Smorgasbord Health Column – Painkillers – Prescribed and Over the Counter – Side Effects and Addiction.


Over the last twenty years, the USA has been on a downward spiral with regard to opioid addiction.

In 2002, 5,000 people died from overdosing with prescription opioids such as extra strength Oxycontin – Pure Oxycodone  ( a semi-synthetic opioid loosely related to morphine and originally based on elements of the opium poppy) and from others such as Percocet, Percodan which are usually oxycodone mixed with Tylenol or Ibuprofen. Other opioid drugs include Fentanyl, Hydrocodone and codeine in various strengths and mixed with NSAIDs or paracetamol.

In 2015 these deaths caused by opioid overdose had increased to 52,000 per annum.

The UK has also seen an increase in addiction. However some of those who are afflicted go unreported, such as when associated with the very elderly. I have personal experience of this with the prescription of Tramadol in excessive doses, and also Oramorph which is a liquid opioid, to my mother in her late 80 and early 90s. And then with the safe withdrawal from those drugs over several months after taking issue with the prescription.

It is hard not to be cynical when our elderly are being given addictive opioids, that can severely impact breathing, and who may be only interested in the pain relief they offer, rather than the very small print on the leaflet enclosed.

The UK has a public health system which is far more regulated than in the US, and the pharmaceutical companies do not have such a lucrative market place. However, we have still managed to become a nation of pill-poppers at a cost of around £16 billion per year to the NHS.

In the USA, the prescriptions for Oxycontin had risen to 6 million a year by 2009 but the use of the pills became big business on street corners and became part of the overall drug problem facing the nation. Also there is often a transition to the use of illegal drugs such as heroin, when the prescribed source of the painkiller dries up. It is no longer the stereotypical junkie who is on the front pages of newspapers, but young mums and sometimes both parents passed out in cars with children in the back seat.

Here is an interesting statistic that caught my eye when reading various reports on opioid addiction.

“Other developed countries, including the UK, have been grappling with a rise in opioid addiction, too, although Britain’s public health system means the issue of massive over-prescription is less acute.

But the US is the epicentre and the origin of the crisis, consuming more than 80% of global opioid pills even though it has less than 5% of the world’s population and no monopoly on pain.”

Read more of this very informative article: https://www.theguardian.com/us-news/2017/oct/25/americas-opioid-crisis-how-prescription-drugs-sparked-a-national-trauma

There is no doubt that there are life saving drugs developed that are beneficial to mankind, and that for short term relief of extreme pain, opioids are one of the few options. But unfortunately once the body is no longer in pain, and the drugs are continued to be taken, the neurotransmission in the brain is disrupted.

This is the way that neurons (nerve cells) communicate in the brain and they determine the way we feel, think and behave.

Each of our neurons produces one or more neurotransmitters such as serotonin or dopamine. For example, dopamine is mostly found in areas of the brain that determine feelings of reward. Prescription opioids produce effects similar to the neurotransmitters such as dopamine as well as endorphins (creating the feel good factor) effecting pain relief but when production of the neurotransmitters is disrupted, it can also result in lack of focus, lack of inhibition and become life threatening by inhibiting the ability to breathe.

Withdrawal from these addictive prescribed painkillers after long term use, is not easy at all, and can be dangerous. It takes professional intervention and help to rid the body of the toxins and to also normalise the functionality of the neurotransmitters in the brain.

What about over the counter painkillers.

It is easy to assume that if a drug or painkiller is available over the counter then it cannot be harmful. Unfortunately this is not always the case, especially with the class of drugs known as NSAIDs or Non-steroidal anti-inflammatory drugs which includes Ibuprofen and Aspirin (Disprin).

Millions of us will walk into a pharmacy and buy both these painkillers to reduce the inflammation of certain common conditions such as arthritis. However, there is increasing concern about the long-term use for chronic conditions.

Even the low-dose aspirin taken as a preventative against heart conditions, can contribute to some of the side effects that have been recorded.

Increased risk of Heart Failure.

NSAIDs encourage the body to retain sodium. The body then hangs on to water to dilute the concentration. You then have more fluid around individual cells and additional volume of blood in the cardiovascular system. This results in a lot of additional work and pressure on blood vessels which can harden, which in turn leads to high blood pressure, heart attack or a stroke. If you find yourself becoming breathless easily, developing puffy ankles, suffer from indigestion more frequently, tight feeling in the chest, nausea and sweating and a persistent cough, please go to the doctor immediately.

Kidney damage.

The anti-inflammatory and sodium retention properties of these drugs can lead to damage to the kidneys, and if after prolonged use of Aspirin of other NSAIDs you notice that you have poor energy levels, dry itchy skin, pain both sides of your lower back, frequent urination or blood in your urine, you should go to a doctor immediately.

Internal bleeding from stomach ulcers and gastrointestinal damage.

Although the 75mg preventative dose of aspirin has been thought to be less of a risk in relation to internal bleeding, there is growing evidence that in some people it can still result in damage throughout the digestive tract including the esophagus. Taking full strength aspirin for extended periods has been associated with stomach ulcers and intestinal bleeding. If you smoke, have a family history of ulcers of have other medical problems you should seek medical advice before taking this painkiller.

Allergic reaction.

My mother was allergic to aspirin and so am I. Possibly because we have the asthma gene from my grandmother. Asthma sufferers should be very careful about taking NSAIDs without medical advice and should be monitored carefully.. This is particularly important if you have children who have asthma, and in fact it is not recommended for under sixteens to take NSAIDs at all.

Paracetamol is generally considered safe as it does not have the same anti-inflammatory properties, select age appropriate dosages such as in children specific products, but again it is wise to ask the advice of the pharmacist.

You should also never give NSAIDs like aspirin to children with chickenpox or with influenza as it can result in damage to the liver and the brain.

What are the alternatives.

That is really tough because when it comes to acute short term pain such as following injury or post operative, it is difficult to beat NSAIDs, and in extreme cases opioids.

However, chronic pain management needs to be approached in a holistic way that maximises the effect on the pain, but minimises the damage to the whole body and its major organs.

Diet and exercise is very important as sitting all day and not using the body does not release natural endorphins that help with pain.

Eating sufficient good fats, vitamin C rich foods to help the production of collagen (for joint pain) and a wide range of anti-oxidants with a reduction in refined sugars.

Here is my basic nutritional shopping list and if you are eating these foods regularly you should see some benefit. Those with particular anti-inflammatory properties are tomatoes, green vegetables such as spinach, nuts, fatty fish and berries.

https://smorgasbordinvitation.wordpress.com/2014/05/19/a-basic-shopping-list-for-a-nutritionally-balanced-diet/

Sometimes diet and exercise is not sufficient, in which case it might be worth exploring acupuncture, which is a therapy that I have used for chronic knee pain successfully.

Physiotherapy can also help relieve muscle and join pain as can certain forms of exercise such as swimming.

Personally I use a daily turmeric spray as it has anti-inflammatory properties when used over an extended period of time.

Finally

At the end of the day, pain needs to be managed. If it is acute pain from an injury or post operative, then you may require prescribed medication in the short term. In which case you should work with your doctor to reduce the painkillers over a period of time as the pain becomes manageable with non-opiate alternatives.

If you suffer from chronic pain then also work with your doctor and pharmacist to manage with both physical therapies and the right pain medication that does not cause any serious side-effects. Do not be afraid to ask questions about any prescribed medication and read the leaflet carefully to maximise safe usage. For example taking with food to help prevent damage to the stomach or intestinal tract.

Also review your diet, lost weight if that might relieve joint pain in hips and knees and explore alternative health products that may work for you. Talk to a qualified assistant and check out online first. If you have any questions them please do not hesitate to ask. sally.cronin@moyhill.com.

For more information on Opioids and NSAIDs here are some links.

https://familydoctor.org/condition/opioid-addiction/

https://drugabuse.com/library/opiate-abuse/

https://www.health.harvard.edu/pain/pain-relief-taking-nsaids-safely

I hope you have found this of interest and I look forward to your feedback. Thanks Sally