aspirin can help prevent blood clotting, which is why it helps people at risk of heart attacks and strokes,” says Cryer. “But in people with ulcers, it can lead to more serious gastrointestinal bleeding.”

What if you have an ulcer and are at high risk for a heart attack or stroke? Balancing the benefits and risks of these drugs can be tricky, says Cryer

“People need to talk to their doctors to find out what’s best for them,” he says. But in people at high risk for heart attack or stroke, he says aspirin’s cardiovascular benefits may outweigh its gastrointestinal risks.

If you have an ulcer, what should you do the next time you have a headache? In general, people with ulcers should use over-the-counter acetaminophen for pain relief. Unless your doctor says it’s okay, you shouldn’t use aspirin, ibuprofen, ketoprofen, or naproxen sodium. If acetaminophen does not help your pain, see your doctor.

Other options for pain relief

Painkillers are not the only solution to many of life’s pains. Many effective and safe alternatives have no side effects at all.

  • Ice packsfor acute injuries such as sprained ankles, can keep swelling down and ease pain.
  • Fever with a warm towel or heating pad can be helpful in treating chronic overuse injuries. (However, you should not use heat on recent injuries.)
  • Physical activity can help reduce some types of discomfort, such as arthritis pain.
  • Relaxation with techniques like yoga or meditation — can reduce pain. Biofeedback may also help. These methods are best for pain that worsens with stress, such as tension headaches.
  • Alternative methods with low risk – such as acupuncture – benefit some people.

So remember: Pain relief doesn’t just come from a pill bottle.

Pros and cons of painkillers

Here’s an overview of the benefits and risks of some popular pain relievers. That should help simplify your choices when you’re at the pharmacy.

Keep in mind that you should not use over-the-counter pain relievers on a regular basis. If you have this much pain, you need to talk to your doctor.

ACETAMINOPHEN
Tylenol, Panadol, Temperature (and also ingredients in Excedrin)

  • How it works. Acetaminophen is not an NSAID. Experts aren’t really sure how it works, but it seems to affect chemicals that increase the sensation of pain.
  • Pros. Acetaminophen relieves pain and lowers fever. Unlike aspirin and other NSAIDs, acetaminophen is believed to be safe for people with ulcers. It does not affect the natural lining of the stomach. Since it does not thin the blood, it also does not increase the risk of bleeding. It is safe for pregnant and breastfeeding women.
  • Side effects and risks. Experts say acetaminophen is safe for people with ulcers. But like all medicines, it can cause other side effects. Very large doses of acetaminophen—well above the recommended maximum of 4,000 mg/day—can cause severe liver damage. Long-term use of high doses of acetaminophen — especially when used with caffeine (Excedrin) or codeine (Tylenol with codeine) can cause kidney problems.

    Acetaminophen does not reduce inflammation like aspirin and other NSAIDs do. It may be less helpful in treating pain caused by inflammation, such as some types of arthritis.

ASPIRIN
Bayer, Bufferin, Ecotrin (and also ingredients in Excedrin)

  • How it works. Aspirin is an anti-inflammatory drug that circulates through the bloodstream. It blocks the effects of substances that increase the sensation of pain.
  • Pros. Aspirin has earned its reputation as a “wonder drug.” It reduces pain and lowers fever. It can also reduce inflammation, which means it can treat the symptoms (pain) and sometimes the cause (swelling.)

    Aspirin also reduces the risk of blood clots, heart attacks, and strokes, especially in people at high risk of these problems. Only very low daily doses – 81 milligrams, or one aspirin for a child – are usually recommended for cardiovascular protection. Other NSAIDs (such as ibuprofen, ketoprofen, or naproxen sodium) and acetaminophen do not have this effect. However, you should never start taking aspirin daily without first talking to your healthcare provider.

  • Side effects and risks. Aspirin can cause or worsen ulcers. If possible, people with ulcers should avoid it. Even in very low doses, aspirin can cause gastrointestinal symptoms, such as heartburn, stomach discomfort or pain. Coated or “buffered” aspirin does not reduce this risk. Over time, wounds can cause inflammation and build-up of scar tissue. This can become so severe that it can prevent food from leaving the stomach.

    Aspirin can be dangerous for people with liver disease, gout, juvenile arthritis, or asthma. Rarely, aspirin can cause tinnitus or hearing loss.

    Pregnant women should not use aspirin, as it can harm the mother and cause birth defects. Unless your healthcare provider says it’s OK, children and teenagers shouldn’t use aspirin because it puts them at risk for Reye’s syndrome.

    Although inflammation can cause pain, it is often a key part of the body’s natural healing process. Because high-dose aspirin can prevent inflammation, it can also slow recovery from certain injuries.

IBUPROFEN
Advil, Motrin IB, Nuprin

  • How it works. Like all NSAIDs, ibuprofen blocks the effects of substances that increase the sensation of pain.
  • pros. Ibuprofen can lower fever, ease pain, and reduce inflammation.
  • Side effects and risks. People with ulcers should not use ibuprofen unless their health care providers say it is safe. Ibuprofen can cause or worsen ulcers. It also causes other gastrointestinal symptoms, such as heartburn, stomach discomfort or pain. Drinking alcohol while using ibuprofen increases the risk of gastrointestinal upset.

    Ibuprofen can also increase the risk of heart attacks and strokes. The US Food and Drug Administration (FDA) now requires pharmaceutical companies to highlight the potential risks of ibuprofen. Use of this drug in combination with other NSAIDs in pregnant women has been associated with birth defects.

    Some people are allergic to ibuprofen and other NSAIDs. It can cause hives and swelling of the face. It can be dangerous for some people with asthma. People with ulcers should avoid ibuprofen if possible. In some cases, ibuprofen can slow down the body’s natural healing process.

KETOPROFEN
Orudis,Orudis KT, Oruvail

  • How it works. Ketoprofen blocks the effect of substances that increase the sensation of pain.
  • pros. Ketoprofen can reduce fever, ease pain and reduce inflammation.
  • Side effects and risks. People with ulcers should not use ketoprofen unless their health care providers say it is safe. Ketoprofen can cause or worsen ulcers. It also causes other gastrointestinal symptoms, such as heartburn, stomach discomfort or pain.

    Drinking alcohol while using ketoprofen increases the risk of gastrointestinal upset. Ketoprofen also increases the risk of heart attacks and strokes. The FDA now requires drug companies to highlight these risks.

    Use of this drug in combination with other NSAIDs in pregnant women has been associated with birth defects. In some cases, ketoprofen can slow down the body’s natural healing process.

NAPROXENA SODIUM
do not act like this

  • How it works. Naproxen sodium blocks the effects of substances that increase the sensation of pain.
  • pros. Naproxen sodium can lower fever, relieve pain, and reduce swelling.
  • Side effects and risks. People with ulcers should not use naproxen sodium unless their healthcare providers say it is safe. Naproxen sodium can cause or worsen ulcers. It also causes other gastrointestinal symptoms, such as heartburn, stomach discomfort or pain.

    Drinking alcohol while using naproxen sodium increases the risk of gastrointestinal upset. Naproxen sodium can also increase the risk of heart attack and stroke. The FDA now requires drug companies to highlight these risks.

    Use of this drug in combination with other NSAIDs in pregnant women has been associated with birth defects. In some cases, naproxen sodium can slow down the body’s natural healing process.

PERMITTED PROTECTIVE DRUGS

Many pain medications—including higher doses of NSAIDs—are available by prescription. Since they are more potent versions of over-the-counter NSAIDs, they often carry the same or greater risks. Some examples are Daypro, Indocin, Lodine, Mobic, Naprosyn, Relafen and Voltaren.

Cox-2 inhibitors are a relatively new type of NSAIDs. Although these drugs are supposed to have fewer gastrointestinal side effects than standard NSAIDs, they can still cause some of the same problems. They can also increase the risk of heart attack and stroke.

Two of these drugs, Vioxx and Bextra, have been withdrawn from the market due to various side effects. Cox-2 inhibitors still available include Celebrex, Mobic, Relafen, and Voltaren.

Narcotics are another type of prescription pain medication. Examples include OxyContin, Percocet, and Vicodin. These drugs are reserved for people with severe pain. They generally have less risk for people with ulcers. They have other side effects, including constipation, fatigue, and the risk of addiction.

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