How to Safely Use Pain Medicine

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Medicine safety

Millions of pills and liquids are taken by people every year - the majority of them are for pain relief. It may come as no surprise then that many emergency admissions to hospital arise due to these medicines being taken incorrectly. In addition, depending on what country you are in the names of medications could be completely different even although they contain the same ingredients. For example in the UK 'paracetamol' is the most common form of pain relief - in the USA you would probably ask for Tylenol. So if travelling outside your own country make sure you know what medication you are buying.

Pain relief is safe provided you not only follow the directions, but understand how your own medical history may affect medicines you can take safely. This is particularly important if you are buying medicines rather than having them prescribed by a doctor.

Pain relief medicine can affect all areas of the body
Pain relief medicine can affect all areas of the body | Source
Pain relief medicine travels all around the body via the blood stream
Pain relief medicine travels all around the body via the blood stream | Source

Why do we have to be safe when taking medicines?

We need to be careful with any form of medication as most of them, although beneficial, can be harmful to the body under certain circumstances.

Any kind of pain killer or other medicine will go through four basic processes in the body. They are:

  1. Absorbed - so they can enter the blood stream
  2. Distributed - distributed by the blood throughout the body
  3. Metabolised - broken down by the body so that the chemicals can be used. It is as this stage that the side effects of a medicine may start to be felt. Most metabolism of drugs take place in the largest organ of the body - the liver. This is why too much of a drug or large combinations of drugs can sometimes overwhelm the liver causing toxic - and potentially lethal - effects.
  4. Excreted - enzymes in the liver make the drug inactive so preparing it for excretion from the body in urine or faeces. This is sometimes why urine will change colour when you are on certain medicines, it is the left overs from the drugs taken.


We'll take a look at two common pain relief medicines that people can buy or be prescribed by a doctor and review how to take them safely. However, the procedure is really the same for all medications.

{Pain relief for terminally ill people is a specialised field and there are different criteria for the medications used, so will not be included in this hub.)

Two of the most familiar kinds of pain relief medicinces are:

  • Paracetamol/tylenol/acetaminophen. These are common worldwide and come under various other names.
  • Non-steroidal anti-inflammatory (NSAID) - eg brufen, ibuprofen, aspirin, - there are many of these preparations worldwide that come under literally hundreds of brand names.


We'll firstly take a look at why each of these categories of pain relief medicine can be harmful. In addition, be careful with preparations that also contain codeine. These can be addictive and also have side effects such as constipation, dry mouth, dizziness. They may also have a sedative effect so you need to be careful when you take them - for example if driving.

Ibuprofen tablets can cause major health risks
Ibuprofen tablets can cause major health risks | Source
NHS research and admissions reveal serious health issues due to pain relief medicine
NHS research and admissions reveal serious health issues due to pain relief medicine | Source
The human liver is the main organ that metabolises pain relief medicine
The human liver is the main organ that metabolises pain relief medicine | Source

The risks of pain medication - paracetamol/tyleno//acetaminophen

Here are some of the main problems that may arise if pain relief is not taken properly.

Paracetamol/tylenol/acetaminophen

This medicine has been around for a long time and is useful for mild to moderate pain and also for controlling fever. The most common danger associated with this medication is accidental overdose leading to liver damage - it is the UK's most common cause of liver failure. In addition, the NHS UK reported over 70,000 cases of self-harm in one year, due to paracetamol. The UK researchers further reported that death due to accidental overdose is more common than people who self-harm with the same drug.

People particularly at risk from paracetamol toxicity are:

  • People who have liver or kidney problems.
  • If you drink a significant amount of alcohol on a regular basis. This is because some liver damage may have already occurred due to heavy consumption of alcohol over a long period of time.
  • People who are under-weight and malnourished.
  • If you are currently on other medication or a supplement then check with a pharmacist or doctor before taking paracetamol.

The specific problem with paracetamol lies with toxicity that can severely affect the liver. When this particular pain relief is metabolised by the liver there is a toxin produced called:

  • N-acetyl-p-benzoquinone imine - usually written as the abbreviation NABQI in the UK.

This poison is capable of destroying liver cells and also depleting the liver's normal amount of glutathioine.

Glutathioine is an antioxidant and these help to keep the liver and other organs of the body healthy. When too much paracetamol is taken NAPQI, normally only produced in tiny quantities, overwhelms the liver as it's levels rapidly rise. The liver is unable to detoxify, becomes damaged and can go into liver failure which could be fatal. There have been documented cases where young, very fit and healthy adults have died due to liver failure after accidentally taking too much paracetamol. This occurs easily when for example treating a cold. Many liquid cough and flu medicines also contain paracetamol. People take these liquids in addition to paracetamol tablets, perhaps over a seven day period, They are unaware that they are overdosing on the medicine. Inevitably the levels of NAPQI begin to rise dangerously high without the person realising it. The signs that something is wrong usually comes in the form of sudden jaundice, nausea, vomiting, abdominal pain and sometimes hallucination.


Non-steroidal anti-inflammatory - NSAID

These are a second group of pain relief medicines that people use for general aches and pains. However, taking these medications over a long period of time can cause serious health problems such as:

  • Ulcers
  • Gastrointestinal bleeding

Health researchers in the UK found that a high proportion of admissions to hospital for gastrointestinal problems were directly related to taking NSAID medication and of this number a small proportion did result in death. Anti-inflammatory medicines such as ibuprofen cause damage to the stomach and intestines because they contain chemicals that destroy the cells of the lining that protects these organs.

Oxford University conducted research among long term users of ibuprofen and found that there was increased incidents of stroke and heart disease. This is in addition to the risks of congestive heart failure and kidney disease developing that researchers also found among regular, long term users of these drugs.

Aspirin can have the same affect as ibuprofen. Neither drug should be taken if you have a history of excess stomach acid/ulcers etc. In addition both these drugs must always be taken either with food or after food, not before. Aspirin itself is not used as much now for pain relief. However, it has found a place for the emergency and on-going treatment of heart attack and stroke patients.

Summary of pain relief medicines

Medicine
Used For
Taking the Medicine Safely
Main Dangers
Paracetamol
mild to moderate pain and to control fevers.
ensure that you only take the prescribed dose. Ensure that any other medicines you are taking such as cough mixtures, don't also contain paracetamol/tylenol. If you have had a history of liver problems, avoid taking this medication until you get the advice of a doctor.
liver disease, liver failure, heart problems. Can be lethal.
NSAID - ibuprofen etc.
mild to moderate pain and has some use in controlling fevers.
take this medicine according to instructions given. Always ensure that you take this medication either with food or after having something to eat. If you have a history of ulcers or any stomach, intestine problems, then speak to a doctor before taking this medication.
stomach and intestinal bleeding, ulcers
Anti-inflammatory medicines can lead to gastric ulcers - as seen using an endoscope
Anti-inflammatory medicines can lead to gastric ulcers - as seen using an endoscope | Source

Definition of medicine side effects and adverse reactions

Side Effect
A side effect is an additional body response that arises beyond what the medicine is intended to do. For example codeine used for pain can also induce nausea, fatigue and constipation. Side effects can disappear after a few days.
Adverse Reaction
An adverse reaction is an unexpected or dangerous reaction to a medicine. An example of an adverse reaction could be the body having a severe allergic reaction to a medicine taken.
 
 
 
 

Pain Relief Medications

As a society are we relying far too much on medications and should we concentrate more on safer alternatives?

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Taking medicines safely

For medications to be taken safely there are some simple rules to follow:

  • Read the instructions carefully on the prescription label, packet or leaflet and follow them. For example if the instructions say to take a medicine with food, this advice is given for an important reason and it should be followed. This is the same for any guidance given on how to take medicines.
  • Ensure you know what side effects may occur.
  • Be aware that medical conditions you currently have or have had in the past could exclude you from taking certain medications. Ask for advice from your doctor if you are unsure.
  • Before taking more than one medication check that you will not overdose. For example if you have the flu and are taking paracetamol tablets for pain, but also a liquid preparation for flu/cold symptoms, check that the liquid does not also contain paracetamol.

When actually taking medications it's a good idea to use some of the 'Five R's' that nurses and health care workers use when administering medication:

  1. Right medication? Ensure that what you are taking is the proper medication and not medicine belonging to someone else.
  2. Right Time? Is there a set time for taking medication? For example paracetamol/tylenol should be taken four hours apart and only up to 8 tablets in any 24 hour period.
  3. Right Dose? If the instructions say to take 500mg then take only this amount.
  4. Right Route? Check that the preparation you have is for swallowing and not for example to be put under the tongue or some other route into the body. This may seem obvious but I think you would honestly be shocked at how many people swallow suppositories, pessaries etc. I genuinely looked after one gentleman who came in to hospital with abdominal pains and it turned out he had swallowed suppositories instead of inserting them - you know where!
  5. Right Person? If more than one person in your family is taking medications, check the name on the label if it is a prescribed medicine. If it is bought, check the name on the packet. This again may seem obvious, but thousands of mistakes are made yearly because of the similarity with packaging or not reading a label properly.

Modern pain relief is very effective and safe. All that is needed is a little thought about your own health and being aware of the safety aspect while taking medicines. Most people who end up in hospital because of pain relief mistakes, could have avoided the situation with just a little knowledge and care - don't be another statistic. Keep safe!

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Comments 32 comments

writer20 profile image

writer20 4 years ago from Southern Nevada

I'm one of those people who does as she's told by what the Dr. and prescription says.

The painkillers I'm on, I take a pill to coat my stomach 30-an 1hr before eating then I take my other pain killers and I do this sincerely.

Voted up, useful and interesting, Joyce.


JanTutor profile image

JanTutor 4 years ago from London, England

Interesting hub and sound advice. This is especially pertinent as I take a HUGE cocktail of tablets everyday. Some of the pain medication is particularly potent and has to be locked in a safe by the pharmacist prior to collection. Bizarrely, many of the tablets I take are necessary to counteract the effects of other pills. Before my illness I never even took aspirin or paracetamol - a life of tablets takes some getting used to. Perhaps you'd be so kind as to write a hub on why pain is worse at night!!!


mperrottet profile image

mperrottet 4 years ago from Pennsauken, NJ

You have lots of great information here. So many of us take pills like Tylenol or NSAIDs without realizing that there can be serious side effects. Voted Up, useful and interesting. Well done!


Gypsy Rose Lee profile image

Gypsy Rose Lee 4 years ago from Riga, Latvia

Voted up and useful. Thanks for sharing this very important and informative hub. I usually don't like taking any medication unless it's absolutely necessary like in case of pain or fever but I always check to see about natural alternatives first. Passing this on.


ChitrangadaSharan profile image

ChitrangadaSharan 4 years ago from New Delhi, India

Very useful and a must read for everyone. One should be very careful while taking pain medicines. Thanks for sharing.


Frank Atanacio profile image

Frank Atanacio 4 years ago from Shelton

Seeker there is so much useful information here on how to safely use pain medicine.. Your reserach must have been extensive...bless you :)


Seeker7 profile image

Seeker7 4 years ago from Fife, Scotland Author

Hi Joyce,

I'm on a stomach tablet as well, although thankfully I don't have to take them every day. I started having problems with my stomach when I had my gall bladder removed a number of years ago. Since then I've to watch my diet as some foods I just d0n't tolerate at all. But like yourself I stick to the rules and know that I'm as safe as anyone can be. I can understand why you also want to stick to what the prescription says. Some of these medications are pretty powerful stuff and there's no point in mucking around with them.

Thanks for stopping by and for your interesting comment.


Seeker7 profile image

Seeker7 4 years ago from Fife, Scotland Author

Hi Jan, many thanks for stopping by and thank you for leaving such an interesting comment.

I sympathise with you and your 'cocktail' of pills. It does seem that the more medication you are on, then they are added to again to combat side-effects and so on. You do therefore end up with so many pills that your life can literally revolve around them. But as you've pointed out it only takes one illness to start a snowballing effect, even although you had never needed pain relief before. Obviously now, unfortunately, you do need significant pain relief and with these powerful analgesics come the side effects. Before I had my gall bladder removed I was the same, never really needed anything. Then I developed an ulcer after taking Naproxen for wrist injury and that's basically where my life with pills started as well.

It's interesting about nightime pain, so many people dread the night coming on, when they should be looking forward to it for rest. I will certainly look into this subject and see if I can get enough good information to make up a hub that would be useful to people like yourself. Take care, and lovely to hear from you!


Seeker7 profile image

Seeker7 4 years ago from Fife, Scotland Author

Hi mperrottet, it's always a pleasure to hear from you and thank you for the positive comment about the hub - it's greatly appreciated. I agree with you, so many of us do take pills but we don't really know what harm they could be doing - sometimes until it's too late.


Seeker7 profile image

Seeker7 4 years ago from Fife, Scotland Author

Hey Gypsy! Lovely to hear from you!

I don't think there are many of us who do like swallowing pills unless we have to and when we read about how they can affect the body, it put's you off even more. I think what is worse, is that the damage seems to build up without anyone really feeling anything, then all of a sudden things go badly wrong.

Many thanks again Gypsy for your comment and the share!!


Seeker7 profile image

Seeker7 4 years ago from Fife, Scotland Author

Hello ChitrangadaSharan,

Lovely to hear from you - and many thanks for the follow and the fan mail, greatly appreciated! Thank you also for taking the time to stop by and leave a comment.


Seeker7 profile image

Seeker7 4 years ago from Fife, Scotland Author

Hi Frank - thank you so much for such a lovely comment - greatly appreciated and makes the hard work worthwhile!


akirchner profile image

akirchner 4 years ago from Central Oregon

Really important info, Helen - especially with all the side effects and OD's I see every day with these things...I begin to think that half the world is on some kind of meds--or 17--but pain meds are especially troublesome. Even if they aren't narcotic, they aren't placebos and can cause all kinds of harm--like ulcers, bleeding, etc. Even the super high dose aspirin I was on caused a bleed into my leg when I fell a few months ago. It's all about knowing what you're taking and how to manage it! Again, great info!


Seeker7 profile image

Seeker7 4 years ago from Fife, Scotland Author

Hi Audrey,

Many thanks for stopping by and glad that you enjoyed the hub. I knew that due to your work experience you would be able to relate to what was in the hub. But like many of us here you have also had personal experience of what can happen with some of these medicines. Luckily I didn't have a bleed, but was given naproxen for a damaged wrist and ended up with an ulcer. But before that, I had been on the contraceptive pill and that had caused gall stones, so got my gall bladder removed and ended up with a weakened stomach because of this and that the naproxen damaged! It only takes one illness or one injury sometimes to set you off on a train of never ending pills and potions. Luckily today I've weaned myself off most tablets and feel better for it.


Seeker7 profile image

Seeker7 4 years ago from Fife, Scotland Author

Hi ausmedus, many thanks once again for a visit and for your great comment - it is always appreciated sincerely! Thank you!


kittythedreamer profile image

kittythedreamer 4 years ago from the Ether

Ohhh, VERY appropriate to the class that I'm taking right now...and believe it or not the first part with the 4 processes of pharmacokinetics (absorption, distribution, metabolism, and excretion) is on my quiz tomorrow! LOL. I'm taking pharmacology and am in my 2nd semester of RN nursing school. Thanks for the review and an awesome article.


old albion profile image

old albion 4 years ago from Lancashire. England.

Hi Seeker7. This really is a most informative hub. I shall save it for reference as I use Paracetamol on a regular basis. Good to know also of the change of name in the USA. Thank you.

Voted up and all.

Graham.


Seeker7 profile image

Seeker7 4 years ago from Fife, Scotland Author

Hi Kitty, glad that the hub was really useful to you and how is that for synchronicity!! I used to really enjoy pharmacology I always found the interactions between these chemicals and the body fascinating!!


Seeker7 profile image

Seeker7 4 years ago from Fife, Scotland Author

Hi Graham, as always it's a pleasure to hear from you and glad that you enjoyed the hub. I used to be on co-c0damol but now take tramadol, so I can relate to how people feel about medications and how they affect the body. Hopefully I'll be able to give up the tramadol soon as well.


toknowinfo profile image

toknowinfo 4 years ago

This hub is so well written and informative. I really appreciate the way you presented this info. Some things I knew, and some things were new to me. I love learning new things that are practical knowlege. Thanks for such a well done article. Rated up and useful, awesome, and interesting.


Alastar Packer profile image

Alastar Packer 4 years ago from North Carolina

An excellent reference and breakdown on why one should use caution and know the facts on Tylenol and ibuprofen. One thing that gets me Helen is over here there's a problem with people selling or abusing pain meds and tranquilizers etc which causes more hassles for those legally prescribed folks who take them as written. One new law has someone on prescribed pain meds having every word they say transcribed during a doctor visit. Many folk in chronic pain would not have any quality of life without them and shouldn't be penalized with the bad apples but that's how it goes.


Jamie Brock profile image

Jamie Brock 4 years ago from Texas

Thank you for this truly informative hub.. I think a fair amount of people don't understand that these drugs can be just as dangerous as any other drug. It was scary when I found that when taking ibuprofen and my antidepressant together on an empty stomach was very dangerous, increasing the risk of stomach ulcers. Great hub, voting up, informative and useful.


Seeker7 profile image

Seeker7 4 years ago from Fife, Scotland Author

Hi toknowinfo - many thanks for stopping by and thank you for the comment - coming from an excellent writer like yourself does mean a lot to me .


Seeker7 profile image

Seeker7 4 years ago from Fife, Scotland Author

Hi Alastar - many millions of thank you's for the great comment and glad that you liked the hub.

Wow! That's a queer law having ill folks words being recorded! As you say Alastar in this day and age everyone is getting tarred with the same old brush with no thought on if the 'laws' are any dam good or if people's rights are being stepped on! But hey, if your country is anything like ours, then basically it's too bad on the victims as long as the 'criminals' are allowed their rights the politicians sleep at night! And like you rightly say Alastar, these ill folks depend on them for quality of life and have enough stress to go through without having to justify every pill the put in their mouths.


Seeker7 profile image

Seeker7 4 years ago from Fife, Scotland Author

Hi Jamie Brock, many thanks for stopping by and glad that you enjoyed the hub. It is very scary when you find out just how lethal these meds can be. I think one of the saddest stories I heard, although unfortunately not uncommon, was of a young fitness instructor who died of liver failure after treating herself with different medicines all containing paracetamol/tylenol - she had the flu and was only trying to make herself feel better! If I remember correctly she was only 23 years old.


Nell Rose profile image

Nell Rose 4 years ago from England

Great hub and really detailed, I do take pain medicine sometimes and have to be careful with my thyroid tabs and others as well, side effects of any tablets can be horrible, I know, I had carbamazole for a high thyroid and ended up in hospital with terrific pain, voted up and shared, nell


HubTub profile image

HubTub 4 years ago from The Sunshine State

Great hub on the pros and cons of pain medicine. I believe it is extremely important for everyone to know exactly what they are ingesting and the potential risks and side effects. There are so many people out there that simply trust their doctors, don't do their homwework, and then wind up with very serious complications later on down the road.


Seeker7 profile image

Seeker7 4 years ago from Fife, Scotland Author

Hi Nell, many thanks for stopping by and taking the time to leave a comment - and a very interesting one as well! Carbamazole is, in my opinion, one of the worst drugs they ever invented. If everything goes fine with it, then yes it does it's job. But if things go wrong - as unfortunately it did with you - it has a horrible habit of causing all sorts of nasties to come out!


Seeker7 profile image

Seeker7 4 years ago from Fife, Scotland Author

Hi HubTub, nice to meet you and many thanks for the follow - will pop along soon and have a nose at your own hubs! I agree entirely that people shouldn't always just follow blindly. I think we should all keep ourselves informed and that way we can make more informed choices about what happens to our body in particular. Most doctors and nurses (and I'm a nurse myself) are great and have only the patient's/client's best interest at heart, but you do get the few who are useless and as such are not competent at keeping patients informed.


HubTub profile image

HubTub 4 years ago from The Sunshine State

Nice to meet you as well, and thank you also for the reciprocal follow. As well as being an animal lover, I spent many years working as a scrub nurse in the OR. My long-time childhood friend also lives in Scotland. So, it seems we'll get along just fine (smile).


Seeker7 profile image

Seeker7 4 years ago from Fife, Scotland Author

Hi Hub Tub if I think we will get on great and its always nice to meet someone with so much in common!


HubTub profile image

HubTub 4 years ago from The Sunshine State

Cheers! Have a wonderful weekend!

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