DOCTORS AREN’T TRAINED IN PAIN: What you must know to manage your pain

THE PROBLEM OF PAIN

The problem isn’t pain. The problem is pain that doesn’t go away. Pain is a natural signal from the body that there is something wrong. You stub your toe—pain! You sprain your ankle—pain! Inflammation is destroying cartilage in your knee—pain! Lack of circulation causes nerve damage in your feet—pain! When you are in pain, you are motivated to solve the problem. That’s good.

Unfortunately, there are problems that are not accompanied by pain. One of them is internal bleeding. Later in this article you’ll learn why NSAIDS pain medications are so dangerous. One of the reasons is that there’s often no pain signal to sound the alarm that you may be bleeding to death. That’s bad.

CHRONIC PAIN IS A HUGE PROBLEM

Pain that doesn’t go away is a huge problem. The National Institutes of Health report that over 90 million people in the United States suffer from pain that has lasted more than six months. Dr. Elliot Krames, M.D., an international pain management specialist, says that pain that persists for more than three months is no longer biologically useful as a way of signaling a problem. The pain itself has now become the problem. “Chronic pain is a major, major problem in the United States,” he states.[i]

According to Dr. Krames, chronic pain is the leading cost of medical care in the U.S. Back pain is the second leading cause of doctor visits and the third leading cause of hospitalization. Unfortunately, chronic pain is very poorly managed by most doctors.

DOCTORS AREN’T TRAINED IN PAIN

A recent national survey of medical schools in The Journal of the American Geriatric Society (October, 2005) found that doctors just aren’t trained in pain. The survey discovered that most doctors receive only a few hours of training in how to treat and cure pain. They were especially ignorant of how to treat musculoskeletal, neuropathic and low back pain. They also weren’t trained in multidisciplinary and alternative pain therapies—which pain specialists now say are the most effective way to treat pain.

Pain sufferers agree that what doctors are doing now isn’t working very well. One survey of over a thousand people by a pharmaceutical company (Partners Against Pain, Purdue Pharma) revealed that two thirds of the surveyed pain patients said that their over-the-counter medication wasn’t working. Over 50 percent said their prescription medication wasn’t working. Over 60 percent of the pain sufferers had experienced pain for at least five years! They had been to three doctors and taken almost four types of medication for their pain—without success.

IS THERE REALLY A PROBLEM WITH NSAIDS?

If you have pain, you’ve probably taken an over-the-counter non-steroidal anti-inflammatory drug (NSAIDS) or acetaminophen such as Tylenol. In fact, you’ve probably taken many. Anacin, Bayer, Bufferin, Excedrin, Tylenol, Advil, and Motrin are among the most commonly taken drugs in the world. Americans alone take 30 billion doses of NSAIDS and acetaminophen annually.[ii] Acetominophen, commonly sold as Tylenol, is not technically an NSAID because it does not reduce inflammation, but it is used to reduce pain. Millions of people take an aspirin, an Advil or a Tylenol, or all three, every day. Although the word is getting out that there may be serious side effects associated with NSAIDS and acetaminophen, the belief that these medications are safe is strongly ingrained in our minds.

When you have a headache, a sore shoulder, a bad back, or a sore knee you probably think nothing of reaching for a Tylenol, aspirin or Advil. You can pick up a bottle at any drugstore, gas station, supermarket and convenience store. They are heavily advertised on television and in magazines, and are given to children. They just don’t seem that dangerous. Are they?

Yes. Most people have no idea how dangerous. The FDA estimates that 200,000 people are admitted to hospitals every year due to aspirin, acetaminophen and NSAIDS-related injury and illness—especially internal bleeding. There are 16,500 deaths from arthritis patients taking NSAIDS.[iii] [iv] If you counted all the people taking NSAIDS, aspirin and acetaminaphin for reasons other than arthritis such as headaches or lower back pain the numbers would be much higher.

What are the odds of you having serious internal bleeding ? A lot depends on age.

Out of 10,000 people taking NSAIDS[v]

For people age 45-64:

15 will have a serious bleed; 2 will die.

For people age 65-74:

17 will have a serious bleed: 3 will die.

For people age 75 or older:

91 will have a serious bleed: 15 will die.

Only one in five will have warning symptoms of pain, vomiting or black, tarry stools.

To put all those numbers in perspective, there are more deaths due to NSAIDS than there are deaths from melanoma skin cancer. You may be diligent in applying sunscreen every day to prevent lethal skin cancer, but don’t think twice about popping that Advil. If you are a woman, you probably go to the trouble and expense of getting a PAP smear every year to diagnose early cervical cancer. Did you know that your risk of dying from GI bleeding from NSAIDS is greater than your risk of dying from cervical cancer?[vi]

WHO TAKES AS DIRECTED?

According to a survey by Harris Interactive (2002), consumers regularly take higher than the recommended dosage and are unaware of adverse effects. The survey discovered that only 10 percent of OTC users read the label for cautions. (That could be because the print is so small it takes a magnifying glass.) One out of three people surveyed used more than the recommended dose. Almost 70 percent took more than the recommended dose at one time and 63 percent took the next dose sooner than directed on the label. So the chances of most people taking greater than the recommended dosage is pretty high.

ARE YOU AT RISK?

What about risk factors? There’s no doubt that NSAIDS help relieve pain and may be safe when taken as directed and if you have no risks. The problem is that a lot of people who take them have at least one risk factor A large US study found that 42% of 707,000 NSAID users had at least one risk factor.[vii] Do you drink at least one glass of alcohol a day? Are you over the age of 60? Do you take aspirin, prednisone or warfarin regularly? Have you ever had a peptic ulcer, high blood pressure, liver or kidney problems? Have you been taking NSAIDS regularly over 10 days? Do you take both aspirin and ibuprofen? If you answered yes to any of the questions, you are at higher risk for internal bleeding and liver damage.[viii] [ix] See the article Natural Solutions to End Your Pain in this issue for safe, natural options to pain relief.

IS ACETAMINOPHEN SAFER?

Acetaminophens such as Tylenol do not cause stomach bleeding like NSAIDS but higher than the recommended dosage can cause liver failure. It is the leading cause of drug-induced liver failure in the U.S. The incidence of acetaminophen caused liver failure jumped from 28 percent to 51 percent of all cases over six years (1998-2003) Of those, 35 percent died. [x]

Accidental overdoses commonly were caused by people taking two or more products that contained acetaminophen at the same time. Combining even normal dosages of acetaminophen with alcohol can damage both the kidneys and the liver. Doses of 4000 mg over 24 hours can be toxic.[xi]

How could you possible take that much? Easy. One extra-strength Tylenol pill contains 500 mg. Eight a day and your liver is history. Or maybe you have the flu and arthritis and you take your regular two extra-strength pills for your arthritis (1,000 mg) plus two Tylenol Cold and Flu Severe (1,000 mg per dose) plus two Nyquil (500 mg each) you’re up to 4,000 mg already. Add a Contac and maybe some Robitussin cough syrup and Alka-Seltzer Plus and you’re over the limit. Add a brandy toddy for that cold and you’re really in trouble. The average consumer just doesn’t consider these common products to be dangerous—but they are.

One of the authors of a study on the dangers of this popular pain reliever, Dr. Tim Davern, says in an article in The New York Times, “It’s extremely frustrating to see people come into the hospital who felt fine several days ago, but now need a new liver.”[xii]

NSAIDS AND THE OTHER DRUGS YOU TAKE

According to the Mayo Foundation for Medical Education and Research, NSAIDS also have many potentially dangerous drug interactions with prescription drugs. Approximately 90% of people over 60 take at least one prescription medication daily and more than 50% take two or more.

High blood pressure drugs and NSAIDS are an especially bad combination. Seniors who take diuretics and NSAIDS can double their risk of hospitalization for congestive heart failure.[xiii] NSAIDS can also reduce effects of ACE inhibitors, beta-blockers and thiazides and increased risk of toxicity from digoxin and increase risk of kidney failure.[xiv]

MAKE THE SWITCH TO SAFE, NATURAL PAIN RELIEF

The American Geriatrics Society issued guidelines back in 2002 that advised seniors to use “extreme caution” when taking NSAIDS. Based on the evidence, exploring safe, natural options for pain relief is a sensible thing to do. See the accompanying article in this issue Natural Solutions to End Your Pain to find out the latest research on safely ending your pain. Many natural solutions are as effective as NSAIDS and acetaminophen—without the risks of liver failure, internal bleeding and death.

[i] Battling back: overcoming the undertreatment of chronic pain. WebMD Live Events Transcript. Available from: www.medicinenet.com.

[ii] Life Extension Foundation. Acetaminophen and NSAID toxicity. Updated 3/8/06. Available from: www.lef.org.

[iii] Peura DA. Gastrointestinal safety and tolerability of nonselective nonsteroidal anti-inflammatory agents and cyclooxygenase-2-selective inhibitors.

Cleve Clin J Med. 2002;69 Suppl 1:SI31-9. Review.

[iv] Nsaids and adverse effects. Available from: http://www.jr2.ox.ac.uk/bandolier/booth/painpag/nsae/nsae.html

[v] Comparative effectiveness and safety of analgesics for osteoarthritis (2006). The Agency for Healthcare Research and Quality, Eisenberg Center at the Oregon Health and Science University. www.ahrq.gov

[vi] G Singh. Recent considerations in nonsteroidal anti-inflammatory drug gastropathy. Amer J Med. 1998 105(1B): 31S-38S.

[vii] Moore RA. Nonsteroidal anti-inflammatory drugs (NSAIDs), cyxlooxygenase-2 selective inhibitors (coxibs) and gastrointestinal harm: review of clinical trials and clinical practice. BMC Musculoskeletal Disorders. 2006, 7:79

[viii] Ong CKS, et al. An evidence-based update on nonsteroidal anti-inflammatory drugs. Clin Med Res. 2007 Mar;5(1):19-34. Review. .

[ix] Miller KE. Alcohol and NSAIDS increase risk for upper GI bleeding. Am Fam Phys. May 1, 2000

[x] Bartlett D. Acetaminophen toxicity. J Emerg Nurs. 2004 Jun;30(3):281-3. Review.

[xi] Bromer MQ, et al. Acetaminophen hepatotoxicity. Clin Liver Dis. 2003 May;7(2):351-67. Review.

[xii] Franklin, D. Poisonings from a popular pain reliever are rising. The New York Times. Nov 29 2005.

[xiii] Heerdink, ER, et al. NSAIDS associated with increased risk of coronary heart failure in elderly patients taking diuretics. Arch Int Med. 1998;158:1108-12.

[xiv] Fields, TS, et al. The renal effects of nonsteroidal anti-inflammatory drugs in older people. J Am Ger Soc. 1999;47:507-511.

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