Friday, March 18, 2016

the trouble with pain relief

First, the CDC wants to cut narcotic use for "chronic pain".

Now, we are told officially what we docs have known for years. Tylenol (aka paracetamol) doesn't help osteoarthritis pain.

Referring to concerns over acetaminophen's potential for liver toxicity, Moore added: "Its safety is also questioned, not just in overdose.”
With the addictive properties of opioid painkillers, the heart concerns surrounding NSAIDs and the apparent ineffectiveness of acetaminophen, the dearth of safe and effective painkillers is a particular problem for the roughly 27 million Americans over age 60 who suffer from osteoarthritis. Nearly twice as many women as men have the condition, which can impair mobility and discourage the kind of exercise that is probably one of the condition's most effective remedies. 

The problem we docs see is bleeding ulcers (although these are fewer with Ibuprofen/advil etc than with plain ordinary aspirin). This problem came up when the cox2 drugs were released, and essentially stopped people from taking them ...but the dirty little secret is that the older medicines did the same thing, but not so much.
(they are still around but only for "short term use).

And these drugs also might make you retain fluid if you have congestive heart failure and might counteract the blood thinning properties if you take aspirin daily to keep your blood from clotting.

And then there is "analgesic nephropathy".(kidney failure from people taking a lot of OTC pain medicines) 

but hey, Aspirin and NSAIDs might lower your chance of intestinal cancers. 

I went to a conference many years ago about the kidney problems but when pushed, the doc admitted that he told patients to take tylenol but it didn't work well so he took an NSAID instead.

I myself take Naproxen which works for me better than the others. But if I take it a lot, I have to add  a PPO: Prilosec, or in the days before the price dropped, the purple pill that bankruped the insurace companies.

I kept telling my patients it didn't work and they kept insisting it did. Even one of my mentally disabled patients cried until he saw the pill and then grabbed it (he had severe reflux and was too physically fragile to risk surgery for it).

Oh yes: for reflux surgery may be making a comeback, since there is now a keyhole operation that doesn't require a huge hole in your side.

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