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Pain patients are hurting. It's bad enough that they have to suffer with aching backs, arthritis and chronic headaches -- now they face a dilemma. Is there any analgesic that's safe?

Two weeks ago headlines announced that regular long-term use of the aspirin substitute acetaminophen may increase the chance of kidney damage. A new study linked daily use of the ingredient in such popular products as Anacin-3, Tylenol, Datril and Panadol to a three-fold boost in risk.

Scientists have known for a long time that prolonged use of high doses of acetaminophen can damage the liver, especially for people who drink alcohol. Otherwise this painkiller was thought to be extremely safe.

Advertising slogans proclaimed that hospitals trusted this analgesic and consumers should too. The maker of Tylenol brags that doctors recommend Tylenol more than any other brand for everyday aches and pains.

The new research may force physicians and chronic pain patients to reevaluate their strategy.

Aspirin is an excellent pain reliever, but it too has some serious disadvantages. It can cause stomach upset, even ulceration, when taken over prolonged periods. Children who have to take aspirin on a regular basis for arthritis or other chronic pain problems run a higher risk of Reyes syndrome. And aspirin can interact dangerously with a large number of prescription medications.

That leaves ibuprofen as the only other non-prescription pain reliever. Sold under the brand names Advil, Nuprin, Medipren, and the soon-to-be-announced Motrin IB, this drug is the fastest growing piece of the $2.3 billion over-the-counter analgesic pie.

But ibuprofen, like aspirin and acetaminophen, is not without risk when taken daily. (Occasional use of any of these is safe.) Although a little less likely than aspirin to upset the stomach, ibuprofen can cause indigestion, heartburn and even ulcers.

The package insert that comes with prescription ibuprofen (Motrin) warns physicians that peptic ulceration and gastrointestinal bleeding, sometimes severe, have been reported. It goes on to mention the potential for liver reactions (jaundice and hepatitis), visual problems and even kidney damage.

What all this means is that people with recurrent headaches, bad backs, arthritis, nerve damage or other chronically painful conditions are caught between a rock and a hard place.

It is essential that anyone taking aspirin, acetaminophen or ibuprofen on a daily basis be checked periodically for signs of stomach, kidney or liver damage.

Some physicians are returning to aspirin, which appears safer for kidneys and livers. Coated aspirin tablets (Ecotrin, Easprin, Encaprin) may reduce the likelihood of stomach irritation. But those sensitive to aspirin or on incompatible medications will still have to stick with acetaminophen, ibuprofen or a prescription pain reliever.

Coffee helped asthma

Q -- You saved my honeymoon and I just want to thank you.

My husband and I left for Hawaii immediately after the wedding. In all the excitement I forgot my asthma medicine. Although I don't have to take it every day I always keep some on hand.

The day after we arrived we took a long walk on the beach and by the time we got back I was wheezing. I almost panicked until I remembered reading in your book that coffee can act as an emergency treatment for asthma.

Three cups controlled my attack and I didn't have any more trouble. The rest of the honeymoon was great.

A -- Congratulations! That was quick thinking. The caffeine in coffee opens airways very much like the asthma medicine theophylline.

Although it is not an adequate substitute for medication, two or three cups of brewed coffee may provide relief in a pinch for someone experiencing a mild asthma attack. (Obviously, if this doesn't work, get yourself off for the nearest emergency room.)

Your story demonstrates just how important it is to pack medication along with your toothbrush and other essential items. With vacation season right around the corner it's a good time to review your traveling medicine kit.

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