When Relieving the Pain Raises the Risk

Many Americans Gamble With Over-the-Counter Painkillers

From the WebMD Archives

Jan. 30, 2003 -- Many Americans may be playing a dangerous game of Russian roulette when it comes to numbing their pain. A new survey shows nearly half of the 175 million adults who take over-the-counter pain relievers admit to exceeding the recommended dose, and few are aware of the potential risks.

Although most nonprescription pain relievers are safe for healthy people when used as directed, some of the most commonly used medications, known as NSAIDs or nonsteroidal anti-inflammatory drugs, can cause potentially deadly side effects. NSAIDs include aspirin and drugs containing ibuprofen or naproxen, such as Advil and Aleve.

Researchers say 16,500 people die and 103,000 are hospitalized each year because of NSAID-related problems.

"Too often, consumers just want the pain to go away, so they take more medicine than the label instructs, and they don't talk to their doctor about possible risks," says Linda Golodner, president of the National Consumers League, who sponsored and presented the results of the survey today at a briefing in New York City. "But just because a medication is available without a prescription doesn't mean it's risk free."

The survey of more than 4,200 adults, conducted by Harris Interactive, is one of the largest public opinion polls to date on over-the-counter pain medications. Researchers say the results show that many consumers are simply unaware of the potentially serious health risks associated with NSAIDs, such as stomach bleeding and ulcers.

For example, the survey shows that 50% of respondents who took an over-the-counter pain medication in the last year were not concerned about side effects, and nearly half of them (45%) said it is more important to control pain regardless of risk.

The survey also found that Americans are twice as likely to take NSAIDs for pain than other acetaminophen-based pain relievers, such as Tylenol. And those who use NSAIDs are more likely to take more than the recommended dose or take the drugs while drinking alcohol.

That type of behavior could put some people at risk for serious complications, according to experts. Exceeding the recommended dosage, taking the drugs for an extended period of time, taking them along with other pain medications, and taking NSAIDs in combination with alcohol can all increase the risk of stomach or intestinal bleeding or other side effects.

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Marie Griffin, MD, professor of preventive medicine at Vanderbilt University, says the risk of complications is relatively low for young, healthy people who take the drugs as directed. But the risk is considerably higher for older adults, especially for women who frequently take the drugs for persistent pain.

Griffin says non-prescription NSAIDs are not intended to treat chronic pain caused by conditions that affect many older women, such as arthritis or migraines.

"[Over-the-counter] NSAIDs are not a treatment for arthritis," says Griffin, who also spoke at the briefing. "NSAIDs don't really treat the arthritis, they really just help the symptoms, like pain and discomfort. But some people are under the impression that they actually retard the progression of arthritis or that by taking it their arthritis will get better, but that's not true."

Many older adults may also already be using a prescription NSAID, such as Vioxx, for chronic pain, and should consult their doctor before taking an over-the-counter NSAID for other aches and pains.

Mel Wilcox, MD, professor of medicine at the University of Alabama at Birmingham, says one of the most common mistakes people make is simply not knowing what type of pain medications they're taking.

"Many don't know what prescription drugs they're on," says Wilcox, who is also a spokesperson for the American Gastroenterology Association. But he says if it's a drug to treat virtually any type of pain, it could pose a risk if taken with an over-the-counter NSAID.

He says many of his patients who have been warned to stay away from aspirin because of potential stomach problems are often unaware that many "non-aspirin" pain medications are still NSAIDs and could pose a health risk.

But the survey shows that more than half of over-the-counter drug users do not talk with their doctor about their over-the-counter drug use, and even fewer doctors initiate discussions about over-the-counter medications.

Researchers say reading the warning labels that come with over-the-counter pain medications is a good way for consumers to make an informed decision about their health. But only 16% of those surveyed said they read the entire product label before using an over-the-counter pain medication.

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Sometimes even that may not be enough, as former schoolteacher Susan Burkholder learned four years ago. The 72-year-old retiree from Goshen, Ind., was prescribed an NSAID by her doctor to treat a painful heel spur. But she felt so much better on the medication that she kept taking it for three months longer than originally prescribed and ended up in the hospital after suffering severe nausea and vomiting caused by a stomach ulcer.

"I guess I was overly confident," says Burkholder. "I read the little sheet that came with the drug and then folded it up and said it wouldn't happen to me. Busy people will always do whatever is convenient in order to get over the pain."

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Sources

SOURCES: Harris Interactive Poll, conducted Dec. 16-19, 2002 • Linda Golodner, president, National Consumer's League • Marie Griffin, MD, professor of preventive medicine, Vanderbilt University • C. Mel Wilcox, MD, professor of medicine, University of Alabama-Birmingham; and spokesperson, American Gastroenerological Association • Susan Burkholder, retired schoolteacher, Goshen, Ind.

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