Doctor’s Tip: Non-prescription medications for pain |

Doctor’s Tip: Non-prescription medications for pain

Dr. Greg Feinsinger

The February issue of the Harvard Men’s Health Watch had an article titled “Know your pain relievers.” People assume that if you can buy a medication across-the-counter (OTC) it must be safe, but that’s not always the case.

Due to the opioid epidemic, doctors don’t prescribe narcotics as much as they used to, and OTC medications have been shown to be just as effective in many situations. Following are pros and cons of the common OTC pain meds:

ACETOMINOPHEN (common brand name Tylenol) is an effective pain reliever but does not reduce inflammation, which is often the source of pain. It can cause liver toxicity if the maximum dose is exceeded for even short periods of time, and liver damage can also occur in people who regularly take small to moderate doses for extended periods. People with liver abnormalities such as fatty liver (a common disease as Americans get heavier) should avoid it, as should women who regularly drink more than 1 drink a day and men who consume over two drinks a day (one drink is usually defined as 4 oz of wine, 12 oz of 3.2% beer, or 1 oz of hard alcohol). The maximum recommended dose of acetaminophen is 4,000 mg. a day, which would be 12 regular-strength or eight extra-strength tablets a day — to be on safe side avoid taking more than 3,250 mg. a day. Be aware of acetaminophen in other pain relievers, cold and flu medications, and prescribed narcotics such as Percocet.

ASPIRIN belongs to the class of drugs called NSAIDS — non-steroidal anti-inflammatory drugs. It was routinely used for acute and chronic pain and inflammation prior to the development of other NSAIDS such as ibuprofen and naproxen in the 1970s. It is still used for acute pain, but currently its primary use is in low doses (usually 81 mg.) as an anticoagulant for heart attack and stroke prevention. The maximum daily dose for chronic pain is up to 6,000 mg. a day — usually 350-650 mg. every four hours or 500 mg. every six hours. A minor side effect of high-dose aspirin is ringing in the ears (tinnitus). A major side effect is stomach irritation, that can result in stomach and duodenal (the outlet of the stomach) ulcers, which can erode into blood vessels causing life-threatening blood loss. Another serious side effect is increased risk of hemorrhagic stroke, caused by rupture of a blood vessel in the brain. Furthermore, because aspirin has anticoagulation properties, people taking it are more apt to suffer serious complications from trauma, such as a “blood clot on the brain” after a head injury.

OTHER NSAIDS such as ibuprofen (Motrin is one brand name) and naproxen (brand name Aleve) are potent pain and inflammation relievers. Daily limits are 1,200 mg for ibuprofen and 660 mg. for naproxen. All NSAIDS except aspirin can elevate blood pressure, can irritate stomach lining resulting in ulcers and serious bleeding, and can contribute to GERD (gastroesophageal reflux disease). They can also increase the risk of heart attack, stroke, and kidney failure. Topical diclofenac (Voltaren gel), another NSAID, is relatively free from side effects when applied to painful knees and other joints.

MEDICATION OVERUSE (ANALGESIC REBOUND) HEADACHES can occur in people who take OTC pain relievers on a regular basis more than 15 days a month. Although these medications are not addictive, withdrawal as each dose wears off can cause headaches, so these people take another dose and end up in a vicious chronic pain cycle.

“NATURAL” PAIN RELIEF should be considered because it is side effect-free. This includes modalities such as massage, active release and meditation. Raw turmeric 1/2 teaspoon daily has potent anti-inflammatory and analgesic properties, especially when combined with a sprinkle of black pepper — although the addition of pepper is controversial because it slows down the metabolism of turmeric markedly, resulting in very high blood levels. Physical exercise releases the body’s own pain-relieving endorphins. And a plant-based, whole food is anti-inflammatory, and animal-based patients who adopt this diet are often surprised that their aches and pains go away.

Dr. Feinsinger is a retired family physician with special interest in disease prevention and reversal through nutrition. Free services through Center For Prevention and The People’s Clinic include: one-hour consultations, shop-with-a-doc at Carbondale City Market, and cooking classes. Call 970-379-5718 for appointment, or email

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